App-Based Hearing Screenings in Preschool Children With Different Types of Headphones: Diagnostic Study

Background

Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings.

Objective

This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System-Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry.

Methods

We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined.

Results

A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001).

Conclusions

The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity.

The development of a parent report instrument of early communication and language skills of infants and toddlers in mainland China

OBJECTIVE

This study was designed to produce a new parent-report measure, the Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler Assessment of Communication and Language (DREAM-IT) in order to provide norms for the developmental skills of children aged 0-36 months in four areas: expressive language, receptive language, cognitive play and social skills.

METHODOLOGY

The scale was designed to be both broader and deeper than existing instruments that neglect one or more of these significant domains involved in early language. Items were chosen by a group of specialists with clinical experience working with the age group and with attention to the developmental literature. Caregivers were tested individually by a trained person who asked the questions and provided examples. In addition to an extensive health questionnaire, caregivers answered questions in Mandarin about their child's behaviour using a scale of 'not yet', 'sometimes' or 'always' or listing out words and/or sounds understood or said by the child. The 476 participating caregivers were recruited at maternal and child healthcare clinics centred in Chengdu, China, 191 of whom were tested a second time seven months later. The children were sampled in three-month age-bands from 0 to 36 months. The sample was balanced for child gender by age band, and parental education was balanced. Caregivers of 0-24-month-old children and caregivers of 12-36 months were each asked a different set of questions, to determine the appropriate age range and cutoff points for each question, requiring the sample size to be doubled for children aged 12-24 months.

RESULTS

The results were subject to item-response theory analysis to remove outlying items, and the resulting internal reliability was high for each domain (average Cronbach's alpha=0.87). The final instrument (between 67 and 113 questions in total) was refined to include the least redundant questions that had the highest intercorrelations, with attention paid to coverage of all domains across the age range. Two scales were developed: one for children 0-18 months, the second for children aged 18-36 months. The longitudinal design permitted the creation of growth curves and norms for each domain for six-month intervals from 0 to 36 months. A small sample of 32 parents of children with Down syndrome aged 18-36 months provided validation that the scales are highly sensitive to developmental delay.

CONCLUSION

The instrument shows considerable promise for detecting early communication problems in children in China.

WHAT THIS PAPER ADDS

What is already known on the subject In China, efforts were made in recent years to develop language assessments for infants and toddlers, but limitations existed with the domains included and number of items included per age group. Many clinical practitioners also continued to rely on language subtests of general developmental scales, which were limited in depth and breadth of language skills tested and were never intended for diagnosis of language delay. What this paper adds to existing knowledge This paper discusses the development of a valid caregiver report instrument for early communication and language skills of infants and toddlers in mainland China. The Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler (DREAM-IT) includes foundational domains necessary for language and communication development in young children (receptive language, expressive language, cognitive play and social communication domains). The results show strong internal reliability (Cronbach's alpha) for each domain on a sample of 716 children sampled in three-month age bands from 0 to 36 months. The external validity proved strong when tested on a group of 32 young children with Down syndrome. What are the potential or actual clinical implications of this work? Besides helping to inform the diagnosis of language delays in infants and toddlers in China, the caregiver report instrument has special features to support clinical practitioners in a field that is just emerging in China. The unique support features include the automatic generation of a profile of relative strengths and weaknesses of the child on the report and the recommendation of child-specific caregiver coaching videos on a companion app.

[Effects of the COVID-19-Pandemic on the AffectiveWell-Being of Preschool Children]

The aim of this study was to determine the predictive value of corona-specific variables and post-traumatic stress symptoms associated with the COVID-19-pandemic, considering sociodemographic data and health-related quality of life, on the affective well-being of preschool children and to identify predictors of positive and negative affect. A secondary analysis of third-party assessment data by parents of three- to six-year-old preschool children from the Tyrolean COVID-19 Children's Study at two measurement time points (123 records at t₁ in summer 2020; 467 records at t₂ in winter 2020/21) was conducted. To answer the research question hierarchical multiple regression analyses were performed.The largest part of the variance explanation of affective well-being was explained by health-related quality of life: while self-esteem and psychological well-being were measurement-time-independent, effects of physical well-being, preschool, family, and friends were only significant in winter. Coronaspecific variables caused additional variance explanation due to subjective threat experience in winter; post-traumatic stress symptoms had an effect at both measurement-times. In times of crisis children's self-esteem, psychological well-being, and post-traumatic stress symptoms should be considered.Measurement-time-dependent results suggest that the pandemic course plays a decisive role regarding the influence on children's affective well-being. Everyday life and routines must be redefined accordingly and communicated to the children.

The COVID-19 pandemic and measurement of preschoolers' executive functions

Given the far-reaching effects of the COVID-19 pandemic, it is important to investigate how executive function (EF) assessments were impacted by changes in measurement protocols, context, and timing due to the pandemic. The present study used data from two projects. The first project occurred prior to the pandemic (N = 244, 44.67% female; Mage = 44.27 months) with teacher ratings and objective EF measures collected in the spring of preschool, fall of prekindergarten (pre-K), and spring of pre-K. The second study was comprised of two cohorts, a transition cohort (i.e., Fall 2019 to Fall/Winter 2020) and a post-COVID lockdown cohort (i.e., Fall 2020 to Fall/Winter 2021). For both cohorts, data were collected in the fall of pre-K, spring of pre-K, and fall/winter of kindergarten (N = 130, 46.2% female, Mage = 44.84 months). Aims included: (1) evaluating the measurement characteristics of a virtual assessment of EF, (2) examining cohort differences in teacher and objective EF measures, (3) testing longitudinal mean-level change in EF, and (4) evaluating associations between COVID impact and change in EF. Teachers reported a marginal decrease in EF for the transition cohort and no change in the post-COVID cohort, whereas objective measurements demonstrated the expected increase in EF. Child and family COVID-19 impact emerged as risk factors for reduced EF for the transition cohort but not the post-COVID cohort. Overall, this study provides novel evidence that the timing and type of EF assessment differentially impacted estimates of children's EF. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The characteristics of spontaneous language in young children identified as language delayed in Mandarin

BACKGROUND

Little is known about the spontaneous speech characteristics of young children with language delay in Mandarin, relative to their peers. Until the recent development of standardized language assessments normed in China on Mandarin-speaking children, it was difficult to independently identify atypically developing children to study their spontaneous speech, and only case studies have been available.

AIM

To investigate which aspects of spontaneous speech might be distinctive for atypical development in a short play session.

METHODS & PROCEDURES

A total of 86 Mandarin-speaking children, boys and girls aged 2;6-4;6, were tested using the new standardized assessment for Mandarin, Diagnostic Receptive Expressive Assessment of Mandarin-Comprehensive (DREAM-C), at a major urban hospital in China. Of the children, 39 were identified by DREAM-C as atypically developing in language development (Total Standard score M = 72, SD = 8.9), and 47 scored in the typical range (Total Standard score M = 103, SD = 10.8), using the four scales of Receptive, Expressive Semantics and Syntax. All children then took part in a 15-min semi-structured play session during which their spontaneous speech was recorded by professionals. A variety of games and pictures were used in an attempt to elicit spontaneous questions, negatives and descriptions. Their recorded speech samples were then coded by linguists directly into a database in FilemakerPro for different aspects of vocabulary, sentence variety and grammatical morphemes/structures heard.

OUTCOMES & RESULTS

The results describe the characteristics of the speech samples for the typical and atypical groups for age groups 2;6-3.5 (N = 52) and 3;6-4.6 (N = 34). Vocabulary diversity was indicated on an ordinal scale ranging from simple communicative signals including headshakes and words such as 'hi' to 'a rich variety of different content words'. Grammatical diversity similarly ranged from 'only yes/no answers', through to the appearance of multi-clause sentences. Morphosyntax was coded in terms of which morphemes were observed at all in the session, such as aspect markers (LE, ZAI, GUO), and nominal morphemes (DE, GE), and also whether function words such as pronouns, Wh-questions and classifiers were singular or varied in the session. There is considerable optionality in morpheme expression in Mandarin, so measurements such as the percentage supplied in obligatory contexts, though useful for languages such as English, are harder to compute. Nevertheless, the data show change over age in all these aspects of language, and reveal what a typically developing child might be expected to produce in a 15-min sample in such a session. For example, it was rare for the typically developing children by age 3.5 not to have at least simple sentences with some function words, and to use adjectives, nouns and verbs, unlike the children with atypical scores. The morphemes DE, LE and GUO showed significant differences in likelihood across groups for both ages, but BA and ZAI were significantly different only for the older age group. In contrast, GE was common in all groups. The atypical group has markedly lower frequency in several grammatical aspects such as the use of diverse questions, classifiers and pronouns, with much less change across age groups, implying slower growth. The results provide useful information on the relative likelihood of observing different varieties of words, sentence types and morphemes in a short speech sample, which are substantially different in the typical versus atypical groups in both age bands, and change over age.

CONCLUSIONS & IMPLICATIONS

These data validate the DREAM-C classifications, but the details can also be used to inform the choice of targets for intervention for young children who experience delays in Mandarin language acquisition.

WHAT THIS PAPER ADDS

What is already known on the subject Spontaneous language samples have been used as a means of studying language in China. However, because of the amount of training and time required to transcribe and analyse spontaneous language samples, there is not yet a sufficient basis for identifying language differences between children with and without language disorder in mainland China. What does this paper add to existing knowledge After using DREAM-C to provide an objective measurement of children with and without language disorders, an easy-to-administer spontaneous language assessment protocol and scoring record form allowed the comparison of the spontaneous language of 39 children with atypically developing language with 47 children who scored in the typical range to observe language differences between those with and without typical language development. What are the potential or actual clinical implications of this work? The study documents differences in vocabulary and sentence variety, and use of different morphemes such as classifiers, passives and aspect markers to aid in choosing targets for intervention by demonstrating the path of development. In addition, the spontaneous language assessment protocol and scoring record form holds promise for allowing clinicians and researchers to more easily study the language of individual children to personalize intervention, but also of groups of children to understand the emergence of basic Mandarin linguistic features.

Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample

Objective

Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor.

Method

One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews.

Results

An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes.

Conclusion

General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count.

Clinical trial registration information

The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

Screening accuracy of the parent-report preschool Strengths and Difficulties Questionnaire in primary care

OBJECTIVE

To evaluate the screening test accuracy and reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings.

METHODS

Children 24-48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2 and 12 weeks. At 12 weeks, parents were invited to a semi-structured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA). Criterion validity between baseline P-SDQ scores (Total Difficulties Score [TDS], internalizing and externalizing subscale) and DSM-5 diagnoses on PAPA was evaluated using area under the curve (AUC) and calculating screening test properties (sensitivity and specificity). Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient (ICC).

RESULTS

183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed P-SDQ at 2 weeks, 107 (58%) completed PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 22 (21%) had internalizing disorders, and 9 (8%) had externalizing disorders. TDS identified any diagnosis with AUC = 0.67 (95% CI: 0.55, 0.79); internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity, and test-retest reliability, were satisfactory for TDS and externalizing subscale, and less satisfactory for the internalizing subscale.

CONCLUSION

The externalizing subscale has sufficient accuracy and reliability to identify children aged two to four years at risk for attention deficit/hyperactivity disorder and disruptive behavior disorders in primary care.

Brief report: noise reduction in preschool from a self-regulated learning perspective-implementation of a game-based voice regulation training program

An 8-week voice regulation training program (VRTP) incorporating everyday activities was implemented in an experimental preschool classroom (EG; n = 34), which was compared with a control preschool classroom (CG; n = 31). The VRTP includes songs, games, and conversations aiming to raise children's awareness of noise levels and teach voice modulation skills. Grounded in the theoretical framework of self-regulated learning, the study's objectives were to evaluate the impact of the VRTP on noise levels, children's self-regulation, and pre-literacy skills. Noise levels were assessed weekly using an electronic noise meter before and during the program. The EG preschoolers demonstrated modest but significant improvements over their pre-VRTP levels of voice modulation, behavioral and emotional self-regulated learning, and pre-literacy skills, in contrast with the CG children. The findings provide evidence that young children's self-regulation may be enhanced in preschool, challenging the field of developmental-educational psychology to consider self-regulated learning during early childhood.

Barriers to preschool aged children's participation in swimming lessons in New South Wales, Australia

ISSUE ADDRESSED

To understand barriers to uptake of subsidised swimming lessons by children aged 3-6 years old ('preschool aged children'), including from priority populations, in New South Wales (NSW).

METHODS

A thematic analysis of 4191 qualitative responses from parents/carers of preschool aged children describing barriers that resulted in their child's non-participation in subsidised swimming lessons in the past 12 months was conducted. Data, including parent/carer sociodemographic variables, were collected through registrations for the NSW Government's First Lap voucher program.

RESULTS

Seven overarching barriers to participation were identified: (1) child's disability or health needs; (2) swimming lesson affordability; (3) family or personal circumstances; (4) lack of or poor availability of swimming lessons; (5) parent/carer availability, including to fulfil participation requirements; (6) COVID-19 and (7) deprioritisation of formal swimming lessons due to parent/carer perceptions relating to its importance. These may limit the uptake of swimming lessons in preschool aged children, particularly those who are Aboriginal and Torres Strait Islander, from culturally and linguistically diverse backgrounds, living with a disability, from low socioeconomic families and living in regional and remote areas.

CONCLUSION

Structural barriers must be addressed to increase uptake of swimming lessons in preschool aged children, particularly in priority populations, to reduce drowning risk. SO WHAT?: Evidence-based policy initiatives, with robust evaluation, should seek to address the availability and flexibility of swimming lessons, including for priority populations; complexities associated with supervision requirements; poor awareness of parents/carers of the importance of swimming for preschool aged children and the lack of continuity of swimming for children in out of home care.

The Effect of Weaning Practices on the Nutritional and Health Status of Saudi Preschool Children

Background Weaning is a complex procedure that gradually introduces complementary foods to the baby's diet. Solid food should be started between the ages of 6 and 12 months. Weaning is a challenging and crucial stage in an infant's development. Extreme caution should be used during weaning an infant because delaying it can cause issues like sluggish growth, difficulties feeding, malnutrition, and iron deficiency. Objective The current study aims to determine the impact of delayed or early weaning practices on the nutritional status of preschool children in Saudi Arabia. Data was gathered about the time of complementary food introduction, preferred foods in the initial stages, and a child's health compared to those practices.  Methodology By convenient sampling, a cross-sectional study was conducted to gather data from 385 parents of Saudi children at preschool age. Questionnaires were shared online. Data were recorded and analyzed on IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Descriptive analysis and multivariate ANOVA (MANOVA) tests were performed. Results Only 6.23% of the infants were introduced to complimentary food at optimal age (6 to 12 months), whereas 85% were found to have delayed weaning. As per the BMI, 74.4% of preschool children were severely underweight, 53.6% of infants consumed pureed vegetables early during weaning, and 64% of infants were introduced to eggs and cheese within the first year of life. The timing, pattern, and food items of weaning had a significant (p<0.05) impact on general physical health, as 48.8% of children had pale skin, 46.9% felt tired, 36.5% had swollen joints, and 42% complained of itching and an upset stomach. Conclusion This study couldn't define the direction of significance. Further studies can be done on a larger scale where biochemical tests, and screening can be done on children to find if any significant health problem is prevailing, and the direction of association can be defined.

Improved Neurodevelopmental Outcomes at 5.5 Years of Age in Children Who Received Bovine Milk Fat Globule Membrane and Lactoferrin in Infant Formula Through 12 Months: A Randomized Controlled Trial

OBJECTIVE

To evaluate the neurodevelopmental outcomes at 5.5 years of age in children who were previously randomized to cow milk-based infant formula (control) or similar formula (milk fat globule membrane + lactoferrin) with added sources of bovine milk fat globule membrane and bovine lactoferrin through 12 months of age.

DESIGN

Children who completed study feeding were invited to participate in follow-up assessments: cognitive development across multiple domains (primary outcome; Wechsler Preschool & Primary Scale of Intelligence, 4th Edition), inhibitory control/rule learning (Stroop Task), flexibility/rule learning (Dimensional Change Card Sort), and behavior/emotion (Child Behavior Checklist).

RESULTS

Of 292 eligible participants (control: 148, milk fat globule membrane + lactoferrin: 144), 116 enrolled and completed assessments (control: 59, milk fat globule membrane + LF: 57). There were no group demographic differences except family income (milk fat globule membrane + lactoferrin significantly higher). Wechsler Preschool & Primary Scale of Intelligence, 4th Edition composite scores (mean ± standard error) for Visual Spatial (100.6 ± 1.7 vs 95.3 ± 1.7; P = .027), Processing Speed (107.1 ± 1.4 vs 100.0 ± 1.4; P < .001), and Full-Scale IQ (98.7 ± 1.4 vs 93.5 ± 1.5; P = .012) were significantly higher for milk fat globule membrane + lactoferrin versus control, even after controlling for demographic/socioeconomic factors. Stroop Task scores were significantly higher in milk fat globule membrane + lactoferrin versus control (P < .001). Higher Dimensional Change Card Sort scores (P = .013) in the border phase (most complex/challenging) were detected, and more children passed the border phase (32% vs 12%; P = .039) for milk fat globule membrane versus control. No group differences in Child Behavior Checklist score were detected.

CONCLUSIONS

Children who received infant formula to 12 months of age with added bovine milk fat globule membrane and bovine lactoferrin versus standard formula demonstrated improved cognitive outcomes in multiple domains at 5.5 years of age, including measures of intelligence and executive function.

TRIAL REGISTRATION

Clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT04442477.

Food allergy knowledge, attitude and management among preschool personnel in Malaysia

BACKGROUND

Children are vulnerable, and they may experience their first serious food allergy reaction at school, where they spend much of their time. The present study aims to determine the level of food allergy knowledge, attitude and management (KAM) among preschool personnel in Klang Valley, Malaysia.

METHODS

A cross-sectional study was conducted with 292 personnel working in Klang Valley preschools. The participants completed an online questionnaire asking about sociodemographic information and food allergy KAM. Mann-Whitney U and chi-squared tests were used to compare the KAM level between public and private preschool personnel and examine the association of KAM of food allergy with various sociodemographic factors, respectively.

RESULTS

Some 86.3% of the participants demonstrated a low level of food allergy knowledge, 64.7% showed a negative food allergy attitude and 57.9% indicated fair food allergy management. The total mean score for food allergy knowledge was higher (p < 0.01) among the private preschool personnel compared to the public group, although there was no significant difference in attitude (p = 0.244) or practice (p = 0.171). Age group (p < 0.01) and monthly income (p < 0.05) were significantly associated with the level of attitude, whereas no sociodemographic factor was associated with knowledge and management of food allergy.

CONCLUSIONS

Most preschool personnel in Klang Valley have a low level of food allergy knowledge, negative attitudes and a fair level of ability to manage food allergy reactions. The findings of the present study may guide future studies to improve the food allergy KAM of preschool personnel and provide a safer environment for children with food allergies.

Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers

BACKGROUND

Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover, the interaction between these risk factors may be particularly pronounced among children of mothers with emotion regulation (ER) difficulties. The current study examined the independent and interactive effects of maternal invalidation and child physiological reactivity to frustration on teacher-reported aggression in an at-risk sample of preschool children.

METHOD

Participants included 77 mothers (Mage = 33.17 years, s.d. = 4.83; 35% racial/ethnic minority) and their children (Mage = 42.48 months; s.d. = 3.78; 56% female; 47% racial/ethnic minority). Groups of mothers with and without clinician-rated ER difficulties reported on maternal invalidation, and child respiratory sinus arrhythmia (RSA) was assessed continuously during a frustration task as an indicator of physiological reactivity. Teachers or daycare providers reported on child aggression.

RESULTS

Results demonstrated positive associations between maternal ER difficulties and both maternal invalidation and child RSA reactivity to frustration. As expected, the interaction between maternal invalidation and child RSA reactivity was significant, such that higher maternal invalidation and greater child RSA reactivity to frustration predicted more aggression in a daycare or preschool setting. Importantly, this effect was demonstrated while controlling for demographic covariates and baseline RSA.

CONCLUSIONS

Findings are in line with diathesis-stress and biosocial models of risk and point to multiple targets for prevention and early intervention.

Language and early literacy professional development: A complex intervention for early childhood educators and speech-language pathologists

Purpose: Improving language and literacy skills in preschoolers can lead to better life outcomes. One way speech-language pathologists (SLPs) can improve these skills in preschoolers is by supporting educators through professional development (PD). However, PD in early childhood education and care (ECEC) settings is a complex intervention. To improve preschoolers' language and literacy skills using PD, SLPs must first work with educators to change or increase educators' language and literacy-promoting behaviours. This paper aimed to describe educator behaviours and preschooler skills following a real-world language and literacy PD intervention facilitated by two community SLPs.Method: Two pragmatic studies were conducted across four ECEC centres: (1) an observation study of 13 educators' self-reported language and literacy promoting behaviours, and (2) a non-randomised controlled trial investigating the language and literacy skills of 82 preschoolers as reported by their educators and parents/carers.Result: After the intervention, educators rated themselves as performing language and literacy-promoting behaviours more frequently. Educators also rated the early reading skills of preschoolers more highly after the PD intervention, but not preschoolers' oral language or early writing skills. Parents/carers did not report any significant improvements in preschoolers' skills.Conclusion: PD as an SLP intervention, whilst promising, showed mixed outcomes. Educator outcomes improved; however, preschooler outcomes were varied.

Case Report: A playful digital-analogical rehabilitative intervention to enhance working memory capacity and executive functions in a pre-school child with autism

Background

Autism Spectrum Disorder (ASD) is often associated with deficits in Working Memory Capacity (WMC) and Executive Functions (EFs), as early as the first years of life. Research has shown that, even young children with ASD, WMC and EF deficits can be effectively addressed through interventions employing digital and/or analogical tools. Early intervention is important because executive dysfunction can negatively impact on the quality of life, both of children and their families. However, very few studies have been carried out involving intervention with pre-schoolers with ASD. To fill this gap, we developed an intervention that promotes pre-schoolers' WMC and EFs by employing both digital apps and analogical playful activities. This study reports on the feasibility of this intervention, which was carried out in a rehabilitative context.

Methods

A male pre-schooler diagnosed with ASD was engaged in a total of 17 intervention sessions, all held in a clinical context, over a nine-week period. Outcomes were measured using a battery of pre- and post-treatment tasks focusing on WMC, EFs and receptive language. The clinician who administered the intervention made written observations and noted any improvements in the child's performance emerging from the digital and analogical activities.

Results

The pre- and post-test scores for the cognitive tasks revealed qualitative improvements in the following cognitive domains: (a) WMC in the language receptive domain; (b) updating in WMC; (c) inhibition, specifically concerning control of motor response; (d) receptive vocabulary. Furthermore, when monitoring the child's performance, the clinician noted improvement in almost all the playful activities. Particularly notable improvements were observed in interaction with the apps, which the child appeared to find very motivating.

Conclusion

This study supports feasibility of a playful digital-analogical intervention conducted by a clinician in a rehabilitation context to promote cognitive abilities in pre-schoolers with ASD. Further studies are needed to establish whether the intervention's effectiveness can be generalized to a broad sample of children with ASD.

Healthy eating perceptions of mothers and caregivers of children in South Africa

Background

The perceptions of mothers and caregivers of children attending early childhood development (ECD) centres play a very critical role in promoting healthy eating habits in children and impact long-term health consequences. Food preferences that are developed during childhood continue into adolescence and adulthood and are difficult to change.

Aim

The aim of the study was to assess the perception of mothers and caregivers of children attending ECD centres regarding healthy eating practices.

Setting

The study was conducted in ECD centres in Gauteng, North West and Limpopo.

Methods

A quantitative descriptive design was used to collect data among 290 respondents using a structured, researcher-administered questionnaire.

Results

The findings indicated that the majority (77%) of respondents did not believe that choosing a healthy diet is a matter of knowing foods that are good and bad for health. The majority (59%) of respondents believed that the food they eat and drinks are healthy and see no need to make changes.

Conclusion

The study findings showed that the majority of respondents lack awareness about choosing healthy diets. Furthermore, the current dietary patterns of respondents and their children will remain the same as long as the mothers and caregivers feel that the food they eat is healthy.

Contribution

The findings of the study contribute to the appropriate measures of educating mothers and caregivers in offering healthy diets to children at home and in early childhood centres.

Emotion regulation as a complex system: A multi-contextual and multi- level approach to understanding emotion expression and cortisol reactivity among Chinese and US preschoolers

Are children from "Eastern" cultures less emotionally expressive and reactive than children from "Western" cultures? To answer this, we used a multi-level and multi-contextual approach to understand variations in emotion displays and cortisol reactivity among preschoolers living in China and the United States. One hundred two preschoolers from China (N = 58; 55% males) and the United States (N = 44, 48% males) completed three (i.e., control, interpersonal-related, and achievement-related) emotion-challenging paradigms over 3 days. Behavioral emotion expressions were coded, and salivary cortisol was sampled 30 minutes before and across 90 minutes post-task. Without considering context, Chinese preschoolers displayed fewer levels of positive and negative emotion expressions relative to their United States counterparts. However, Chinese preschoolers displayed similar levels of expressions as their United States counterparts during an achievement-related challenge that is more salient to their sociocultural emphases and showed higher negative emotion expressions in this challenge, relative to other contexts. Moreover, only the achievement-related challenge elicited increased cortisol levels among Chinese preschoolers, and this was correlated with higher levels of negative expressions. For US preschoolers, no cortisol increase was observed in any challenging paradigms, nor was cortisol associated with emotional expressions. Findings counter prior notions that East Asian children are generally less emotionally expressive. Instead, an achievement-related challenge elicited higher emotion expression and cortisol reactivity among Chinese preschoolers, suggesting that children's emotion expression and biological reactivity may be most responsive to contexts salient to their socio-cultural environments. We discuss the importance of considering cultural contexts when studying emotion regulation. RESEARCH HIGHLIGHTS: Chinese preschoolers displayed lower overall positive and negative expressions relative to their US counterparts without considering situational contexts. Chinese preschoolers displayed similar levels of emotion expressions as their US counterparts during an achievement-related challenge salient to their social-cultural environment. Chinese preschoolers are particularly responsive to achievement-related challenges, relative to other emotion-challenging situations that are less culturally salient. No cortisol increase was observed in any of the emotion-challenging paradigms among US preschoolers. Children's emotion expression and biological reactivity may be most responsive to challenges relevant to their socio-cultural environments.

Effects of Combined Movement and Storytelling Intervention on Fundamental Motor Skills, Language Development and Physical Activity Level in Children Aged 3 to 6 Years: Study Protocol for a Randomized Controlled Trial

This study protocol aims to analyze and compare the effects of combined movement and storytelling intervention (CMSI) on fundamental motor skills (locomotor skills and object control), language development (language comprehension, language expression, vocabulary and language description), and physical activity levels (light intensity, moderate-to-vigorous intensity and sedentary time) in children aged 3 to 6 years. The sample will consist of 144 children from 12 class groups, randomly assigned to 3 experimental groups (n = 72 children) and 3 control groups (n = 72 children), belonging to 4 class groups of upper-middle-level classes (2 experimental and 2 control; 3 to 4 years), 4 transition level 1 classes (2 experimental and 2 control; 4 to 5 years) and 4 transition level 2 classes (2 experimental and 2 control; 5 to 6 years). The experimental groups will perform CMSI for 3 sessions per week (40 min per session) over 12 weeks (using one motor story per week), while the control groups will not receive any treatment. The main outcome will provide information about fundamental motor skills, language development, and physical activity levels. Our hypothesis indicates that CMSI has the potential to generate significant increases in selected assessments. If this intervention proves to be beneficial, it could contribute to preschool and school curricula.

Early childhood educators' mental state language and children's theory of mind in the preschool setting

The study examined the presence and nature of a relationship between 13 early childhood educators' mental state language (MSL) and 77 preschool children's (3- to 5 years) Theory of Mind (ToM). Educator language samples were elicited during two naturalistic group-time contexts, wordless picture book storytelling and an instructional building task. MSL was coded according to a comprehensive scheme that captures facets of MSL content and quality. To account for well-established determinants of ToM, a range of child- and family-level factors were also measured. Results indicated no significant relationship between educator MSL during group level instruction and children's ToM in the preschool setting. Although these findings challenge the assumption that educators' MSL is important for children's ToM development, important future directions are discussed.

Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

Background

Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD.

Methods

We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597).

Results

Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; p < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; p = 0.45) but the confidence of estimate was very low.

Conclusions

Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.

[Síndrome de fiebre periódica, adenitis, faringitis y aftosis en un preescolar con síndrome de Asperger: reporte de caso]

Background

Autoinflammatory diseases are a heterogeneous group of pathologies whose prevalence is undefined to date. Within these, the Periodic Fever Syndrome, Adenitis, Pharyngitis and Aphthosis (PFAPA) is determined as the most common and the most studied. Neurodevelopmental and behavioral disor- ders, including those of the Autism Spectrum, are especially prevalent in patients with allergic and autoimmune diseases, however, there is little documented regarding their relationship with autoinflammation.

Case report

The case of a patient with Asperger Syndrome with subsequent onset of this autoinflammatory disease is shown. Two weekly blood counts and complete serum immunoglobulins are obtained, which do not show a decrease in neutrophil counts or sublevels or supralevels in immunoglobulins.

Conclusion

When he returned to his follow-up appointment, he reported a feverish peak 2 days before, which ceased with the administration of the steroid, and if there was presence of oral ulcers on this occasion, fulfilling the modified Marshall criteria. Likewise, a great change is noted in their development and cooper- ation in exploration. The duality of this autoinflammatory syndrome in a patient with Asperger Syndrome is determined.

Effects of Tier 1 Class-Wide Function-Related Intervention Teams (CW-FIT) on On-task Group Behavior in a Preschool Classroom

Disruptive behaviors such as elopement, calling-out, and aggression are often a major barrier to instruction in preschool classrooms. One widely used class-wide behavior management system is Class-Wide Function-Related Intervention Teams (CW-FIT). To date, we could only locate two studies on CW-FIT used in preschool settings which found a therapeutic change in on-task behavior as well rates of teacher praise, teacher reprimands, student socials skills, and student problem behaviors. The current study used a withdrawal design to also evaluate the effectiveness of Tier 1 CW-FIT on on-task student behavior and teacher praise and reprimand behavior in a preschool setting during both large and small group activities. Results suggested that the implementation of the Tier 1 components of CW-FIT increased on-task group behavior in both settings. Results for rates of teacher's praise and reprimand statements were variable.

Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration

Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.

Application of ultrasound in the management of TRASH (the radiographic appearance seemed harmless) fractures in preschool children: A review

Elbow fracture is one of the most common fractures in preschool children, and the secondary ossification center appears regularly with age increasing. Transphyseal separation of the distal humerus, medial humeral condyle fracture, lateral humeral condyle fracture, radial head osteochondral separation, and Monteggia fracture (minimal ulnar bow type) are difficult to diagnose based on X-ray films alone because of the unossified secondary ossification center or a suspicious non-alignment of the anatomical cartilage of the elbow joint in preschool children. These 5 fractures above are defined as The Radiographic Appearance Seemed Harmless fractures in preschool children (TRASH-PS). The TRASH-PS fractures must be taken into consideration when there is swelling at the injured site without fracture feature on X-ray. Additionally, relevant misdiagnosis or unsuitable management can lead to elbow dysfunction and deformity. Therefore, this work reviews the application of ultrasound in the management of TRASH-PS fractures.

Community Readiness Assessment of the "Take TIME for Your Child's Health" Intervention

Take TIME (Tobacco-free, Injury-free, Moving daily, Eating healthy) was an early intervention strategy targeting community readiness to support healthy lifestyles for young children in Uxbridge, Canada. This study aimed to assess the effectiveness of Take TIME using the Community Readiness Model adapted for childhood obesity prevention. Six interviews were completed in Uxbridge, before and after the intervention, with purposively selected community leaders in education, political, business, religious, not-for-profit, and healthcare fields. Each interview was rated independently by two scorers. Interview content was scored (scale from 1 to 9, with 1 being no awareness and 9 being a high level of community ownership) according to the Community Readiness Model criteria on six dimensions, with overall readiness calculated as the mean score of all dimensions. T-tests compared readiness by time-point and between communities. Overall community readiness significantly improved (p = 0.03) in Uxbridge from pre-intervention (3.63 ± 1.14 vague awareness) to post-intervention (5.21 ± 0.97 preparation). Seven interviews were also completed with leaders in the matched town of Rockwood, Canada which served as the control community. Rockwood readiness was close to the Uxbridge post-intervention score (5.35 ± 1.11). Results indicated increased awareness and leadership support post-intervention in Uxbridge, but further improvements in community knowledge, formalized efforts, and additional leadership support are desired. Take TIME increased community readiness to support healthy lifestyles for young children and may be useful to other communities at similar stages, given its theoretical alignment with the community readiness model. Future research should investigate the impact of Take TIME in demographically diverse communities and appropriate interventions to move communities from the preparation to the action stage.