Parents’ perception of the quality of life of preschool children at risk or having developmental disabilities

Health-related quality of life of caregivers of children with low language: Results from two Australian population-based studies

Purpose: To examine (1) the association between low language (LL) and caregiver's health-related quality of life (HRQoL), (2) whether persistent LL affects caregiver's HRQoL and (3) whether child social-emotional-behavioural (SEB) difficulties attenuates the association between LL and caregiver's HRQoL.Method: Data were from the Early Language in Victoria Study (ELVS) and the Longitudinal Study of Australian Children (LSAC). Caregiver's HRQoL was measured using the EuroQoL-5 dimensions and the Assessment of Quality of Life-8 dimensions. Language ability was determined using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool-2nd or 4th edition (ELVS) and the Peabody Picture Vocabulary Test-3^rd edition or CELF-4 recalling sentences subscale (LSAC). Child SEB difficulties were measured using the Strengths and Difficulties Questionnaire. Multivariable linear regression was used for the analysis.Result: At 11-12 years, an association between LL and reduced caregiver's HRQoL was found in LSAC, but not in ELVS. Persistent LL from 4-11 years seemed to not affect caregivers' HRQoL in either cohort. Child SEB difficulties attenuated the association between caregiver's HRQoL and LL.Conclusion: Both LL and SEB difficulties contributed to reduced caregiver's HRQoL at children age 11-12 years. Interventions supporting children with LL should consider caregiver's well-being in provision of care that meets families' needs.

Valuation of Life With Disability: An International Comparison Study in Vietnam, Peru, and Haiti

The authors measured perceived quality of life for 4 disabilities among 450 adults in 3 resource-limited countries, measuring mean utilities using time trade-off, and surveying participants on 35 sociocultural characteristics to compare utilities for disabilities by country and examine associated sociocultural characteristics. Mean utilities were >0 for mild and moderate, but <0 for severe and profound. Utilities differed across countries (P = .007, .000, .017, .000 for mild, moderate, severe, profound, respectively). Vietnamese utilities correlated with residence (P = .03, moderate), education (P = .03, severe), and number of children (P = .03, moderate). Peruvian utilities correlated with education (P = .05, mild; P = .05, severe), experience with disability (P = .001, mild), gender (P = .04, moderate; P = .03, profound), number of hospitalizations (P = .04, severe). In Haiti, the only correlate was rejection (P = .02, moderate). Culture-specific variables differentially shape perceptions of disability in developing countries, thereby affecting cost-effectiveness calculations. Given substantially negative perceptions, reducing major disability would improve cost-effectiveness of health-policy decisions more than reducing mortality.

Does quality of developmental care in NICUs affect health-related quality of life in 5-y-old children born preterm?

BACKGROUND

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse experiences, which may affect health-related quality of life (HRQoL) even in the absence of prematurity-related morbidities. The aim of this multicenter longitudinal study was to examine the relation between quality levels of NICU Developmental Care (DC) and HRQoL at 60 mo in children who were born preterm.

METHODS

HRQoL of 102 very preterm (VPT) children from 20 NICUs and 110 full-term controls was assessed using TNO-AZL Preschool Children's Quality of Life Questionnaire (TAPQOL). In VPT children, we compared HRQoL by splitting NICUs into units with high- and low-quality of DC according to the following two factors: (i) the infant centered care (ICC), and (ii) the infant pain management (IPM).

RESULTS

Compared to VPT children from NICUs with high-quality of ICC, VPT children from NICUs with low-quality in ICC scored lower in HRQoL component which resulted from the aggregation of lively, positive emotionality, social and motor functioning. No differences were found between VPT children from high-quality ICC NICUs and full-term children and for the IPM index.

CONCLUSION

Findings suggest that higher quality of DC in NICU related to ICC might mitigate long-term negative quality of life outcomes.

Quality of Life for Transition-Age Youth with Autism or Intellectual Disability

We examined the subjective health and well-being of 389 transition-age youth with autism or intellectual disability using the parent proxy version of the KIDSCREEN-27. Parents reported well-being of youth with autism and youth with intellectual disability lower than a normative sample in the domains of Physical Well-being, Psychological Well-being, and Social Support and Peers. For both groups of young people, the lowest ratings were reported in Social Support and Peers. Higher ratings of well-being in one or more domains were predicted by minority status, youth character strengths, involvement in community activities, and religious faith. Challenging behaviors, autism, age, and speech as the primary mode of communication were predictive of lower ratings of well-being. We discuss implications for special educators and service providers and offer directions for future research.

Psychometric Properties of the Chinese Version of the Kid-KINDLR Questionnaire for Measuring the Health-related Quality of Life of School-aged Children

Objective/Background

The reliability and validity of the Chinese version of the Kid-KINDLR questionnaire were examined with school-aged children in Hong Kong.

Methods

A total of 112 healthy children were selected by convenience sampling from two primary schools and 30 children with global developmental delay were selected from an outpatient occupational therapy department of a convalescent hospital. The Kid-KINDLR questionnaire was translated using independent forward and backward translation. The content validity of the translated instrument was evaluated by four experts. Internal consistency, factor analysis, and construct validity were examined in the healthy children group, whereas known-group comparison was performed in the group with global developmental delay.

Results

The significance value of the Shapiro—Wilk test was greater than 0.05, indicating that the sample displayed a normal distribution. The total score had good internal consistency (Cronbach's alpha = .77); however, the consistency of the subscales varied (Cronbach's alpha ranged from .47 to .70). The children and parent questionnaires did not load onto the six factors originally hypothesized. Instead, seven factors were generated. Evidence supporting the questionnaire's validity included a lack of age and sex bias and positive known-group differentiation (Wilks’ lambda = 0.906, p = .035).

Conclusion

The Chinese version of the Kid-KINDLR questionnaire exhibited good psychometric properties, but the internal consistency of the translated instrument needs further improvement. It is recommended that practitioners focus on the Kid-KINDLR total score when interpreting the Kid-KINDLR data. Overall, the study findings indicate that the Chinese version of the Kid-KINDLR is an important tool for use in clinical practice.

Self-reported health of people with intellectual disability

Self-reported health is an important outcome in the evaluation of health care but is largely ignored in favor of proxy-based reporting for people with an intellectual disability. This study briefly reviews the role of self-report in health assessment of people with intellectual disability and the challenges and recommendations that have emerged from the considerable body of research on interviewing and self-report. Limitations in current recommendations are addressed from the perspective of the cognition of self-report. The review describes conceptual directions for the reconciliation of the two contradictory themes in the treatment of self-report: the centrality given to personal perceptions and choices and the methodological concerns over the meaningfulness and validity of the self-reporting process.

Are anxiety disorders associated with a more severe form of bipolar disorder in adolescents?

BACKGROUND

Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents.

AIM

To study the prevalence of anxiety disorders among adolescents with remitted bipolar disorder and examine their association with the course and severity of illness, global functioning, and quality of life.

MATERIALS AND METHODS

We evaluated 46 adolescents with DSM IV bipolar disorder (I and II) who were in remission, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. We measured quality of life using the Pediatric Quality of Life Inventory and global functioning using the Children's Global Assessment Scale, and then compared these parameters between adolescents with and without current anxiety disorders. We also compared the two groups on other indicators of severity such as number of episodes, suicidal ideation, presence of psychotic symptoms, and response to treatment.

RESULTS

Among the 46 subjects, the prevalence of current and lifetime anxiety disorders were 28% (n=13) and 41% (n=19), respectively. Compared with others, adolescents with anxiety had more lifetime suicidal ideation, more number of episodes, lower physical, psychosocial, and total subjective quality of life, and lower global functioning.

CONCLUSIONS

Among adolescents with bipolar disorder, anxiety disorders are associated with a poorer course, lower quality of life, and global functioning. In these subjects, anxiety disorders should be promptly recognized and treated.

PedsQL relates to function and behavior in very low and normal birth weight 2- and 3-year-olds from a regional cohort

STUDY OBJECTIVE

To compare PedsQL scores in young children who were very low (< or =1,500 g) or normal birth weight (>2,500 g) and to examine the relationship of the PedsQL score to behavioral and functional scores.

METHODS

The PedsQL, Achenbach Child Behavior Checklist and the PEDI functional scales were telephone administered to parents of a regional cohort of 672 very low birth weight and 455 normal birth weight children, 2- and 3-years old. PedsQL scales were regressed on behavior, function and health conditions.

RESULTS

Mean (SD) overall PedsQL score was 91 (8.4) for normal birth weight and 87 (12) for very low birth weight children, and changed little when standardized to the race/ethnicity and maternal education of corresponding Wisconsin births. Mobility function and the CBCL explained 58% of the variance in PedsQL, but the relationship was curvilinear.

CONCLUSION

The PedsQL is sensitive to health problems of very low birth weight in young children. The PedsQL is quite strongly related to mobility and behavior problems, but scales these differently than do standard instruments. Parents either do not think of subtle issues with child function and behavior without specific prompting or do not perceive them as problems affecting quality of life.

Is waiting for rehabilitation services associated with changes in function and quality of life in children with physical disabilities?

OBJECTIVES

To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life.

METHODS

Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases.

RESULTS

Half of the sample waited more than 9.1 months (95% confidence interval: 6.5-16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p< .05).

CONCLUSION

Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.