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Castagna A, Butti N, Cordolcini L, Innocenti MS, Montirosso R. Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities. Front Psychol 2024; 14:1306227. [PMID: 38250103 PMCID: PMC10796769 DOI: 10.3389/fpsyg.2023.1306227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue. Methods This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress. Results Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors. Discussion These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.
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Affiliation(s)
- Annalisa Castagna
- 0–3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Niccolò Butti
- 0–3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Laura Cordolcini
- 0–3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Mark S. Innocenti
- Institute for Disability Research, Policy & Practice, Utah State University, Logan, UT, United States
| | - Rosario Montirosso
- 0–3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
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Fong VC, Baumbusch J, Khan K. "Can you hear me OK?": Caregivers of Children With Medical Complexity and Their Perspectives of Virtual Care During COVID-19. J Pediatr Health Care 2024; 38:30-38. [PMID: 37725030 DOI: 10.1016/j.pedhc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION The rapid and widespread shift to virtual care during COVID-19 created new opportunities and unique challenges for families of children with medical complexity (CMC). However, few studies have examined perceptions of virtual care during the pandemic in this population. METHOD To address this gap, the current study used a qualitative approach and semistructured interviews via Zoom to explore parent perspectives of virtual care. Purposive sampling was used to recruit 30 parents residing with their CMC (aged 0-18 years) in British Columbia, Canada. RESULTS The findings identified from the data included (1) advantages and opportunities, (2) concerns and challenges, and (3) parent choice and preference. DISCUSSION Our findings indicate the need for healthcare professionals to receive training to use virtual care in their practice effectively. In addition, policies about standards for virtual care and ensuring families have access to the necessary technology will help reduce barriers and improve equity and inclusion for this population.
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Ondruskova T, Royston R, Absoud M, Ambler G, Qu C, Barnes J, Hunter R, Panca M, Kyriakopoulos M, Oulton K, Paliokosta E, Sharma AN, Slonims V, Summerson U, Sutcliffe A, Thomas M, Dhandapani B, Leonard H, Hassiotis A. Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38329108 PMCID: PMC11017145 DOI: 10.3310/jkty6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. Objective To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. Design, setting, participants A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Intervention Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. Main outcome measure The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. Results We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. Limitations There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Conclusions Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Future work Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. Study registration This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Rachel Royston
- Division of Psychiatry, University College London, London, UK
| | - Michael Absoud
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University, University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- National and Kapodistrian University of Athens, Vyronas-Kessariani Community Mental Health Centre, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, UK
| | - Aditya Narain Sharma
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
| | - Vicky Slonims
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Helen Leonard
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Totsika V, Hastings RP, Hatton C, Emerson E. Pathways to social well-being of children with intellectual disability: testing the Family Investment Model. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1354-1366. [PMID: 37648377 DOI: 10.1111/jir.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Social well-being, including prosocial and peer relationship skills, independence and co-operation, is a particularly important developmental outcome in intellectual disability (ID). The present study investigated pathways to social well-being through the early years' family environment, particularly the role of parental investments in mediating the path from family poverty to child social well-being. METHODS In line with the Family Investment Model (FIM), we tested whether parental investments between 3 and 5 years of age mediate the impact of family poverty at 9 months of age on children's social well-being at 7 years. Structural equation models were fitted to data from 555 children with ID identified from a UK population-based cohort. RESULTS Findings indicated that home learning investments and the structural home environment (though not play) significantly mediated the effect of family poverty on children's social skills, albeit in different directions. While all parental investments reduced in the presence of poverty, the home learning environment appeared to promote social well-being, whereas the structural home environment did not. Sensitivity analyses controlling for co-occurring autism confirmed the pattern of findings. Child gender, ethnicity and parental educational qualifications did not moderate the mediational relationships, suggesting that FIM pathways to social well-being were relevant to all families. CONCLUSIONS The FIM provides a helpful framework to map developmental pathways for children with an ID. Parental investments related to home learning, the structural home environment and play are reduced in the presence of poverty although their impact on child social well-being appears to differ.
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Affiliation(s)
- V Totsika
- Division of Psychiatry, University College London, London, UK
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
| | - R P Hastings
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
| | - C Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - E Emerson
- Centre for Disability Research, Division of Health and Medicine, Lancaster University, Lancaster, UK
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Camperdown, NSW, Australia
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Zabidi AS, Hastings RP, Totsika V. Spending leisure time together: Parent child relationship in families of children with an intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104398. [PMID: 36565519 DOI: 10.1016/j.ridd.2022.104398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Relationship quality between a parent and a child typically differs between families with a child with intellectual disability (ID) and families with other children. Parent-child relationship quality matters in ID as it has been linked with child outcomes. However, there are few research studies examining factors that are related to parent-child relationship quality in ID. AIMS The aim of the present study was to investigate factors associated with parent-child relationship quality in families of children with ID. In particular, we aimed to examine the association between the amount of time parents and children spend together in leisure activities and parent-child relationship quality. METHODS AND PROCEDURES The sample was drawn from the 1000 Families Study, a survey including parent-reported data from families of children with ID aged 4-16 years. Measures of parent-child relationship quality and shared parent-child time were available. OUTCOMES Regression analyses showed that parental investment in shared leisure time was significantly associated with parent-child closeness and conflict, even after controlling for a number of factors related to relationship quality. Parental psychological distress was also associated with parent-child relationship quality. CONCLUSIONS AND IMPLICATIONS Interventions that aim to improve parent-child relationship quality may want to investigate the role of shared parent-child time in leisure activities as one of the mechanisms of change.
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Affiliation(s)
- Amira Sofia Zabidi
- UCL Division of Psychiatry, 6th Floor, Wing A, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
| | | | - Vaso Totsika
- UCL Division of Psychiatry, 6th Floor, Wing A, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom; CEDAR, University of Warwick, Coventry CV4 7AL, United Kingdom; Tavistock & Portman NHS Foundation Trust, United Kingdom.
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The Impact of a Family-Centred Intervention for Parents of Children with Developmental Disabilities: A Model Project in Rural Ireland. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020175. [PMID: 36832304 PMCID: PMC9954624 DOI: 10.3390/children10020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
The greater risk of poor mental health and social isolation, experienced by parents of children with developmental disabilities, is compounded by family circumstances and living in rural settings. Often parents receive little personal support. Family-centred interventions have been recommended internationally for promoting children's development, as well as boosting parental wellbeing. Yet, in many countries, current service provision is predominately child-focused and clinic-centred. An innovative, family-centred support service was designed and evaluated in a rural county of Ireland. Support staff visit the family home every month for around one year with regular check-ins by phone. The service aims included setting developmental goals for the child that were agreed with parents, alongside actions to address the personal needs of parents and siblings. In addition, community activities are identified or created to promote the social inclusion of the child and family in local communities, as well as locating opportunities for social activities for mothers. To date, 96 families with 110 children have been involved and three monthly reviews have been undertaken of each child's progress. Baseline measures on parents' mental health and social isolation were gathered and repeated when parents had completed their involvement with the project, along with qualitative information regarding the parents' experiences. Most children attained their learning targets, alongside those selected as personal goals by parents; in particular, parents reported their child's greater involvement in community activities, increased knowledge and skills, and with more confidence and resilience. Significant increases in parental well-being scores were reported, but there was a limited impact on their social participation and that of their child. This evidence-based model of provision is an example of how current social care provision for families who have a child with developmental disabilities could be cost-effectively re-envisioned even in rural areas.
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Sanders M, Hoang NPT, Hodges J, Sofronoff K, Einfeld S, Tonge B, Gray K. Predictors of Change in Stepping Stones Triple Interventions: The Relationship between Parental Adjustment, Parenting Behaviors and Child Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13200. [PMID: 36293782 PMCID: PMC9602721 DOI: 10.3390/ijerph192013200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
The current study explored the process of change in Stepping Stones Triple P (SSTP) using a community-based sample of 891 families of children with developmental disabilities (DD) who participated in an SSTP intervention at a community level. A preliminary analysis of outcome data indicated that SSTP intervention was effective in reducing parental adjustment difficulties, coercive parenting, and children's behavioral and emotional difficulties immediately after the intervention. The effects were maintained at 12-month follow-up. The results also indicated that change in parental adjustment over the course of intervention was significantly associated with a change in parenting behaviors. However, change in parenting behaviors but not change in parental adjustment, predicted children's behavioral and emotional problems following the intervention. The results suggest that positive parenting skills are the most salient ingredient driving the change in child behaviors in SSTP interventions.
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Affiliation(s)
- Matthew Sanders
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nam-Phuong T. Hoang
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Julie Hodges
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kate Sofronoff
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stewart Einfeld
- Brain and Mind Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Bruce Tonge
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, VIC 3800, Australia
| | - Kylie Gray
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, VIC 3800, Australia
- Centre for Educational Development, Appraisal, and Research, University of Warwick, Coventry CV4 7AL, UK
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Baird A, Papachristou E, Hassiotis A, Flouri E. The role of physical environmental characteristics and intellectual disability in conduct problem trajectories across childhood: A population-based Cohort study. ENVIRONMENTAL RESEARCH 2022; 209:112837. [PMID: 35101401 DOI: 10.1016/j.envres.2022.112837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/13/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours. AIMS To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories. METHOD The sample included 8168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status. RESULTS Exposure to external environmental domains was not associated with differences in children's conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p < .001) and damp problems (b = 0.14, p < .001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p < .001), autism spectrum disorder (b = 1.18, p < .001), male sex (b = 0.26, p < .001), poverty (b = 0.19, p < .001), maternal depression (b = 0.65, p < .001), and non-nuclear family structure (b = 0.35, p < .001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p < .01). CONCLUSIONS Our findings highlight the potential harmful consequences of poor internal residential conditions on children's development of disruptive behaviours.
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Affiliation(s)
- Alister Baird
- UCL Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7BN, United Kingdom.
| | - Efstathios Papachristou
- UCL Institute of Education - Psychology and Human Development, 20 Bedford Way, London, WC1H 0AL, United Kingdom.
| | - Angela Hassiotis
- UCL Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7BN, United Kingdom.
| | - Eirini Flouri
- UCL Institute of Education - Psychology and Human Development, 20 Bedford Way, London, WC1H 0AL, United Kingdom.
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Gore N, Bradshaw J, Hastings R, Sweeney J, Austin D. Early positive approaches to support (E-PAtS): Qualitative experiences of a new support programme for family caregivers of young children with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:889-899. [PMID: 35289031 PMCID: PMC9311085 DOI: 10.1111/jar.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early Positive Approaches to Support (E-PAtS) is a co-produced and co-facilitated group programme that aims to provide early years support to family caregivers of children with Intellectual and Developmental Disabilities. METHOD Thirty-five caregivers who had attended E-PAtS groups took part in individual interviews or focus groups. Caregiver experiences concerning attendance of E-PAtS were explored, in relation to process variables and perceived outcomes. Interviews were thematically analysed. RESULTS Three major themes were identified: our group, evolving emotions, and positive approaches. Being with and being supported by other families was very important to caregivers. Families reported increased confidence and greater realisation of the need for self-care. Children were reported to show fewer behaviours that challenge and increases in adaptive skills. Findings corresponded to mechanisms and outcomes in the E-PAtS logic model. CONCLUSION E-PAtS shows promise as one way families and children with Intellectual and Developmental Disabilities can access early years support.
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Affiliation(s)
- Nick Gore
- Tizard Centre, Cornwallis North East, University of Kent, Canterbury, Kent, UK
| | - Jill Bradshaw
- Tizard Centre, Cornwallis North East, University of Kent, Canterbury, Kent, UK
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Williams CA, Bailey T, Hastings RP. Modelling triadic relationships in families of children with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:843-855. [PMID: 35187793 PMCID: PMC9306971 DOI: 10.1111/jar.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/01/2022]
Abstract
Background Method Results Conclusions
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Affiliation(s)
- Caitlin A. Williams
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick Coventry UK
| | - Tom Bailey
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick Coventry UK
| | - Richard P. Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick Coventry UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry Monash University Melbourne Victoria Australia
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12
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Huang W, Weinert S, Wareham H, Law J, Attig M, von Maurice J, Roßbach HG. The Emergence of 5-Year-Olds' Behavioral Difficulties: Analyzing Risk and Protective Pathways in the United Kingdom and Germany. Front Psychol 2022; 12:769057. [PMID: 35069345 PMCID: PMC8767965 DOI: 10.3389/fpsyg.2021.769057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to advance our understanding of 5-year-olds' behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries-the United Kingdom (13,053) and Germany (2,022), the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children's behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking (low) parental education, parental distress, and children's difficult temperament to children's behavioral difficulties. Further, the tested model controlled for families' income as well as children's sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children's vocabulary skills served as a mechanism mediating the association between parental education and children's behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children's behavioral development. The findings suggest that promoting parents' sensitive interactive behaviors, favorable disciplinary practices, and child's vocabulary skills have potential for preventing early behavioral difficulties.
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Affiliation(s)
- Wei Huang
- Leibniz Institute for Educational Trajectories, Bamberg, Germany
- Bamberg Graduate School of Social Sciences, University of Bamberg, Bamberg, Germany
| | - Sabine Weinert
- Department of Developmental Psychology, University of Bamberg, Bamberg, Germany
| | - Helen Wareham
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Manja Attig
- Leibniz Institute for Educational Trajectories, Bamberg, Germany
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Coulman E, Gore N, Moody G, Wright M, Segrott J, Gillespie D, Petrou S, Lugg-Widger F, Kim S, Bradshaw J, McNamara R, Jahoda A, Lindsay G, Shurlock J, Totsika V, Stanford C, Flynn S, Carter A, Barlow C, Hastings R. Early positive approaches to support for families of young children with intellectual disability: the E-PAtS feasibility RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/heyy3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Parents of children with intellectual disability are 1.5–2 times more likely than other parents to report mental health difficulties. There is a lack of clinically effective and cost-effective group well-being interventions designed for family carers of young children with intellectual disability.
Aim
To examine the feasibility of a randomised controlled trial of the clinical effectiveness and cost-effectiveness of the Early Positive Approaches to Support (E-PAtS) intervention.
Design
A feasibility study (including randomisation of families into a two-arm trial), questionnaires to assess the feasibility of proposed outcome measures (including resource use and health-related quality of life) and practitioner/family carer interviews. An additional question was included in an online UK survey of families, conducted by the research team to assess usual practice, and a survey of provider organisations.
Setting
Families recruited from community contexts (i.e. third sector, local authority services, special schools) and self-referral. The E-PAtS intervention was delivered by trained community-based providers.
Participants
Families with at least one child aged 1.5–5 years with an intellectual disability. At least one parent had to have English-language ability (spoken) for E-PAtS programme participation and participants had to provide informed consent.
Interventions
E-PAtS intervention – two caregivers from each family invited to eight 2.5-hour group sessions with usual practice. Usual practice – other support provided to the family, including other parenting support.
Objectives
To assess randomisation willingness/feasibility, recruitment of providers/parents, retention, usual practice, adherence, fidelity and feasibility of proposed outcome measures (including the Warwick–Edinburgh Mental Well-Being Scale as the proposed primary outcome measure, and parent anxiety/depression, parenting, family functioning/relationships, child behavioural/emotional problems and adaptive skills, child and parent quality of life, and family services receipt as the proposed secondary outcome measures).
Results
Seventy-four families (95 carers) were recruited from three sites (with 37 families allocated to the intervention). From referrals, the recruitment rate was 65% (95% confidence interval 56% to 74%). Seventy-two per cent of families were retained at the 12-month follow-up (95% confidence interval 60% to 81%). Exploratory regression analysis showed that the mean Warwick–Edinburgh Mental Well-Being Scale well-being score was 3.96 points higher in the intervention group (95% confidence interval –1.39 to 9.32 points) at 12 months post randomisation. High levels of data completeness were achieved on returned questionnaires. Interviews (n = 25) confirmed that (1) recruitment, randomisation processes and the intervention were acceptable to family carers, E-PAtS facilitators and community staff; (2) E-PAtS delivery were consistent with the logic model; and (3) researchers requesting consent in future for routine data would be acceptable. Recorded E-PAtS sessions demonstrated good fidelity (96% of components present). Adherence (i.e. at least one carer from the family attending five out of eight E-PAtS sessions) was 76%. Health-related quality-of-life and services receipt data were gathered successfully. An online UK survey to assess usual practice (n = 673) showed that 10% of families of young children with intellectual disability received any intervention over 12 months. A provider survey (n = 15) indicated willingness to take part in future research.
Limitations
Obtaining session recordings for fidelity was difficult. Recruitment processes need to be reviewed to improve diversity and strategies are needed to improve primary outcome completion.
Conclusions
Study processes were feasible. The E-PAtS intervention was well received and outcomes for families were positive. A barrier to future organisation participation is funding for intervention costs. A definitive trial to test the clinical effectiveness and cost-effectiveness of E-PAtS would be feasible.
Trial registration
Current Controlled Trials ISRCTN70419473.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nick Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jeremy Segrott
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Geoff Lindsay
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | - Vaso Totsika
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Catherine Stanford
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Samantha Flynn
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | | | - Richard Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
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Maternal Psychological Problems During Pregnancy and Child Externalizing Problems: Moderated Mediation Model with Child Self-regulated Compliance and Polygenic Risk Scores for Aggression. Child Psychiatry Hum Dev 2022; 53:654-666. [PMID: 33743096 PMCID: PMC9287202 DOI: 10.1007/s10578-021-01154-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/05/2022]
Abstract
A potential pathway underlying the association between prenatal exposure to maternal psychological problems and childhood externalizing problems is child self-regulation. This prospective study (N = 687) examined whether self-regulated compliance mediates the relation between maternal affective problems and hostility during pregnancy and childhood externalizing problems, and explored moderation by child polygenic risk scores for aggression and sex. Self-regulated compliance at age 3 was observed in mother-child interactions, and externalizing problems at age 6 were reported by mothers and teachers. Polygenic risk scores were calculated based on a genome-wide association study of aggressive behavior. Self-regulated compliance mediated the associations between maternal psychological problems and externalizing problems. Aggression PRS was associated with higher externalizing problems reported by mothers. No evidence was found of moderation by aggression PRS or sex. These findings support the hypothesis that maternal psychological problems during pregnancy might influence externalizing problems through early self-regulation, regardless of child genetic susceptibility or sex.
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15
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Grumi S, Borgatti R, Provenzi L. Supporting Parenting at Home-Empowering Rehabilitation through Engagement (SPHERE): study protocol for a randomised control trial. BMJ Open 2021; 11:e051817. [PMID: 34907057 PMCID: PMC8672000 DOI: 10.1136/bmjopen-2021-051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infants with neurodevelopmental disabilities (NDs) show emotional, cognitive and sociointeractive dysregulation dramatically impacting on caregiving behaviour. Early video-feedback interventions (VFIs) are effective in promoting sensitive parenting, which in turn supports infants' development, even in case of ND. In the light of limited resources of the healthcare systems, technological advances in telemedicine may facilitate the delivery of VFI to a greater number of families of infants with ND. To date, no study has implemented a telemedicine VFI (TVFI) for families of infants diagnosed with ND. METHODS AND ANALYSIS The Supporting Parenting at Home-Empowering Rehabilitation through Engagement project is a randomised controlled trial aimed at assessing the effectiveness of an early family-centred TVFI parenting support on dyads with infants diagnosed with ND. It includes two arms (TVFI vs Booklet Psychoeducational Intervention) and three assessment phases: T0, baseline; T1, immediate postintervention; T2, 6-month follow-up. ETHICS AND DISSEMINATION This study is funded by the Italian Ministry of Health and was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER The study protocol has been also registered on NIH Clinical Trials (protocol code NCT04656483; Pre-results).
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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16
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Totsika V, Emerson E, Hastings RP, Hatton C. The impact of the COVID-19 pandemic on the health of adults with intellectual impairment: evidence from two longitudinal UK surveys. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:890-897. [PMID: 34212443 PMCID: PMC8447167 DOI: 10.1111/jir.12866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/22/2021] [Accepted: 06/20/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND People with an intellectual impairment experience high levels of social and health inequalities. We investigated the impact of COVID-19 on the physical and mental health of people with intellectual impairment, controlling for demographic risk, socio-economic circumstances and pre-pandemic health levels. METHOD Data were drawn from two UK birth cohorts that surveyed their participants on the impact of COVID-19 in May 2020: the Millennium Cohort Study (20-year-old participants) and the British Cohort Survey (50-year-old participants). Health outcomes (COVID-19 infection, COVID-19 symptoms, self-reported physical health, mental health, health service use and impact on health behaviours) were compared between people with and without intellectual impairment, adjusting for gender and ethnicity. Differences were further adjusted for self-reported health pre-pandemic and the impact of COVID-19 on socio-economic circumstances. RESULTS Controlling for gender and ethnicity, poor health was reported less often by younger adults [relative risks (RR): 0.44 95% confidence interval (CI) 0.23, 0.86] and more often by older adults (RR: 1.99 95% CI 1.45, 2.73) with intellectual impairment compared with peers. Older adults were also more likely to experience fever and loss of taste/smell. Adjusting for pre-pandemic health and socio-economic circumstances eliminated some differences in the older cohort, but not in the younger one. CONCLUSION In young adulthood, the impact of COVID-19 on health outcomes was not negative. The pattern was reversed in later adulthood, although differences were mostly eliminated after adjustment suggesting a socio-economic and age gradient of COVID-19 impacts on intellectual impairment.
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Affiliation(s)
- V. Totsika
- Division of PsychiatryUniversity College LondonLondonUK
- Centre for Educational Development Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and PsychologyMonash UniversityMelbourneVictoriaAustralia
| | - E. Emerson
- Centre for Disability Research, Faculty of Health and MedicineLancaster UniversityLancasterUK
- Centre for Disability Research & Policy, Faculty of Health SciencesUniversity of SydneySydneyNew South WalesAustralia
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - R. P. Hastings
- Centre for Educational Development Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and PsychologyMonash UniversityMelbourneVictoriaAustralia
| | - C. Hatton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
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17
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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18
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Langley E, Totsika V, Hastings RP, Bailey T. Family Relationships and Their Associations With Perceptions of Family Functioning in Mothers of Children With Intellectual Disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:187-202. [PMID: 33910238 DOI: 10.1352/1944-7558-126.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
We explored whether reports of three dyadic relationships (marital/partner, parent-child, sibling) were related to perceptions of family functioning in 467 mothers of children with intellectual disability aged 4-15 years. Structural equation models were fitted to examine associations between relationship indicators and family functioning. The final structural model showed that partner relationship satisfaction, partner disagreement, child-parent conflict, and sibling relationship warmth accounted for the most variance in family functioning, with partner relationship satisfaction having the strongest positive association. Dimensions of dyadic relationships appear to be associated with broader constructs of family functioning in this sample of mothers, signifying the potential for systemic intervention.
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Affiliation(s)
- Emma Langley
- Emma Langley, University of Warwick, Coventry, UK
| | | | | | - Tom Bailey
- Richard P. Hastings and Tom Bailey, University of Warwick, Coventry, UK
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19
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Bailey T, Hastings RP, Totsika V. COVID-19 impact on psychological outcomes of parents, siblings and children with intellectual disability: longitudinal before and during lockdown design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:397-404. [PMID: 33634520 PMCID: PMC8013753 DOI: 10.1111/jir.12818] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Parents of children with intellectual disability (ID) report comparatively lower levels of well-being than parents of children without ID. Similarly, children with ID, and to a lesser extent their siblings, are reported to show comparatively higher levels of behaviour and emotional problems. Psychological problems may be accentuated by restrictions associated with the COVID-19 pandemic, due to increased social, caring and economic stressors and reduced social support. However, existing studies have not been able to examine the impact of COVID-19 restrictions accounting for pre-COVID levels of well-being in these families. In a naturalistic design, we examined outcomes for parents, siblings and children with ID in a two-wave longitudinal study where Wave 2 data were gathered for some families before and some during COVID-19 restrictions. METHODS Parents of children with ID who took part in a Wave 2 survey pre-lockdown (n = 294) and during/post-lockdown (n = 103) completed a number of measures about their well-being and the behaviour and emotional problems of both their child with ID and their nearest-in-age sibling. These same measures had also been completed for all families 2-3 years previously in Wave 1 of the study. RESULTS After accounting for covariates including family socio-economic circumstances, pre-lockdown and post-lockdown groups did not differ on Waves 1 to 2 change for measures of parental psychological distress, life satisfaction, the impact of caregiving on their lives or perceived positive gains; nor child or sibling internalising or externalising behaviour problems. CONCLUSIONS Findings of the current study indicate that during and shortly after the COVID-19 lockdown in the United Kingdom, well-being in families of children with an ID (as reported by parents) was at similar levels compared with prior to the lockdown period.
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Affiliation(s)
- T. Bailey
- CEDARUniversity of WarwickCoventryUK
| | - R. P. Hastings
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVicAustralia
| | - V. Totsika
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVicAustralia
- Department of PsychiatryUniversity College LondonLondonUK
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Childhood disadvantage, neurocognitive development and neuropsychiatric disorders: Evidence of mechanisms. Curr Opin Psychiatry 2021; 34:306-323. [PMID: 33587493 PMCID: PMC9458466 DOI: 10.1097/yco.0000000000000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children living in socioeconomically disadvantaged households have excess risks of neurodevelopmental and neuropsychiatric problems. The purpose of this review is to synthesize evidence for mechanisms that may contribute to these excess risks. RECENT FINDINGS The majority of the 60 studies included in our review focused on children's neurocognitive development and behavioural problems. About half conducted mediation analyses of factors in the family and neighbourhood environments, including access to resources (e.g. cognitive inputs within the home environment) and exposure to stressors (e.g. negative parenting practices), as well as neurobiological embedding of childhood disadvantage. In addition, many studies conducted moderation analyses of factors that were hypothesized to interact with (i.e. exacerbate or mitigate) the harmful effects of childhood disadvantage. SUMMARY Many of the factors that contribute to the excess risk of neurodevelopmental and neuropsychiatric problems among children in disadvantaged households are potentially modifiable (e.g. cognitively stimulating materials, parental language input, cultural resources, parental stress and psychopathology, negative parenting, neighbourhood violence). If their causality is ultimately established, they could be targets for the prevention and reduction of disparities. The continued search for mechanisms should not detract from work to reduce and hopefully eliminate children's exposure to disadvantage.
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21
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Sapiets SJ, Totsika V, Hastings RP. Factors influencing access to early intervention for families of children with developmental disabilities: A narrative review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:695-711. [PMID: 33354863 PMCID: PMC8246771 DOI: 10.1111/jar.12852] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Early intervention (EI) can improve a range of outcomes for families of children with developmental disabilities. However, research indicates the level of access does not always match the level of need. To address disparities, it is essential to identify factors influencing access. METHOD We propose a framework where access to EI is conceptualised as a process that includes three main phases. A narrative review examined potential barriers, facilitators and modifiers of access for each phase. RESULTS The process of access to EI includes the following: 1) recognition of need, 2) identification or diagnosis and 3) EI provision or receipt. Several factors affecting access to EI for each phase were identified, related to the family, services, the intersection between family and services, and the context. CONCLUSION A broad range of factors appear to influence the process of access to EI for this population. Our framework can be used in future research investigating access. Broad implications for policy, practice and future research to improve access to EI are discussed.
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Affiliation(s)
- Suzi J. Sapiets
- Centre for Educational Development, Appraisal and Research (CEDAR)University of WarwickCoventryUK
| | - Vasiliki Totsika
- Centre for Educational Development, Appraisal and Research (CEDAR)University of WarwickCoventryUK
- Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityClayton VIC 3800Australia
| | - Richard P. Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR)University of WarwickCoventryUK
- Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityClayton VIC 3800Australia
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22
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Day JJ, Hodges J, Mazzucchelli TG, Sofronoff K, Sanders MR, Einfeld S, Tonge B, Gray KM. Coercive parenting: modifiable and nonmodifiable risk factors in parents of children with developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:306-319. [PMID: 33506597 DOI: 10.1111/jir.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/18/2020] [Accepted: 11/30/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Parents of children with developmental or intellectual disabilities tend to report greater use of coercive parenting practices relative to parents of typically developing children, increasing the risk of adverse child outcomes. However, to date, there is limited research exploring the role and relative contribution of modifiable and nonmodifiable risk factors in parents of children with a disability. The present study aimed to explore the role of various modifiable and nonmodifiable parenting, family and sociodemographic factors associated with the use of coercive parenting practices in parents of children with a disability. METHODS Caregivers (N = 1392) enrolled in the Mental Health of Young People with Developmental Disabilities (MHYPeDD) programme in Australia completed a cross-sectional survey about their parenting and their child aged 2-12 years with a disability. Measures covered a range of domains including relevant demographic and family background, use of coercive parenting practices, intensity of child behavioural difficulties and questions relating to parent and family functioning such as parental self-efficacy, adjustment difficulties and quality of family relationships. RESULTS Parents of older children, those who were younger at the birth of their child, and parents who were co-parenting or working reported more use of coercive parenting practices. Greater intensity of child difficulties, poorer parental self-efficacy and parent-child relationships, and more parental adjustment difficulties were also significantly associated with more use of coercive parenting. Examination of the relative contribution of variables revealed parent-child relationship was a key contributing factor, followed by intensity of child behaviour problems, parent adjustment and parent confidence. CONCLUSIONS These findings highlight a range of factors that should be targeted and modified through upstream prevention programmes and further inform our understanding of how coercive practices may be influenced through targeted parenting interventions.
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Affiliation(s)
- J J Day
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - J Hodges
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - T G Mazzucchelli
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- Child and Family Research Group, Brain, Behaviour and Mental Health Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - K Sofronoff
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - M R Sanders
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - S Einfeld
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - B Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
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23
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Vilaseca R, Rivero M, Ferrer F, Bersabé RM. Parenting behaviors of mothers and fathers of young children with intellectual disability evaluated in a natural context. PLoS One 2020; 15:e0240320. [PMID: 33048940 PMCID: PMC7553331 DOI: 10.1371/journal.pone.0240320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022] Open
Abstract
The aims of this study were to analyze the interactions of mothers and fathers with their children with intellectual disabilities, focusing on certain parental behaviors previously identified as promoting child development, and to explore the relations between parenting and some sociodemographic variables. A sample of 87 pairs of mothers and fathers of the same children were recruited from Early Intervention Centers. The children (58 male and 29 female) were aged 20–47 months. Most of the families (92%) were from the province of Barcelona (Spain), and the remaining 8% were from the other provinces of Catalonia (Spain). Parenting behaviors, divided into four domains (Affection, Responsiveness, Encouragement, and Teaching) were assessed from self-recorded videotapes, in accordance with the validated Spanish version of the PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). Parents were administered a sociodemographic questionnaire. The results revealed strong similarities between mothers’ and fathers’ parental behaviors. Mothers and fathers were more likely to engage in affectionate behavior than in teaching behavior. Only maternal teaching presented a significant positive relation to the child’s age. With respect to the child’s gender, no differences were observed in mothers’ parenting. Conversely, fathers scored significantly higher in Responsiveness, Encouragement and Teaching (and had higher total parenting scores) when interacting with boys. The severity of the child’s ID had a statistically significant effect only on fathers’ Teaching, which showed lower mean scores in the severe ID group than in the moderate and mild ID groups. Teaching also presented a significant positive relation to mother’s age, but father’s age was not related to any parenting domain. Mothers with a higher educational level scored significantly higher in Encouragement and Teaching, and the fathers’ educational level was not significantly related to any parenting domain. Mothers’ and fathers’ Teaching, and fathers’ Responsiveness, Encouragement and total parenting scores, presented a significant positive relation to family income. Finally, mothers spent more time in childcare activities than fathers, particularly on workdays. Our main conclusion is that mothers and fathers show very similar strengths and weaknesses when interacting with their children with intellectual disabilities during play.
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Affiliation(s)
- Rosa Vilaseca
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Magda Rivero
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Fina Ferrer
- Municipal Institute of Social Services of Barcelona, Barcelona, Spain
| | - Rosa María Bersabé
- Department of Methodology for the Behavioral Sciences, University of Malaga, Málaga, Spain
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24
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Provenzi L, Grumi S, Borgatti R. Alone With the Kids: Tele-Medicine for Children With Special Healthcare Needs During COVID-19 Emergency. Front Psychol 2020; 11:2193. [PMID: 33013567 PMCID: PMC7509132 DOI: 10.3389/fpsyg.2020.02193] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Montirosso R, Rosa E, Giorda R, Fazzi E, Orcesi S, Cavallini A, Provenzi L. Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial. BMJ Open 2020; 10:e035249. [PMID: 32699128 PMCID: PMC7375429 DOI: 10.1136/bmjopen-2019-035249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disability (ND) represents an adverse condition for infants' socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens' development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation. METHODS AND ANALYSIS Dyads will be randomly assigned to the video-feedback Intervention Group or Control Group ('dummy' intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T0, baseline; T1, post-intervention; T2, short-term follow-up (3 month); T3, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups. ETHICS AND DISSEMINATION Ethics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences. TRIAL REGISTRATION NUMBER NCT03853564; Pre-results.
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Affiliation(s)
- Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Elisa Rosa
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anna Cavallini
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Provenzi L, Giusti L, Caglia M, Rosa E, Mascheroni E, Montirosso R. Evidence and Open Questions for the Use of Video-Feedback Interventions With Parents of Children With Neurodevelopmental Disabilities. Front Psychol 2020; 11:1374. [PMID: 32625153 PMCID: PMC7314919 DOI: 10.3389/fpsyg.2020.01374] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
The Video-Feedback Intervention (VFI) is a technique aimed at promoting positive parenting that has been found to be supportive of child development and parent-child interaction in different at-risk and clinical populations. The application of VFI with parents of children with neurodevelopmental disabilities (ND; e.g., cerebral palsy, sensory and/or psychomotor delay, and genetic syndromes) is growing. Nonetheless, no systematic review is currently available documenting whether this type of intervention improves children's developmental outcomes (e.g., behavioral stability and cognitive abilities), parental caregiving skills (e.g., responsive parenting), and parental emotional well-being (e.g., depressive symptomatology). In the present mini-review, 212 VFI records were retrieved from three databases (i.e., PubMed, Scopus, and Web of Science), and 10 papers were finally included. Abstracted information included age, diagnosis, methodological aspects (timing, setting, and themes), and child/parent outcomes. Significant improvements from pre- to post-VFI were observed in all studies. Specifically, the VFIs were significantly associated with better children developmental outcomes and parental caregiving skills. Inconsistent findings emerged for the VFI effects on parental emotional well-being. Overall, the current mini-review supports the potential effectiveness of parent-focused VFI interventions for parents of children with ND, despite the presence of open questions that need to be addressed in future clinical trials.
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Affiliation(s)
| | | | | | | | | | - Rosario Montirosso
- 0-3 Centre for the at-Risk Infant, Scientific Institute, IRCCS E. Medea, Lecco, Italy
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Bailey T, Totsika V, Hastings RP, Hatton C, Emerson E. Developmental trajectories of behaviour problems and prosocial behaviours of children with intellectual disabilities in a population-based cohort. J Child Psychol Psychiatry 2019; 60:1210-1218. [PMID: 31225660 DOI: 10.1111/jcpp.13080] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The study examined developmental trajectories of prosocial behaviours, internalising and externalising behaviour problems in children with intellectual disabilities (ID) between pre-school and middle childhood. METHOD Growth models examined the best-fitting trajectories for internalising and externalising behaviour problems, as well as prosocial behaviours, in 555 children with ID between the ages of three and 11 years from the UK Millennium Cohort Study. Models were also fitted to examine the association of child outcomes with time-varying maternal psychological distress and life satisfaction. Finally, models were extended to compare trajectories with typically developing children. RESULTS Externalising behaviour problems and prosocial behaviours generally improved, whereas internalising problems did not change systematically over time. A cubic trend indicated a slowing down of improvement between ages 5 and 7 for prosocial behaviours and externalising problems. Maternal psychological distress positively co-varied with internalising and externalising behaviour problems over time. Life satisfaction was not related to changes in child behaviours over time. Compared to behavioural trajectories in typical development, intercepts were worse and trajectories also differed in the ID group. CONCLUSIONS Over an 8-year period, externalising behaviour problems and prosocial behaviours of children with ID tended to improve. These behavioural improvements slowed between five and seven years, possibly coinciding with school-related environmental changes. Children with ID significantly differ from children with typical development in both the initial level of difficulties (exhibiting higher externalising and internalising behaviours, and lower prosocial behaviours) and subsequent development as they age, showing comparatively lower decreases in both externalising and internalising behaviours, and lower increases in prosocial behaviours. Findings also highlight the significant role of maternal mental health problems in the trajectory of child behaviour problems.
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Affiliation(s)
- Tom Bailey
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
| | - Vasiliki Totsika
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Division of Psychiatry, University College London, London, UK.,Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Chris Hatton
- Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.,Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Emerson E, Robertson J, Baines S, Hatton C. Vaccine Coverage among Children with and without Intellectual Disabilities in the UK: Cross Sectional Study. BMC Public Health 2019; 19:748. [PMID: 31196050 PMCID: PMC6567524 DOI: 10.1186/s12889-019-7106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/05/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research, Lancaster University, Lancaster, LA1 4YT UK
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW 2006 Australia
| | - Janet Robertson
- Centre for Disability Research, Lancaster University, Lancaster, LA1 4YT UK
| | - Susannah Baines
- Centre for Disability Research, Lancaster University, Lancaster, LA1 4YT UK
| | - Chris Hatton
- Centre for Disability Research, Lancaster University, Lancaster, LA1 4YT UK
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