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Ashok P, Fäldt A, Dahlberg A, Durbeej N. Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study. PLoS One 2024; 19:e0303685. [PMID: 38753629 PMCID: PMC11098387 DOI: 10.1371/journal.pone.0303685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden. METHODS In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models. RESULTS In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings. CONCLUSIONS Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.
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Affiliation(s)
- Pavithra Ashok
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Fäldt
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anton Dahlberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Wojtaszek JA, Ham HL, Bruni TP, Sunde E, Drossel C, Maragakis A. Feasibility and Acceptability of a Pediatric Primary Care Physician Training for Anxiety Screening and Evidence-based Intervention. Clin Pediatr (Phila) 2024:99228241234229. [PMID: 38420946 DOI: 10.1177/00099228241234229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Anxiety is one of the most prevalent psychological conditions in the pediatric population, and its associated impairments often persist into adulthood. Pediatricians are in a unique position to screen, briefly intervene, and facilitate treatment to prevent long-term impacts. However, they often do not have adequate training to do so. The current study addressed this gap by providing a brief online educational workshop aimed to promote: (1) screening for anxiety and (2) follow-up with appropriate evidence-based interventions. Fifty-three providers participated, and 38 completed surveys pre- and post-training. Findings indicate acceptability of the training to providers, improved knowledge related to anxiety, and increased readiness to manage anxiety during a medical visit. This study supports the utility of a brief, online training on screening and provision of evidence-based treatment for anxiety in pediatric primary care.
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Affiliation(s)
- Julie A Wojtaszek
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Hannah L Ham
- Departments of Psychology and Pediatrics, University of Michigan Health, Michigan Medicine, Ann Arbor, MI, USA
| | - Teryn P Bruni
- Department of Psychology, Algoma University, Sault Ste Marie, ON, Canada
| | - Eleah Sunde
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Claudia Drossel
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Alexandros Maragakis
- DEREE College-School of Graduate and Professional Studies, The American College of Greece, Athens, Greece
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Duffee J, Szilagyi M, Forkey H, Kelly ET. Trauma-Informed Care in Child Health Systems. Pediatrics 2021; 148:peds.2021-052579. [PMID: 34312294 DOI: 10.1542/peds.2021-052579] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- James Duffee
- Departments of Pediatrics and Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Heather Forkey
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
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Ai J, Horn EM, Bigelow KM. Examining Implementation and Sustainability of Positive Behavior Support in Child Care Centers. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mian ND, Pincus DB, Perrin EC, Bair-Merritt M. Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11033. [PMID: 33324746 PMCID: PMC7732138 DOI: 10.15766/mep_2374-8265.11033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/12/2023]
Abstract
Introduction Pediatric anxiety disorders have high rates of prevalence and confer risk for later disorders if they go undetected. In primary care, they are underdiagnosed, partly because pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of anxiety disorders in primary care. Methods Video content was consistent with the American Academy of Pediatrics Behavioral Health Competencies, as applied to the evaluation of anxiety disorders and guidance for discussing treatment options. This training can be delivered in two formats: videos (43 minutes) can be shown in a live, group-based format, or accessed via an online, asynchronous training. We tested this training program using both formats and developed surveys to evaluate knowledge about child anxiety, perceived evaluation skills, and satisfaction with the training. We also developed a video-based vignette to measure sensitivity to detecting disorders (how much the condition is interfering, diagnostic severity, and referral urgency). Results Pediatric residents from two residency programs completed the training and pre- and posttraining assessments to evaluate program efficacy. Residents' knowledge and perceived evaluation skills increased posttraining, with large effect sizes. Residents also demonstrated increased sensitivity to detecting anxiety disorders on the vignette-based assessment and reported high levels of satisfaction. Discussion Our results suggested that residents participating in this training improved their evaluation skills and that residents found the training beneficial. Video-based trainings can significantly supplement existing education. This cost-effective and minimally burdensome training program can be used to enhance resident education in a much-needed area.
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Affiliation(s)
- Nicholas D. Mian
- Assistant Professor, Department of Life Sciences, University of New Hampshire
| | - Donna B. Pincus
- Associate Professor, Department of Psychological and Brain Sciences, Boston University
| | - Ellen C. Perrin
- Professor, Department of Pediatrics, Tufts University School of Medicine
| | - Megan Bair-Merritt
- Professor of Pediatrics, Department of Pediatrics, Boston University Medical School; Director of BMC Pediatrics Center for the Urban Child and Healthy Family
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Ma HI, Hsieh CE. Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation. BMC MEDICAL EDUCATION 2020; 20:59. [PMID: 32106850 PMCID: PMC7045580 DOI: 10.1186/s12909-020-1976-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/20/2020] [Indexed: 06/09/2023]
Abstract
BACKGROUND People may be stigmatized if they have mental illness, emotional and behavioral disorders (EBD), or physical or intellectual disabilities. Being stigmatized adversely affects one's psychological well-being and quality of life. While occupational therapists frequently work with people with EBD and disabilities, all healthcare practitioners may encounter these populations, and stigmatizing attitudes of healthcare professionals towards such clients can negatively affect the therapeutic relationship, evaluation, and treatment. Therefore, understanding attitudes of healthcare students-as future practitioners in all fields of healthcare-towards people in this regard is fundamental to the future implementation of anti-stigma programs. We aimed to develop and test questionnaires for examining stigmatizing attitudes of healthcare students towards people with mental illness or disabilities and children with EBD. METHODS A literature review was conducted to identify surveys related to attitudes towards people with mental illness, EBD, and disabilities. Items that were pertinent to the concept of stigma were selected and modified to fit into the Taiwanese context. A total of 336 students from departments of occupational therapy, physical therapy, nursing, and medicine in 7 universities across Taiwan completed the questionnaires. Item analysis and factor analysis were used to examine the reliability and validity of the questionnaires. Gender differences were also considered. RESULTS Factor analyses of the three questionnaires yielded factor structures that explained 61.34 to 67.15% of the variance, with Cronbach's α values ranging from 0.71 to 0.89. The Questionnaire on Stigmatizing Attitudes Towards Mental Illness consisted of 16 items with 4 subscales: deviant behavior, social isolation, negative stereotype, and self-stigma. The Questionnaire on Stigmatizing Attitudes Towards Children with EBD consisted of 14 items with 3 subscales: rejective attitude, negative stereotype, and deviant behavior. The Questionnaire on Stigmatizing Attitudes Towards Disabilities consisted of 10 items with 3 subscales: positive stereotype, negative stereotype, and pessimistic expectation. In addition, men had slightly higher stigmatizing attitudes than women. CONCLUSIONS The results showed satisfactory factor structures and internal consistency, and thus support the use of these questionnaires to understand attitudes of healthcare students towards these populations. In addition, particular attention should be paid to gender differences in stigmatizing attitudes of healthcare students.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
- National Cheng Kung University, Institute of Allied Health Sciences, 1 University Road, Tainan, 701 Taiwan
| | - Chu-En Hsieh
- Department of Occupational Therapy, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
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Marks KP, Madsen Sjö N, Wilson P. Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review. Dev Med Child Neurol 2019; 61:419-430. [PMID: 30246256 DOI: 10.1111/dmcn.14044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. METHOD The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. RESULTS US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. INTERPRETATION Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. WHAT THIS PAPER ADDS General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.
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Affiliation(s)
- Kevin P Marks
- Department of Pediatrics, PeaceHealth Medical Group, Eugene, OR, USA
| | - Nina Madsen Sjö
- National Research Centre for Disadvantaged Children and Youth, University College Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, University of Aberdeen, Aberdeen, UK
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Earls MF, Yogman MW, Mattson G, Rafferty J, Baum R, Gambon T, Lavin A, Wissow L. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics 2019; 143:peds.2018-3259. [PMID: 30559120 DOI: 10.1542/peds.2018-3259] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Perinatal depression (PND) is the most common obstetric complication in the United States. Even when screening results are positive, mothers often do not receive further evaluation, and even when PND is diagnosed, mothers do not receive evidence-based treatments. Studies reveal that postpartum depression (PPD), a subset of PND, leads to increased costs of medical care, inappropriate medical treatment of the infant, discontinuation of breastfeeding, family dysfunction, and an increased risk of abuse and neglect. PPD, specifically, adversely affects this critical early period of infant brain development. PND is an example of an adverse childhood experience that has potential long-term adverse health complications for the mother, her partner, the infant, and the mother-infant dyad. However, PND can be treated effectively, and the stress on the infant can be buffered. Pediatric medical homes should coordinate care more effectively with prenatal providers for women with prenatally diagnosed maternal depression; establish a system to implement PPD screening at the 1-, 2-, 4-, and 6-month well-child visits; use community resources for the treatment and referral of the mother with depression; and provide support for the maternal-child (dyad) relationship, including breastfeeding support. State chapters of the American Academy of Pediatrics, working with state departments of public health, public and private payers, and maternal and child health programs, should advocate for payment and for increased training for PND screening and treatment. American Academy of Pediatrics recommends advocacy for workforce development for mental health professionals who care for young children and mother-infant dyads, and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.
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Affiliation(s)
- Marian F. Earls
- Community Care of North Carolina, Raleigh, North Carolina
- Department of Pediatrics at the School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Michael W. Yogman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Gerri Mattson
- Department of Maternal and Child Health at the Gillings School of Global Public Health, Chapel Hill, North Carolina
- Wake County Health and Human Services, Raleigh, North Carolina
| | - Jason Rafferty
- Department of Pediatrics, Thundermist Health Centers, Woonsocket, Rhode Island
- Department of Child Psychiatry, Emma Pendleton Bradley Hospital, East Providence, Rhode Island; and
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Sege RD, Amaya-Jackson L, Flaherty EG, Idzerda SM, Legano LA, Leventhal JM, Lukefahr JL, Sege RD. Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment. Pediatrics 2017; 139:peds.2017-0100. [PMID: 28320870 DOI: 10.1542/peds.2017-0100] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children who have suffered early abuse or neglect may later present with significant health and behavior problems that may persist long after the abusive or neglectful environment has been remediated. Neurobiological research suggests that early maltreatment may result in an altered psychological and physiologic response to stressful stimuli, a response that deleteriously affects the child's subsequent development. Pediatricians can assist caregivers by helping them recognize the abused or neglected child's emotional and behavioral responses associated with child maltreatment and guide them in the use of positive parenting strategies, referring the children and families to evidence-based therapeutic treatment and mobilizing available community resources.
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Affiliation(s)
- Robert D. Sege
- Health Resources in Action, Boston, Massachusetts
- Center for the Study of Social Policy, Washington District of Columbia; and
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, UCLA-Duke National Center for Child Traumatic Stress, Center for Child & Family Health, Duke University School of Medicine, Durham, North Carolina
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