Intellectual Profiles of Clinic-Referred Preschoolers

Intellectual impairments in preschoolers have been widely studied. A regularity that emerges is that children's intellectual impairments have an important impact on later adjustments in life. However, few studies have looked at the intellectual profiles of young psychiatric outpatients. This study aimed to describe the intelligence profile of preschoolers referred to psychiatry for various cognitive and behavioral problems in terms of verbal, nonverbal, and full-scale IQ and to examine their association with diagnoses. Three hundred four clinical records from young children aged under 7 years and 3 months who consulted at an outpatient psychiatric clinic and who had one intellectual assessment with a Wechsler Preschool and Primary Scale of Intelligence were reviewed. Verbal IQ (VIQ), Nonverbal IQ (NVIQ), and Full-scale IQ (FSIQ) were extracted. Hierarchical cluster analysis using Ward's method was employed to organize data into groups. The children had, on average, a FSIQ of 81, which is significantly lower than that expected in the general population. Four clusters were identified by the hierarchical clusters analysis. Three were characterized by low, average, and high intellectual ability. The last cluster was characterized by a verbal deficit. Findings also revealed that children's diagnoses were not related to any specific cluster, except for children with an intellectual disability with, as expected, low abilities. Children referred to an intellectual assessment in an early childhood mental health clinic showed an altered intellectual development, more specifically in the verbal domain.

Stability of language difficulties among a clinical sample of preschoolers

BACKGROUND

Some data call into question the persistence of developmental language disorders (DLDs) identified during the preschool period. For this reason, speech-language pathologists (SLPs) often reassess children. However, it is unclear if the instability of the profiles documented in community sample studies is present in children referred to specialized clinics. Given the scarcity of SLP resources, is re-evaluating the language skills of these children a good use of clinical time?

AIM

To examine the stability of the findings from two SLP assessments in a sample of Canadian preschool children referred to a tertiary clinic between the ages of 2 and 6 years. It was hypothesized that children under the age of 4 years at first assessment and children with less severe initial deficits would show less stability of DLD diagnosis.

METHODS & PROCEDURES

The clinical files of children referred to an early childhood psychiatric clinic in Canada were reviewed. For 149 children with two SLPs assessment reports, persistence of language deficits was documented and tested with McNemar's statistics. Differences between preschoolers under the age of 4 versus 4 years and over, as well as between mildly and severely impaired children, were examined.

OUTCOMES & RESULTS

High level of agreement (94%) and McNemar's test (p = 0.180) supported the stability of initial diagnosis. The stability for children assessed before the age of 4 (n = 64) was 100%, and was significantly different from older children's (n = 85) stability of 89% (Fisher's exact test, p = 0.01; bilateral). The stability for children with mild impairments (n = 18) was 78%, which was significantly lower than the stability (97%) in children with severe impairments (n = 114) (Fisher's exact test, p = 0.007; bilateral).

CONCLUSIONS & IMPLICATIONS

No instability of language status was observed in children assessed before 4 years of age, which could be related to the significant severity of the difficulties that children in this age group presented and be specific to this type of clinical sample. The great stability of language status observed in preschoolers referred to a specialized clinic suggests that clinicians should limit reassessments to devote available resources to intervention efforts.

WHAT THIS PAPER ADDS

What is already known on this subject? Previous research that has demonstrated important instability in the classification of language impairment before 4 years of age gathered data mainly by screening the general population or was not based on a comprehensive clinical assessment. What this paper adds to existing knowledge? This study investigated the classification stability of DLD between two comprehensive SLP assessments in a clinical sample of Canadian preschoolers. The results indicate great stability of language status assessed before 4 years old in this population, suggesting that severity of impairments may trump the age factor in this group. What are the potential or actual clinical implications of this work? In the case of children referred to a specialized clinic, clinicians and policymakers should be aware that DLD diagnosis made before 4 years of age remains stable during preschool age, and that a best practice with this population would be to abandon unnecessary testing in favour of early intervention.

Individual and cumulative risk factors in developmental language disorder: A case-control study

Many mental disorders (MD) share common etiology, fuelling debates about the specificity of clinical categories and whether the presence of specific risk factors (RF) can distinguish among them. The study of developmental language disorder (DLD), more specifically, has been further hindered by a lack of consensus regarding its definition. These limitations increase the risk of under-detection and lifelong consequences for affected children. This paper aims (1) to document which individual RF allow differentiating DLD from other MD and (2) to compare the cumulative RF between children with DLD versus other MD. This case-control design study used medical records of a psychiatric sample of 795 preschoolers (mean age 4:11, 75% boys). A logistic regression measured the predictive value of potential RF on DLD. Later first sentences, maternal immigration and family history of language delay were identified as significant in explaining 30% of the variance for DLD diagnosis. An ANCOVA revealed that children with DLD were exposed to a significantly higher number of RF than were children with other MD. Public health policies informed with the knowledge of specific RF associated with DLD, and their cumulative impact, could improve early detection and reduce the cascade of negative consequences associated with DLD.

Sleep patterns and intraindividual sleep variability in mothers and fathers at 6 months postpartum: a population-based, cross-sectional study

OBJECTIVES

Given that postpartum sleep is an important family process, further investigations including both mothers and fathers are necessary. The present study aimed to describe and compare sleep patterns and intraindividual night-to-night variability in mothers and fathers at 6 months postpartum using subjective and objective sleep measures.

DESIGN

Cross-sectional study.

SETTING

General community-based study in Montreal, QC, Canada.

PARTICIPANTS

Thirty-three couples (mothers and fathers) with no self-reported history of medical and mental health conditions participated in this study.

RESULTS

Parental sleep was measured across 10 consecutive nights using both a daily sleep diary and actigraphy. Results demonstrated that mothers' subjective and objective sleep was more fragmented compared with fathers (shorter longest consecutive sleep duration and more nocturnal awakenings; p<0.001). While mothers and fathers did not differ in their self-reported nocturnal sleep duration (p>0.05), actigraphy indicated that mothers obtained significantly longer nocturnal sleep duration (448.07 min±36.49 min) than fathers (400.96 min±45.42 min; p<0.001). Intraindividual sleep variability was revealed by relatively high coefficients of variation for parents across both subjective and objective indices related to sleep fragmentation (between 0.25 and 1.32). Actigraphy also demonstrated variability by mothers sleeping 6 hours consecutively on less than 3 nights, 27.27% (±22.81), and fathers on less than 6 nights, 57.27% (±24.53), out of 10. Associations were also found between parental sleep and family factors, such as age and infant sleep location (p<0.05).

CONCLUSIONS

These findings advance our knowledge of how sleep unfolds within the family system beyond the early postpartum weeks and/or months. Given the link between disturbed sleep and family functioning, the current research accentuates the importance of examining postpartum sleep patterns and variability in parents.

Comparison of the Wechsler Preschool and Primary Scale of Intelligence-Third Edition and the Leiter-R Intellectual Assessments for Clinic-Referred Children

A review of clinical records was conducted for children with developmental, emotional, and behavioral difficulties who were assessed with both the Wechsler preschool and primary scale of intelligence-third edition (WPPSI-III^CDN; Wechsler, 2004) and the Leiter international performance scale-revised (Leiter-R; Roid & Miller, 1997) within the same psychological evaluation. Forty children, ages 3–7, were included in this study. Pearson correlations showed that the IQ scores of the two instruments are strongly related (r > .70; p < .001). However, paired t-tests showed that overall Leiter-R scores (M = 99.03) were significantly higher than WPPSI-III^CDN scores (PIQ; M = 82.28, FSIQ; M = 75.24) (p < .001). The discrepancies between the instrument’s scores were clinically important as the use of only one of the two instruments could result in misclassification of child intellectual ability. These results should prompt professionals working with this clinical population to be cautious when using results from a single instrument in a child’s intellectual evaluation.

Family alliance as a developmental antecedent of depressive and anxiety symptoms in early adolescence: Friendship quality as a mediating factor

Family interactions constitute a critical context in which children can learn the basic relational skills that they need to make friends. In turn, friendship quality is a robust predictor of child socioemotional functioning. Therefore, friendship is likely to act as a bridge in a socioemotional developmental cascade linking early family interactions to child subsequent socioemotional adjustment. This study aimed to examine a mediation model linking family alliance (the degree of mother-father-child engagement and coordination in joint activities) in kindergarten to anxiety and depressive symptoms in early adolescence through the mediating role of friendship quality in middle childhood. The family alliance of 87 mother-father-child triads was assessed when children were aged 6 years based on a 15-min videotaped interaction. Children reported on the quality of their relationship with their best friend at age 10 and on their anxiety and depressive symptoms at both 12 and 13 years (averaged). Results showed that children who experienced better family alliance at 6 years had higher relationship quality with their best friend at 10 years which in turn, predicted less anxiety (but not depressive) symptoms in early adolescence. There was a significant indirect effect of family alliance on anxiety through friendship quality. Findings suggest that family alliance may play a central role in shaping children's capacity to develop high-quality friendships, with implications for their subsequent socioemotional functioning. Further longitudinal studies are needed to examine the reciprocal influences unfolding over time that are likely to characterize developmental cascades among family systems, children's developing friendships, and their socioemotional functioning.

Perception of infant sleep problems: the role of negative affectivity and maternal depression

STUDY OBJECTIVES

To investigate whether the interaction between infant negative affectivity and maternal depressive symptoms is associated with the degree to which mothers perceive infant sleep to be problematic at 6 months postpartum, independent of infant sleep and sociodemographic factors.

METHODS

Infant negative affectivity and maternal depressive symptoms were assessed in a sample of 59 mother-infant dyads at 6 months postpartum using standardized measures. Mothers reported the degree to which they perceived their infant's sleep to be problematic via an item composite of the Sleep Practices Questionnaire. Nocturnal infant sleep variables (duration, number of awakenings) were retrieved from a 2-week infant sleep diary (maternal report).

RESULTS

There was a significant interaction between infant negative affectivity and maternal depressive symptoms in predicting mothers' perceived extent of infant sleep problems. Simple slope analysis showed that high levels of depression were related to higher maternal perception of infant sleep problem scores only among mothers of infants with high levels of negative affectivity. Moreover, infant negative affectivity and maternal depressive symptoms positively predicted perception scores after adjustment for infant sleep, maternal age, and parity (P < .05).

CONCLUSIONS

The current study provides evidence that high levels of maternal depression combined with high levels of infant negative affectivity may contribute to mothers' perceptions of infant sleep problems, independent of infant sleep duration and awakenings. These findings highlight the importance for pediatricians and other health professionals to consider infant temperament in conjunction with mothers' depressive symptoms when addressing mothers' concerns about infant sleep problems.

Investigating the link between sleep and postpartum depression in fathers utilizing subjective and objective sleep measures

Background

While fathers are at risk of developing poorer sleep and depressive symptoms in the postpartum period, they represent an understudied population in the literature. The present study aimed to explore the association between sleep and postpartum depressive symptoms in fathers using subjective and objective sleep measures.

Methods

Fifty-four fathers reporting no history of depression took part in this cross-sectional study. At 6 months postpartum, paternal sleep was assessed for 2 weeks utilizing a self-report daily sleep diary, a self-report perceived sleep quality rating, and actigraphy. In the same period, depressive symptoms in fathers were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D).

Results

Regression analyses showed that paternal subjective sleep variables captured by the sleep diary (total nocturnal sleep time and number of night awakenings) were not related to postpartum depressive symptoms. However, self-reported perceived sleep quality was significantly associated with postpartum depressive symptom severity in fathers independently of demographic variables related to depression. Alternatively, the objective sleep variables (total nocturnal sleep time, number of night awakenings, sleep efficiency, and wake after sleep onset), measured by actigraphy, did not demonstrate a significant relationship with paternal depression scores.

Conclusions

These findings highlight the importance of perceived sleep quality, along with better understanding its association with postpartum depressive symptoms. Implementing a multi-measure approach enabled us to expand our knowledge about how different facets of sleep relate to postpartum depression, specifically in fathers. The results have important implications for the development of clinical interventions targeting paternal sleep and mood in the postpartum period.

Mothers' and fathers' sleep: Is there a difference between first-time and experienced parents of 6-month-olds?

Sleep disruption and deprivation are highly prevalent among parents of an infant. However, most postpartum sleep studies focus solely on mothers, and few studies have investigated whether sleep differs between first-time and experienced parents. The present study aimed to determine whether self-reported sleep duration and quality differ between first-time and experienced mothers and fathers during the postpartum period. A total of 111 parents (54 couples and three single mothers) of 6-month-old infants completed a 2-week sleep diary to evaluate measures of sleep duration, sleep continuity, and sleep quality. An analysis of covariance model was used to compare the sleep variables of first-time to experienced parents. Breastfeeding frequency, infant sleep location, depression, education, and work status were used as co-variables. First-time mothers reported a longer consecutive nocturnal sleep duration (mean [SEM] 297.34 [17.15] versus 246.01 [14.79] min, p < .05), fewer nocturnal awakenings (mean [SEM] 1.57 [0.20] versus 2.12 [0.17], p < .05), and rated their sleep quality higher (mean [SEM] score 7.07 [0.36] versus 5.97 [0.30], p < .05) than experienced mothers, while total nocturnal sleep duration did not differ. There were no differences in subjective sleep measures between first-time and experienced fathers. The present study indicates that experienced mothers reported more fragmented sleep and perceived having worse sleep quality than first-time mothers, but that paternal sleep did not differ as a function of parental experience. These findings have clinical implications for healthcare professionals working with families of various configurations and sizes.

Sleeping through the night or through the nights?

OBJECTIVE

There are substantial inter-individual differences in infants' longest consecutive sleep duration. However, intra-individual differences are rarely considered. The present study aimed to describe night-to-night variability in achieving 6 or 8 h of consolidated sleep over a 13-night period in 6-month-old infants.

METHODS

Forty-four typically developing infants were part of the study (22 girls). When infants were 6 months old, mothers were asked to complete an infant sleep diary over 13 nights to measure the longest period of uninterrupted sleep each night. Two criteria were used to determine if infants were sleeping through the night: 6 and 8 h of uninterrupted sleep.

RESULTS

On average, mothers reported that their infant slept 6 h consecutively for about 5 nights out of 13. Nine infants (20.5%) never slept 6 h consecutively, three (6.8%) met the criterion every night, but most infants (n = 32; 72.7%) showed high variability between the nights. Mothers reported that their infant slept 8 h consecutively for about 3 nights out of 13. Half of the infants (50.0%) never slept 8 h consecutively, one infant (2.3%) slept 8 h consecutively every night, and twenty-one infants (47.7%) showed high variability.

CONCLUSIONS

These findings expand current knowledge by showing that there is not only high inter-individual variability, but also high intra-individual variability in infant sleep consolidation. Parents and clinicians should be aware that occasional sleeping through the night does not necessarily indicate a consolidation of this behavior.

Sleep Difficulties in Preschoolers with Psychiatric Diagnoses

Background: Sleep problems among preschoolers are highly prevalent. Given the impact of poor sleep quality on development, this relationship is particularly relevant in vulnerable populations but is less documented. This study aims to document parental perception of sleep problems in preschoolers assessed in a psychiatric clinic, as a function of diagnosis type. Methods: Children (14-71 months, n = 228) were evaluated by a psychiatrist, and diagnoses were pooled into four categories: behavioral disorders, relational disorders/psychosocial problems, developmental coordination disorder (DCD), and communication disorders. Sleep problems were measured using the Child Behavior Checklist (CBCL). Results: In this clinical sample of preschoolers, 21.6% of children were identified as having a sleep problem by their parents. Behavioral disorders and communication disorders were associated with increased parental report of sleep problems (respectively, trouble falling asleep and nighttime awakenings), while DCD was associated with lower parental report of sleep problems (fewer nighttime awakenings and less difficulty falling asleep) (p < 0.05). Relational disorders were not associated with parental reports of sleep difficulties (p > 0.05). Moreover, some psychiatric categories were associated with specific sleep symptoms (such as difficulty falling asleep and night awakenings). Conclusion: Parents of preschoolers with behavioral disorders and communication disorders are more likely to report sleep problems in their children than parents of preschoolers with DCD and relational disorders. Since different categories of psychiatric disorders are associated with specific types of sleep complaints, screening, and treatment should be adapted accordingly.

Resolution of diagnosis and parental attitudes among parents of adolescent kidney recipients

The diagnosis of a chronic illness is described as an upsetting event that implies an emotional crisis for parents. Some are able to come to terms with their child's chronic condition and feel a sense of resolution, but for others, strong negative emotions persist through time. The present study examines diagnostic resolution among parents of teenagers with a transplant. The design was qualitative and involved individual interviews with nine parents. Five were donor to their child. Data were analyzed according to the principles of IPA. Early reactions to the diagnosis suggest that parents with an unresolved status experienced trauma. Many factors seem to contribute to diagnostic resolution such as good communication between spouses, positive relationship with the medical staff, and being the parent donor. For all parents, concerns over adherence are central to their relationship with their youth. Results call attention to the support needs of all parents and particularly those with an unresolved status.

Behavior problems of children in foster care: Associations with foster mothers' representations, commitment, and the quality of mother-child interaction

This study investigated different environmental and contextual factors associated with maltreated children's adjustment in foster care. Participants included 83 children (52 boys), ages 1-7 years, and their foster caregivers. Quality of interaction with the foster caregiver was assessed from direct observation of a free-play situation; foster caregiver attachment state of mind and commitment toward the child were assessed using two interviews; disruptive behavior symptoms were reported by foster caregivers. Results showed that quality of interaction between foster caregivers and children were associated with behavior problems, such that higher-quality interactions were related to fewer externalizing and internalizing problems. Foster caregivers' state of mind and commitment were interrelated but not directly associated with behavior problems of foster children. Type of placement moderated the association between foster caregiver commitment and foster child behavior problems. Whereas greater foster caregiver commitment was associated with higher levels of adjustment for children in foster families (kin and non-kin), this was not the case in foster-to-adopt families. Finally, the associations between foster child behavior problems and history of maltreatment and placement related-risk conditions fell below significance after considering child age and quality of interaction with the foster caregiver. Findings underscore the crucial contribution of the foster caregiver-child relationship to fostering child adjustment and, thereby, have important implications for clinical services offered to this population.

Links between children's attachment behavior at early school-age, their attachment-related representations, and behavior problems in middle childhood

The objective of the present study was to examine associations between children's attachment behavior at early school-age, dimensions of narrative performance, and behavior problems as assessed in middle childhood. Children's attachment patterns with mother were assessed at age 6 ( N = 127) using the Main and Cassidy (1988) separation—reunion classification system. Two years later, these children ( N = 109) completed the Narrative Story Stem Battery (Bretherton, Oppenheim, Buchsbaum, Emde, & The MacArthur Narrative Group, 1990), and teachers rated their level of behavior problems using the Social Behavior Questionnaire (Tremblay, Vitaro, Gagnon, Piché, & Royer, 1992). Results indicated that secure children depicted fewer conflict themes in their narratives than did disorganized/controlling children, produced more discipline themes than avoidant children, and had higher coherence scores than ambivalent children. Avoidant children also depicted fewer conflict themes than disorganized/controlling children. Finally, children's narrative conflict themes significantly predicted both level of externalizing and total behavior problems, even after controlling for variance explained by gender and disorganized/controlling attachment behavior. Girls' narratives were more likely to evoke discipline and affection/affiliation themes, and to be more coherent than boys' narratives.