The health of mothers caring for a child with a disability: a longitudinal study

BACKGROUND

Raising a child with disabilities requires a significant parental investment that is greater than that required by typically developing children. Previous studies have shown that parents caring for a child with a disability experience a range of health problems, particularly the mothers. However, few of these studies have controlled for maternal health prior to birth.

METHODS

This study used a sample from the Norwegian administrative register that comprised all children born between 2009 and 2015. We followed the mothers and their children for 11 years, between 2009 and 2019. The outcome variable was the mothers' physical and mental health, which was assessed using specific ICD-10 diagnoses recorded in the Norwegian Patient Register (NPR). The data included information on the mothers' health before and after the birth of their first child, enabling us to control for maternal health prior to birth in our analysis, in addition to socio-demographic characteristics. The analyses of maternal health were performed using multiple logistic regression, and the results are presented on both a relative scale (odds ratio [OR]) and an absolute scale (average marginal effect [AME]), both with 95% confidence intervals.

RESULTS

Mothers caring for a child with a disability have higher odds of having a diagnosis of a musculoskeletal disorder, depression, anxiety, sleeping disorder or migraines than mothers of children without a disability. The differences between the two groups of mothers decrease after adjusting for the characteristics of the children, mothers and families, but remain significant for musculoskeletal disorder, depression, anxiety and sleeping disorder, although the absolute differences are modest.

CONCLUSION

The findings suggest that mothers caring for a child with a disability are more likely to have health problems than mothers of children without a disability after controlling for maternal health prior to birth. Providing more support for mothers of children with a disability might help to improve their health.

Educational achievement among children with a disability: do parental resources compensate for disadvantage?

We examined the impact of child disability on Grade Points Average (GPA) using all children aged 15-16 years who completed their lower secondary education and registered with a GPA score in the period from 2016 to 2020 in Norway (n = 247 120). We use registry data that contain information on the child's main diagnosis, such as physical-, neurological- and neurodevelopmental conditions, and the severity of the condition, additional to the child's family characteristics. First, we examined whether the impact of the child's disability on the GPA scores varied by diagnosis and the severity of the child's condition. Second, we examined whether higher parental socioeconomic status (SES) buffers against the negative impact of child disability on GPA scores. Using longitudinal register data with the school fixed-effect model, the results showed that children with neurological and neurodevelopmental disabilities obtained lower GPA scores than their typically developing peers without chronic conditions, however children with asthma and diabetes had comparable GPA scores. These associations were most evident for neurodevelopmental conditions, such as ADHD and autism but also notable for neurological conditions such as epilepsy. In general, a severe condition impacts GPA scores more negatively than a less severe condition. Moreover, our analysis revealed that children of highly educated parents obtained higher GPA scores than children who had parents with short education. This applied to both disabled and typically developing peers, except children with autism and epilepsy, among whom buffering due to the parent's education did not seem to apply.

Income and conversion handicaps: estimating the impact of child chronic illness/disability on family income and the extra cost of child chronic illness/child disability in Ireland using a standard of living approach

Child chronic illness/ disability can present significant challenges for children, families and society that require appropriate policy responses; yet little is known about the demands placed on families resources from an economics perspective in terms of its impact on household income and the extra income required to achieve the same standard of living as families who do not have a child with a chronic illness/disability. The paper uses data from the Growing Up in Ireland National survey dataset for nine year olds. It is the first study to empirically investigate the impact of child chronic illness/disability on earnings, standard of living and the extra cost of disability together. It is also the first study to explicitly address endogeneity in the standard of living model by using a two-stage process where residuals were harvested to provide efficient estimates. The findings show that families experience significant disadvantage and economic hardship due to reduced household income and a lower standard of living due to the extra cost of disability that would require considerable income to compensate. Policy implications of these findings suggest that a tiered approach to disability support payments which encompass broader criteria for inclusion based on varying severity levels be introduced to alleviate the financial hardship and compromised economic wellbeing of families affected. In addition, more innovative policies are required to implement appropriate timely access to health and social care services and flexi parental employment, which in turn requires the provision of adequate access to high quality educational and care facilities.

Measuring child functioning: Assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge health and demographic surveillance site in Uganda

INTRODUCTION

Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning.

OBJECTIVE

To assess correlation and agreement between children (11-17 years old) and their caregivers' responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda.

METHODS

CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed.

RESULTS

Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach's alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman's rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs.

CONCLUSION

This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

Patient and public involvement of young people with a chronic condition: lessons learned and practical tips from a large participatory program

PLAIN ENGLISH SUMMARY

BackgroundYoung people with a chronic condition are increasingly involved in doing research and developing tools and interventions that concern them. Working together with patients is called Patient and Public Involvement (PPI). We know from the literature that PPI with young people with a chronic condition can be challenging. Therefore, it is important that everyone shares their lessons learned from doing PPI.AimWe want to share our lessons learned from a large program, called Care and Future Prospects. This program helps young people with a chronic condition to, for example, go to school or to find a job. It funded numerous projects that could contribute to this. In all projects, project teams collaborated with young people with a chronic condition.What did we doWe asked young people with a chronic condition and project teams about their experiences with PPI. Project teams wrote reports, were interviewed, and filled out a tool called the Involvement Matrix. Young people filled out a questionnaire.FindingsIn the article, we present our lessons learned. Examples are: it is important to involve young people with a chronic condition from the start of a project and everyone involved in a project should continuously discuss their responsibilities. We provide practical tips on how young people with a chronic condition and project teams can do this. A tip for young people is, for example: 'discuss with the project team what you can and want to do and what you need'. An example of a tip for project teams is: 'Take time to listen attentively to the ideas of young people'.

ABSTRACT

BackgroundThe Patient and Public Involvement (PPI) of young people with a chronic condition receives increasing attention in policy and practice. This is, however, not without its challenges. Consequently, calls have been made to share lessons learned during PPI practice.MethodsWe share our lessons learned from a large participatory program, called Care and Future Prospects. This program aims to improve the social position of young people aged 0-25 with a physical or mental chronic condition by funding participatory projects. We have drawn our lessons from 33 of these projects, using four data sources. One data source provided information from the perspective of young people with a chronic condition, i.e. questionnaires. Three data sources contained information from the perspectives of project teams, i.e. project reports, case studies of projects and Involvement Matrices. For most of the projects, we have information from multiple data sources.ResultsWe have combined the findings derived from all four data sources. This resulted in multiple lessons learned about PPI with young people with a chronic condition. Those lessons are divided into six themes, including practicalities to take into account at the start, involvement from the start, roles and responsibilities, support, flexibility and an open mind, and evaluation of process and outcomes.ConclusionsThe lessons learned have taught us that meaningful PPI requires effort, time and resources from both young people and project teams, from the beginning to the end. It is important to continuously discuss roles and responsibilities, and whether these still meet everyone's needs and wishes. Our study adds to previous research by providing practical examples of encountered challenges and how to deal with them. Moreover, the practical tips can be a valuable aid by showing young people and project teams what concrete actions can support a successful PPI process.

Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda

BACKGROUND

The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda.

METHODS

This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form.

RESULTS

Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all."

CONCLUSION

CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

Assessment of parental nurturing and associated social, economic, and political factors among children in the West Bank of the occupied Palestinian territory (WB/oPt)

Background

Parental nurturing expressed through love and affection is a broad concept that entails caring for children and their activities, encouraging them and praising their achievements. Lack of love and affection makes children more susceptible to psychological problems such as stress, anxiety and depression across their life time. This study aims to evaluate parental nurturing and associated social, economic, and political factors among Palestinian children living in the West Bank (WB).

Methods

Secondary data representative of the Palestinian children living in the WB was used to estimate parental nurturing for children aged 0–12 years as reported by their mothers. Univariate and bivariate analyses were conducted, followed by multivariate analysis for all predictors found significant in the bivariate analysis using SPSS® version 20.

Results

19.90% (231/1162) of children experienced low levels of parental nurturing. No statistically significant differences were detected by the child’s gender. Children with high levels of parental nurturing were those aged 0–6 years, children who were last in the family index, children with no disability, children exposed to low to medium levels of disciplinary methods, children from urban areas, children living in North WB, and children whose families were not subjected to political violence.

Conclusions

Overall, Palestinian mothers reported high levels of parental nurturing towards their children. However, about one-fifth of Palestinian children are at risk of experiencing low levels of parental nurturing. Efforts should be placed in addressing the health and welfare needs of these high-risk children’s groups.

Changes in the health of mothers of children with neurodevelopmental disabilities: An administrative data study

BACKGROUND

Using linked administrative health data, this study compared the health and healthcare service utilization between mothers of children with and without neurodevelopmental disabilities (NDD), before, during, and after the birth of a child.

METHODS

The population (N = 25,388) was based on a cohort of children born in 2000 and who were, along with their mothers, continuously registered with the British Columbia's universal health insurance program between 2000 and 2007.

RESULTS

Compared to mothers of children without NDD, mothers of children with NDD were more likely to have chronic conditions and higher service utilization before child birth. Mothers of children with NDD showed a smaller increase in physician visits in the year before birth but a greater increase in different prescription drugs in the year after birth. There was no further divergence (or convergence) in health and service utilization between the groups in the 7-year period post-birth.

CONCLUSIONS

Differences in health and healthcare service utilization between mothers of children with and without NDD existed before the birth of the child and did not diverge in the 7 years post-birth. Replication of these findings is warranted as well as follow-up analyses examining longer term outcomes for mothers beyond 7 years post-birth.

Identification of phonological processes in Arabic-speaking Egyptian children by single-word test

PURPOSE

Phonological processes are systematic changes in sound classes, sound sequences or syllable structure. The aim of this study was to develop an assessment tool for identification of developmental phonological processes in Arabic-speaking Egyptian children in order to provide normative data of phonological processes in typically developing children and distinguish between normal children and children with phonological impairment.

METHOD

The study design was a cross-sectional descriptive one. Mansoura Arabic Test for Phonological Processes (MATPP) was developed to elicit children's single-word productions through picture naming task. After being pilot-tested, the MATPP was presented to a group of 120 typically developing children in the age range 2-5 years and another group of 30 children with developmental language disorder (DLD) in the age range 2½ - 5years for test validation.

RESULTS

Assimilation processes were the commonest phonological processes followed by syllable structure processes and substitution processes. In contrast to English language, prevocalic devoicing, backing of fricatives and glottal replacement were considered normal for Egyptian children. The face validity was demonstrated by judging all words of the MATPP for being completely relevant to the purpose for which it was meant and Criterion -related validity was demonstrated by higher scores of the DLD children in all phonological processes. MATPP presented test-retest reliability when re-administered by the same examiner or a different examiner to the same child within a two week interval.

CONCLUSION

MATPP is a valid and reliable assessment tool for identification of phonological processes in Arabic-speaking Egyptian children and can differentiate typically developing children from those with a phonological impairment.

Cultural models of child disability: perspectives of parents in Malaysia

Background: This study examined parents' developmental concerns for their children within the context of systems of care in Malaysia. Methods: Focus groups and interviews were conducted in peninsular Malaysia and Borneo. Results: Parents' perceptions of developmental delay stemmed from three sources: the cultural, resource, and the social environments. Conclusion: There is a need to develop a medical support system in Malaysia that considers a life-course perspective, including prenatal care, screening/diagnosis, and services. This system should embrace a family-centered approach to diagnosis, referral, intervention, and support with sensitivity to cultural beliefs, family preferences, and barriers to care. Implications for Rehabilitation Parental perceptions of disability affect the strategies they use to cope. This research found that cultural conceptions of disability, available resources, and social support affect parental perceptions of disability. The resource environment in Malaysia significantly restricts parents' ability to cope with their child's disability. This research recommended that the medical system of Malaysia develops a life-course perspective to disability to provide a range of care for children with disabilities including prenatal care, screening and rehabilitation or coping services.

Using compensating variation to measure the costs of child disability in the UK

The objective of disability policy is to create a society where people with disabilities and their families enjoy an equal standard of living to those without disabilities, though evidence to underpin policy is sparse. We defined the compensating variation (CV) of child disability as the amount of additional income a family with a disabled child would require to achieve the same living standards as a similar family without a disabled child. The aims of this study were to estimate the CV for child disability and to explore how this varied for different levels of disability and reference levels of living standards. Using data on 54,641 families from the Family Resources Survey (2004-2012), we matched families with (cases) and without (controls) a disabled child on family and child characteristics plus living standards and calculated the income difference inclusive of disability benefits. Our findings suggest that across families with the most disabled children, a compensating variation equal to an extra £56-£79 a week was required to achieve the same living standards as matched families without a disabled child compared with the mean level of state disability benefit £47-£71 a week in this group.

Recognizing Maternal Depressive Symptoms: An Opportunity to Improve Outcomes in Early Intervention Programs

Objective A higher rate of depressive symptoms is found among mothers of children with disabilities compared to other parents. However, there is a lack of study of mothers with children <3 years of age participating in Early Intervention (EI) programs. This study aims to more fully describe the extent of mood disorders in these mothers including estimated prevalence, severity and factors associated with maternal mental health, using gold standard clinical diagnostic and symptom measures, and test models associating depressive symptoms with contextual factors and child behavior. Methods A cross-sectional study was conducted with 106 women who had at least one child enrolled in EI. Mothers were interviewed and completed reliable, valid measures to evaluate mental health, health status, family conflict, parent-child interaction, self-efficacy, social support, child behavioral problems, hardship, endangerment, and child disability. Descriptive statistics and multivariate analyses were performed. Results We found 8 % of participants met all criteria for a Major Depressive Episode (MDE) with 44 % of the sample reporting a past episode and 43 % endorsing recurrent episodes. Using the CES-D to assess depressive symptom severity approximately 34 % of mothers screened in a clinically significant range. Using linear regression to predict severity of current depressive symptoms demonstrated that current depression severity was primarily predicted by poorer maternal health status, lower self-efficacy and past MDE (p < 0.05). Conclusions for practice A brief assessment of maternal mood, health and self-efficacy are important factors to assess when evaluating how to support mothers of children in EI.

Validating the UNICEF/Washington Group Child Functioning Module for Fijian schools to identify seeing, hearing and walking difficulties

PURPOSE

This study investigated the seeing, hearing and walking questions of the UNICEF/Washington Group Child Functioning Module and the inter-rater reliability between teachers and parents as proxy respondents.

METHODS

Cross-sectional diagnostic accuracy study, two-gate design with representative sampling, comparing Module responses to reference standard assessments for 472 primary aged students in Fiji. Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cut-off points.

RESULTS

Areas under the curves ranged from 0.823 to 0.889 indicating "good" diagnostic accuracy. Inter-rater reliability between parent and teacher responses was "good" to "excellent". The optimal cut-off determined by the Youden Index was "some difficulty" however a wide spread of impairment levels were found in this category with most children either having none or substantial impairments.

CONCLUSIONS

The diagnostic accuracy of the Module seeing, hearing and walking questions appears acceptable with either parents or teachers as proxy respondents. For education systems, use of the cut-off "some difficulty" with accompanying clinical assessment may be important to capture children who require services and learning supports and avoid potentially misleading categorization. Given the high proportion of the sample from special schools research is required to further test the Module in mainstream schools. Implications for rehabilitation Identification of children who are at risk of disability in Fiji is important to enable planning, monitoring and evaluating access to quality inclusive education. The UNICEF/Washington Group Child Functioning Module appears to be a practical and effective tool that can be used by teachers to identify children at risk of disability. Children identified on the UNICEF/Washington Group Child Functioning Module as having "some difficulty" or higher levels of difficulty in relation to vision, hearing or walking should be referred for further assessment and services. Rehabilitation services in Fiji need to prepare for greater numbers of referrals as the Ministry of Education increasingly rolls out the inclusive education policy, which includes identification by schools of children at risk of disability.

The Trauma of Birth or Parenting a Child: Effect on Parents' Negative Emotion in China

The present study assessed negative emotions associated with the traumas of infertility and child rearing (child's disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.

Language and cognitive outcome for high-risk neonates at the age of 2-3 years - experience from an Arab Country

AIM

To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities.

METHODS

This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations. The studied children were subjected to a protocol of language assessment that included history taking, clinical and neurological examination, audiological evaluation, assessment of language using modified preschool language scale-4, IQ and mental age assessment and assessment of social age.

RESULTS

The studied children had a median gestational age of 37 wk, median birth weight of 2.5 kg. The distribution of the high-risk factors in the affected children were prematurity in 25 children, respiratory distress syndrome in 25 children, hypoxic-ischemic encephalopathy in 15 children, hyperbilirubinemia in 10 children, hypoglycemia in 13 children, mixed risk factors in 15 children. The results revealed that high-risk neonatal complications were associated with impairment of different language parameters and cognitive abilities (P < 0.05). The presence of prematurity, in relation to other risk factors, increases the risk of language and cognitive delay significantly by 3.9 fold.

CONCLUSION

Arabic-speaking children aged 2-3 years who were exposed to high-risk conditions in the perinatal period are likely to exhibit delays in the development of language and impairments in cognitive abilities. The most significant risk factor associated with language and cognitive impairments was prematurity.

Exploring neurodevelopmental outcome measures used in children with cerebral malaria: the perspectives of caregivers and health workers in Malawi

Background

Progress has been made in tackling malaria however there are still over 207 million cases worldwide, the majority in children. As survival rates improve, numbers of children with long-term neurodisabling sequelae are likely to increase. Most outcome studies in cerebral malaria (CM) have focused only on body function and structure and less on outcomes within the broader framework of the International Classification of Functioning and Disability (ICF). The aim of this study was to utilise qualitative methods to identify relevant clinical outcomes in CM to support formulation of a core outcome set relevant to CM and other acquired brain injuries for use in future clinical trials.

Methods

In depth interviews with parent/caregivers (CGs) of children with/without previous CM (N = 19), and in depth interviews with health professionals (N = 18) involved in their care were conducted in community and clinical settings in and around Blantyre, Malawi. Interviews were audio taped, transcribed, translated and a thematic content analysis was conducted. Themes were categorised and placed firstly in an iterative framework derived from the data but then within the ICF framework.

Results

Outcomes perceived as important to carers and professionals fulfilled each level of the ICF. These included impairment in body function and structure (contractures, impaired mobility, visual problems, seizures, cognitive function and feeding); activity and participation outcomes (learning, self-care, relationships in school, play and activities of daily living). Other issues emerging included the social and emotional implications of CM on the family, and balancing care of children with neurodisability with demands of daily life, financial pressures, and child protection. Themes of stigma and discrimination were described; these were perceived to negatively influence care, participation and integration of carer and child into the community.

Conclusions

Outcomes considered important for parents/caregivers and professionals working with children post CM cross all aspects of the ICF framework (impairment, functioning and participation). Outcomes emphasised by families and carers in cross-cultural settings must be given adequate attention when conducting clinical studies in these settings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-016-0763-y) contains supplementary material, which is available to authorized users.

Field testing a draft version of the UNICEF/Washington Group Module on child functioning and disability. Background, methodology and preliminary findings from Cameroon and India

Background

Global child disability data are generally non-comparable, comprising different tools, methodologies and disability definitions. UNICEF and The Washington Group on Disability Statistics (WG) have developed a new tool on child functioning and disability to address this need.

Aims

The aim of this paper is to describe the development of the new module, and to present an independent field test of the draft module in two contrasting settings.

Methods

UNICEF and the WG developed a parent-reported survey module to identify children aged 2-17 years with functional difficulties in population-based surveys through: review of existing documentation, consultation with experts and cognitive testing. A field test of the draft module was undertaken in Cameroon and India within a population-based survey. Functional limitation in each of 14 domains was scored on a scale comprising "no difficulty", "some difficulty", "a lot of difficulty" and "cannot do".

Results

In all, 1713 children in Cameroon and 1101 children in India were assessed. Sixty-four percent of children in Cameroon and 35% of children in India were reported to have at least some difficulty in one or more domain. The proportion reported to have either "a lot of difficulty" or "cannot do" was 9% in Cameroon and 4% in India. There were no significant differences in reported functional difficulties by sex but children aged 2-4 were reported to have fewer functional difficulties of any kind compared with older children in both countries.

Conclusion

Comparable estimates were generated between the two countries, providing an initial overview of the tool's outputs. The continued development of this standardised questionnaire for the collection of robust and reliable data on child disability is essential.

Daily life changes and adaptations investigated in 154 families with a child suffering from a rare disability at a public centre for rare diseases in Northern Italy

BACKGROUND

Living with a disabled child has profound effects on the entire family. With a prevalence of developmental disabilities around 2,5 %, there is a considerable need to promote improvements in the health care system. Little is known about changes and adaptations in the lives of affected families and this paucity of information hinders the improvement of services. This study sought to explore the needs and changes in the everyday life of families with children suffering from rare diseases of varying severity, with and without mental disability. The aim was to measure the socio-demographic characteristics, health care problems and living conditions of a large cohort of families with an affected member.

METHODS

A sample of 154 families was recruited between September 2011 and April 2013 to respond to a 136 item questionnaire that explored different areas of concern (diagnosis and follow-up of clinical specialists, relationship with pediatrician, rehabilitation, school, work, institutional and/or private support, child care needs and family relationships).

RESULTS

All parents answered the questionnaire. They were satisfied with the services provided in particular for diagnosis and follow-up, relationships with the family pediatrician, rehabilitation services and school, regardless of the severity of condition, presence of intellectual disability (ID) or absence of diagnosis. Negative scores were reported for institutional and/or private support and family relationships in severe conditions.

CONCLUSIONS

The Health Care System should maintain a family-centered care and a multi-agency working, improving quality of life of families with disabled child to allow adaptation. At present these services are uncoordinated and financial support is poor, resulting in a heavy burden for these families.

Evaluating the diagnostic accuracy of Arabic SNAP test for children with hypernasality

Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test.

OBJECTIVES

to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children.

METHODS

Nasalance scores of normal children (n=92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity.

RESULTS

Statistically significant differences were found between both groups for all items in nasometric evaluation (p<0.05) except for prolonged/m/sound (p>0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation.

CONCLUSION

The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

The nature of articulation errors in Egyptian Arabic-speaking children with velopharyngeal insufficiency due to cleft palate

Even with early surgical repair, the majority of cleft palate children demonstrate articulation errors and have typical cleft palate speech.

OBJECTIVE

Was to determine the nature of articulation errors of Arabic consonants in Egyptian Arabic-speaking children with velopharyngeal insufficiency (VPI).

SUBJECTS AND METHODS

Thirty Egyptian Arabic-speaking children with VPI due to cleft palate (whether primary repaired or secondary repaired) were studied. Auditory perceptual assessment (APA) of children speech was conducted. Nasopharyngoscopy was done to assess the velopharyngeal port (VPP) movements while the child was repeating speech tasks. Mansoura Arabic Articulation test (MAAT) was performed to analyze the consonants articulation of these children.

RESULTS AND CONCLUSION

The most frequent type of articulatory errors observed was substitution, more specifically, backing. Pharyngealization of anterior fricatives was the most frequent substitution, especially for the /s/ sound. The most frequent substituting sounds for other sounds were /ʔ/ followed by /k/ and /n/ sounds. Significant correlations were found between the degrees of the open nasality and VPP closure and the articulation errors. On the other hand, the sounds (/ʔ/,/ħ/,/ʕ/,/n/,/w/,/j/) were normally articulated in all studied group. The determination of articulation errors in VPI children could guide the therapists for designing appropriate speech therapy programs for these cases.

Addressing the burden of neonatal hyperbilirubinaemia in countries with significant glucose-6-phosphate dehydrogenase deficiency

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an established worldwide risk factor for severe hyperbilirubinaemia. This literature review examined the pattern and management of severe hyperbilirubinaemia in low- and middle-income countries (LMICs) where G6PD deficiency was 10% or more and found that it was frequently associated with neonatal mortality and, or, neurodevelopmental disorders.

CONCLUSION

Low- and middle-income countries need to pay urgent attention to G6PD deficiency to curtail the preventable burden of jaundice-related morbidity, mortality and disability.

The effect of special health care needs and health status on school functioning

BACKGROUND

Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association.

OBJECTIVES

To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes.

METHODS

The analysis was based on 59,440 children aged 6-17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days.

RESULTS

Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health.

CONCLUSIONS

The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning.