The family school : the impact of a group training programme on overactive hard-to-manage preschool children and their parents

Föräldraskap upplevs som en utmanande uppgift i dag och det påstås att föräldrar oftare än förr skulle var i behov av råd och stöd beträffande barnuppfostran. Denna uppgift kan ytterligare försvåras om det i familjen finns ett hyperaktivt okoncentrerat barn att uppfostra. Detta arbete undersökte effekterna av ett kortvarigt gruppbaserat interventionsprogram benämnt Familjeskolan POP (Preschool Overactivity Programme). Familjeskolan är avsedd för familjer med barn i lekåldern, som visar beteendesvårigheter såsom ADHD (Attention Deficit Hyperactivity Disorder), ODD (Oppositional Deficit Disorder) eller CD (Conduct Disorder). Målet för Familjeskolan är att öka föräldrarnas kunskaper och självförtroende då de har ett krävande svårhanterligt barn att uppfostra. Familjeskolan strävar också till att reducera barns icke-önskvärda beteenden genom att öka deras sociala färdigheter och koncentrationsförmåga. Familjeskolan verkställdes i Helsingfors vid ADHD- centrets lokaliteter. 45 mödrar och deras barn från huvudstadsregionen deltog i denna undersökning. Av dessa deltog 33 i Familjeskola-programmet medan de 12 övriga bildade den s.k. kontrollgruppen. Undersökningsresultaten tyder på förbättringar beträffande både moderns och faderns föräldrakunskaper efter Familjeskola-interventionen. Det är att lägga märke till att enbart mödrar deltog i interventionsprogrammet. Efter programmet klarade mödrar enligt egen utsaga vardagen bättre. Speciellt hade de blivit bättre på att hantera barnens beteendesvårigheter och hyperaktivt okoncentrerat beteende. Resultaten påvisade också att programmet var effektivast för de mödrar som före Familjeskolan upplevde sig besitta ringa föräldrakunskaper. Mödrarna rapporterade en signifikant minskning i barnens totala beteendesvårigheter. Efter interventionen ansåg mödrarna att deras barn var mindre olydiga, hyperaktiva samt att deras beteendesvårigheter var lindrigare. Enligt dagvårdspersonalen hade barnens totala beteendesvårigheter och problem med koncentration och hyperaktivitet också minskat. Motsvarande förbättringar uppnåddes inte i kontrollgruppen. Resultaten från uppföljningsintervjun, visade också att barnens beteendeförändringar var bestående både hemma och i daghemmet. Både föräldrar och dagvårdspersonalen rapporterade en signifikant minskning i barnens totala svårigheter jämfört med innan familjerna påbörjade interventionen. Föräldrarna rapporterade en marginell minskning i barnens ADHD-liknande beteende, beteendesvårigheter och i svårigheter med kamrater, dagvårdspersonalen däremot rapporterade en signifikant minskning i barnens beteendesvårigheter, hyperaktivt/okoncentrerat beteende samt i svårigheter med kamrater mellan innan familjerna påbörjade interventionen och uppföljningen ett år efter. Resultaten av denna undersökning stödjer hypotesen att kortvariga gruppbaserade interventionsprogram kan åstadkomma permanenta förbättringar i föräldrakunskaper och barns beteende. Detta gäller främst hyperaktivitet, koncentrationssvårigheter och trotsighet.

Central auditory processing and the acquisition of phonology in 2-year-old children with recurrent acute otitis media

Middle ear infections (acute otitis media, AOM) are among the most common infectious diseases in childhood, their incidence being greatest at the age of 6–12 months. Approximately 10–30% of children undergo repetitive periods of AOM, referred to as recurrent acute otitis media (RAOM). Middle ear fluid during an AOM episode causes, on average, 20–30 dB of hearing loss lasting from a few days to as much as a couple of months. It is well known that even a mild permanent hearing loss has an effect on language development but so far there is no consensus regarding the consequences of RAOM on childhood language acquisition. The results of studies on middle ear infections and language development have been partly discrepant and the exact effects of RAOM on the developing central auditory nervous system are as yet unknown. This thesis aims to examine central auditory processing and speech production among 2-year-old children with RAOM. Event-related potentials (ERPs) extracted from electroencephalography can be used to objectively investigate the functioning of the central auditory nervous system. For the first time this thesis has utilized auditory ERPs to study sound encoding and preattentive auditory discrimination of speech stimuli, and neural mechanisms of involuntary auditory attention in children with RAOM. Furthermore, the level of phonological development was studied by investigating the number and the quality of consonants produced by these children. Acquisition of consonant phonemes, which are harder to hear than vowels, is a good indicator of the ability to form accurate memory representations of ambient language and has not been studied previously in Finnish-speaking children with RAOM. The results showed that the cortical sound encoding was intact but the preattentive auditory discrimination of multiple speech sound features was atypical in those children with RAOM. Furthermore, their neural mechanisms of auditory attention differed from those of their peers, thus indicating that children with RAOM are atypically sensitive to novel but meaningless sounds. The children with RAOM also produced fewer consonants than their controls. Noticeably, they had a delay in the acquisition of word-medial consonants and the Finnish phoneme /s/, which is acoustically challenging to perceive compared to the other Finnish phonemes. The findings indicate the immaturity of central auditory processing in the children with RAOM, and this might also emerge in speech production. This thesis also showed that the effects of RAOM on central auditory processing are long-lasting because the children had healthy ears at the time of the study. An effective neural network for speech sound processing is a basic requisite of language acquisition, and RAOM in early childhood should be considered as a risk factor for language development.

The Strengths and Difficulties Questionnaire (SDQ-Fin) among Finnish children and adolescents

Objective: The psychometric properties of The Strengths and Difficulties Questionnaire (SDQ-Fin), a Finnish version of a brief screening instrument were studied. Emotional and behavioural problems of 7- to 15-year-olds measured by the SDQ were reported, as well as the occurrence of self-reported eating disturbance symptoms and alcohol use among adolescents. Methods and samples: The cross-sectional school survey included 25 items of the SDQ-Fin, items about eating disturbance, alchol use and child psychiatric help-seeking. The study consists of three community samples: 1. The SDQ-Fin parent (n = 703) and teacher (n = 376) versions of 7 – 12 –year-olds, and self-report versions (n = 528) of 11 – 16 years-olds were obtained, and 2. the parent (n = 81) and self-report versions of 15-16 –year olds (n = 129) were obtained in Laitila and Pyhäranta. 3. The self-report versions of 13 – 16 – year-olds (n = 1458) in Salo and Rovaniemi were obtained. Results: The psychometric properties of the SDQ-Fin were for the most part comparable with the other European SDQ research results. The internal consistency (Cronbach’s alpha = 0.71 in all informants’ reports) and inter-rater reliability (between the pairs of reports r = 0.38 - 0.44) were adequate. The concurrent validity (r = 0.75 between the SDQ and the CBCL total scores; r = 0.71 between the SDQ and the YSR total scores) was sufficient. Factor analysis of the SDQ self-report generally confirmed the postulated structure for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The response rates, means and cut-off points of the SDQ self-report scores were similar to those found, e.g. in Norway and in Britain. A high level of psychological problems, especially emotional and conduct problems and hyperactivity-inattention, were associated with high level of eating disturbance symptoms and alcohol use. Conclusion: The results showed that the psychometric properties of the SDQ-Fin are adequate and provide additional confirmation of the usefulness of the SDQ-Fin for, e.g. screening, epidemiological research and clinical purposes.

Lymph node transfer in the treatment of postmastectomy lymphedema

Background: Lymphedema is a debilitating disorder with few treatment options. Clinical studies have shown that microvascular lymph node transfer may improve the lymphatic function of the affected limb. This study provides information about the clinical efficacy and safety of this procedure. Further, the biological background of this technique is clarified with an analysis of postoperative production of lymphatic growth factors and cytokines related to lymphangiogenesis. Patients and Methods: The effect of lymph node transfer to recipient and donor sites was analyzed with lymphoscintigraphy, limb circumference measurements, and appearance of clinical symptoms. Axillary seroma samples were analyzed from four patient groups: Axillary lymph node removal (ALND), Microvascular breast reconstruction (BR), lymph node transfer (LN) and combined lymph node transfer and breast reconstruction (LN-BR). Results: The postoperative lymphatic transport index was improved in 7/19 patients. Ten patients were able to reduce or discontinue compression therapy 6 - 24 months postoperatively. The donor lower limb lymphatic flow was slightly impaired (Ti >10) in 2 patients. No donor site lymphedema symptoms appeared during the 8 – 56-month follow-up. A high concentration of the VEGF-C protein was detected in the seroma fluid of all flap transfer groups. The concentration of the anti-inflammatory and anti-fibrotic cytokine IL-10 was increased in the LN-BR group samples when compared to the ALND or BR group. Conclusions: According to this preliminary study, the lymph node transfer seems to be beneficial for the lymphedema patients. However, a randomized study comparing the effect of BR and LN-BR is needed to evaluate the clinical efficacy of lymph node transfer. In addition, the effect of this surgery on the donor site needs to be studied further. The clinical effects of the lymph node transfer might be partly mediated by increased production of the lymphangiogenic growth factor (VEGF-C) as well as the anti-fibrotic cytokine (IL-10).