Separating the contributions of hearing, lexical knowledge and speech production to speech perception scores in children with hearing impairments.

Open-set word and sentence speech-perception test scores are commonly used as a measure of hearing abilities in children and adults using cochlear implants and/or hearing aids. These tests are usually presented auditorily with a verbal response. In the case of children, scores are typically lower and more variable than for adults with hearing impairments using similar devices. It is difficult to interpret children's speech-perception scores without considering the effects of lexical knowledge and speech-production abilities on their responses. This study postulated a simple mathematical model to describe the effects of hearing, lexical knowledge, and speech production on the perception test scores for monosyllabic words by children with impaired hearing. Thirty-three primary-school children with impaired hearing, fitted with hearing aids and/or cochlear implants, were evaluated using speech-perception, reading-aloud, speech-production, and language measures. These various measures were incorporated in the mathematical model, which revealed that performance in an open-set word-perception test in the auditory-alone mode is strongly dependent on residual hearing levels, lexical knowledge, and speech-production abilities. Further applications of the model provided an estimate of the effect of each component on the overall speech-perception score for each child.

A cost-effectiveness analysis of the management of sore throat in children in Australia

For the first time a cost-effectiveness analysis of the management of sore throat in Australian children has been conducted using accurate epidemiological data generated from recent Australian studies.

Family correlates of fruit and vegetable consumption in children and adolescents : a systematic review

Objectives To review associations between the family environment and young people’s fruit and vegetable consumption.

Design A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6–11 years) and/or adolescents (aged 12–18 years) and at least one potential family correlate of dietary intake was included.

Results Parental modelling and parental intake were consistently and positively associated with children’s fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children’s fruit and vegetable consumption. Parental intake was positively associated with adolescents’ fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents’ FJV consumption.

Conclusions Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.

PTSD symptomatology in children and adolescents : treatment development and evaluation

This thesis developed, implemented and evaluated a cognitive-behavioural group treatment programme for children and adolescents experiencing symptoms of PTSD (Post-traumatic stress disorder). Results of the study indicate that symptoms of sleep disturbance and flashbacks, reduced markedly in the participants, providing a useful tool in reducing synptoms experiences by individuals exposed to trauma. The Professional portfolio presents four case studies that demonstrate the clinical application of the affect of chronic illness on the psychological adjustment of the sufferer and their families.

Effects of physical activity on depression and anxiety in children

This thesis study examined the direct and indirect effects of physical activity, self-efficacy and peer relations in depression and anxiety in children. No direct relationships between physical activity and symptoms of depression or anxiety were found for either sex. The portfolio, using four clinical health psychology case studies, provides an illustration of the clinical application of the transtheoretical model to four different health issues.

Relationships between measures of fitness, physical activity, body composition and vascular function in children

Background : The prevalence of obesity and physical inactivity in Western countries has increased rapidly. Both are modifiable risk factors for cardiovascular disease. Atherosclerosis begins in childhood and endothelial dysfunction is its earliest detectable manifestation.

Methods : We assessed flow-mediated dilation (FMD) in 129 children (75 female; 10.3 + 0.3 yrs; 54 male; 10.4; 0.3 yrs). FMD was normalised for differences in the eliciting shear rate stimulus between subjects (SR_AUC). Fitness was assessed as peak oxygen uptake during an incremental treadmill exercise test (VO₂peak). Body composition was measured using a dual-energy X-ray absorptiometry (DEXA) scan. Physical activity (PA) was assessed using Actigraph accelerometers. The cohort was split into tertiles according to FMD% and also FMD% corrected for SR_AUC to gain insight into the determinants of vascular function.

Results : Across the cohort, significant correlations were observed between FMD%/SR_AUC and DEXA percentage fat (r = −0.23, p = 0.009) and percentage lean mass (r = 0.21, p = 0.008), and also with PA performed at moderate-to-high intensity (r = 0.363, p = 0.001). For children in the lowest FMD%/SR_AUC tertile, a stronger relationship with all PA measures was observed, particularly with high intensity PA (r = 0.572, P = 0.003). Regression analysis revealed that high intensity PA was the only predictor of impaired FMD%/SR_AUC.

Conclusions : These data suggest that traditional risk factors for CHD in adult populations impact upon vascular function in young people. Furthermore, it appears that individuals with impaired FMD may benefit from performing high intensity PA, whereas no relationships exist between FMD and lower intensities of PA or between PA and FMD in those subjects who possess preserved vascular function a priori.

Factors impacting story-grammar production in children's narrative accounts of events

This thesis examined factors associated with increased story-grammar production in police interviews with children who allege abuse. These factors included the child's age, the type of question asked and the nature of the event experienced by the child. Recommendation for improving story-grammar, which in turn enhances witness credibility, were discussed. The portfolio explored how an awareness of specific responsivity factors can inform treatment recommendations and execution in rehabilitation of offenders with substance use issues. Four case studies are presented in illustration.

Neighbourhood physical activity environments and adiposity in children and mothers : a three-year longitudinal study

Background Although neighbourhood environments are often blamed for contributing to rising levels of obesity, current evidence is based predominantly on cross-sectional samples. This study examined associations between objectively-measured environmental characteristics of neighbourhoods and adiposity cross-sectionally and longitudinally over three years in children and their female carers.

Methods Longitudinal study of 140 5-6 year-old and 269 10-12 year-old children and their female carers (n = 369). At baseline (2001) and follow-up (2004), height and weight were measured among children and self-reported among female carers, and were used to compute BMI z-scores and BMI, respectively. A Geographic Information System determined access to destinations (public open spaces, sports options, walking/cycling tracks), road connectivity (density of cul-de-sacs and intersections, proportion of 4-way intersections, length of 'access' paths (overpasses, access lanes, throughways between buildings)) and traffic exposure (length of 'busy' and 'local' roads) within 800 m and 2 km of home. Univariate and multivariable linear regression analyses examined associations between environmental characteristics and BMI/BMI z-scores at baseline and change in BMI/BMI z-scores over the three years.

Results Cross-sectionally, BMI z-score was inversely associated with length (km) of access paths within 800 m (b = -0.50) and 2 km (b = -0.16) among younger and number of sport/recreation public open spaces (b = -0.14) and length (km) of 'access' paths (b = -0.94) within 800 m and length of local roads within 2 km (b = -0.01) among older children. Among female carers, BMI was associated with length (km) of walking/cycling tracks (b = 0.17) and busy roads (b = -0.34) within 800 m. Longitudinally, the proportion of intersections that were 4-way (b = -0.01) within 800 m of home was negatively associated with change in BMI z-score among younger children, while length (km) of access paths (b = 0.18) within 800 m was significant among older children. Among female carers, options for aerobics/fitness and swimming within 2 km were associated with change in BMI (B = -0.42).

Conclusion A small number of neighbourhood environment features were associated with adiposity outcomes. These differed by age group and neighbourhood scale (800 m and 2 km) and were inconsistent between cross-sectional and longitudinal findings. However, the results suggest that improvements to road connectivity and slowing traffic and provision of facilities for leisure activities popular among women may support obesity prevention efforts.