Predictive validity and classification accuracy of ActiGraph energy expenditure equations and cut-points in young children

Objectives
Evaluate the predictive validity of ActiGraph energy expenditure equations and the classification accuracy of physical activity intensity cut-points in preschoolers.

Methods
Forty children aged 4–6 years (5.3±1.0 years) completed a ~150-min room calorimeter protocol involving age-appropriate sedentary, light and moderate-to vigorous-intensity physical activities. Children wore an ActiGraph GT3X on the right mid-axillary line of the hip. Energy expenditure measured by room calorimetry and physical activity intensity classified using direct observation were the criterion methods. Energy expenditure was predicted using Pate and Puyau equations. Physical activity intensity was classified using Evenson, Sirard, Van Cauwenberghe, Pate, Puyau, and Reilly, ActiGraph cut-points.

Results
The Pate equation significantly overestimated VO2 during sedentary behaviors, light physical activities and total VO2 (P<0.001). No difference was found between measured and predicted VO2 during moderate-to vigorous-intensity physical activities (P = 0.072). The Puyau equation significantly underestimated activity energy expenditure during moderate-to vigorous-intensity physical activities, light-intensity physical activities and total activity energy expenditure (P<0.0125). However, no overestimation of activity energy expenditure during sedentary behavior was found. The Evenson cut-point demonstrated significantly higher accuracy for classifying sedentary behaviors and light-intensity physical activities than others. Classification accuracy for moderate-to vigorous-intensity physical activities was significantly higher for Pate than others.

Conclusion
Available ActiGraph equations do not provide accurate estimates of energy expenditure across physical activity intensities in preschoolers. Cut-points of ≤25counts⋅15 s−1 and ≥420 counts⋅15 s−1 for classifying sedentary behaviors and moderate-to vigorous-intensity physical activities, respectively, are recommended.

A randomised group comparison controlled trial of 'preschoolers with autism': a parent education and skills training intervention for young children with autistic disorder

Aim
To determine the effect of parent education on adaptive behaviour, autism symptoms and cognitive/language skills of young children with autistic disorder.

Method
A randomised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample. Two rural and two metropolitan regions were randomly allocated to intervention groups (n = 70) or control (n = 35). Parents from autism assessment services in the intervention regions were randomly allocated to parent education and behaviour management (n = 35) or parent education and counselling (n = 35).

Results
Parent education and behaviour management resulted in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour. Parent education and behaviour management was superior to parent education and counselling. We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children.

A qualitative study of the factors that influence mothers when choosing drinks for their young children

ABSTRACT

Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.

Reliability of the pictorial scale of perceived movement skill competence in 2 diverse samples of young children

The purpose was to determine the reliability of an instrument designed to assess young children's perceived movement skill competence in two diverse samples.

Associations between young children's perceived and actual ball skill competence and physical activity

Objectives: The relationship between actual and perceived object control competence (ball skills) and the contribution to young children’s physical activity is not known.
Design: Cross sectional study.
Methods: The Test Gross Motor Development-2 assessed actual object control competence and a modified version of the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children assessed perceived object control competence. Moderate- to vigorous-intensity physical activity was measured via accelerometry. Three mixed regression models were performed: (i) object control competence as the predictor and the outcome as perceived object control, (ii) perceived object control competence as the predictor and the outcome moderate to vigorous physical activity and (iii) actual object control as the predictor and the outcome moderate to vigorous physical activity. Models adjusted for school clustering, monitor wear time, sex and age. Interactions between respective predictor variables and sex were performed if warranted. A total of 102 children (56% boys, 44% girls) aged 4–8 years (M 6.3, SD 0.92) completed assessments.
Results: Girls had lower perceived and actual object control competence and were less active than boys. Actual object control competence was positively associated with perceived object control competence (B = 0.11, t(96) = 2.25, p < 0.001, p = 0.027) and this relationship did not differ by sex (p = 0.449); however, neither actual (p = 0.092) nor perceived object control competence (p = 0.827) were associated with moderate to vigorous physical activity.
Discussion: Young children’s perceived ball skill abilities appear to relate to actual competence; however, these measures were not associated with physical activity. In older children, object control skill is associated with physical activity so targeting young children’s object control skills is an intervention priority.

Face validity and reliability of a pictorial instrument for assessing fundamental movement skill perceived competence in young children

To determine reliability and face validity of an instrument to assess young children's perceived fundamental movement skill competence.

Evaluation of Actical equations and thresholds to predict physical activity intensity in young children

This study examined the validity of current Actical activity energy expenditure (AEE) equations and intensity cut-points in preschoolers using AEE and direct observation as criterion measures. Forty 4–6-year-olds (5.3 ± 1.0 years) completed a ~150-min room calorimeter protocol involving age-appropriate sedentary behaviours (SBs), light intensity physical activities (LPAs) and moderate-to-vigorous intensity physical activities (MVPAs). AEE and/or physical activity intensity were calculated using Actical equations and cut-points by Adolph, Evenson, Pfeiffer and Puyau. Predictive validity was examined using paired sample t-tests. Classification accuracy was evaluated using weighted kappas, sensitivity, specificity and area under the receiver operating characteristic curve. The Pfeiffer equation significantly overestimated AEE during SB and underestimated AEE during LPA (P < 0.0125 for both). There was no significant difference between measured and predicted AEEs during MVPA. The Adolph cut-point showed significantly higher accuracy for classifying SB, LPA and MVPA than all others. The available Actical equation does not provide accurate estimates of AEE across all intensities in preschoolers. However, the Pfeiffer equation performed reasonably well for MVPA. Using cut-points of ≤6 counts · 15 s−1, 7–286 counts · 15 s−1 and ≥ 287 counts · 15 s−1 when classifying SB, LPA and MVPA, respectively, is recommended.

Sucrose and lollypops to reduce immunisation pain in toddlers and young children: two pilot randomised controlled trials

Aims To evaluate the feasibility, acceptability and preliminary efficacy of sweet taste in reducing pain in toddlers and pre-school children during immunisation and to use the results to inform a sample size estimation for future full-scale trials. Background Sweet solutions reduce procedural pain in newborn infants and in infants beyond the newborn period. It is unclear if sweet taste continues to reduce procedural pain in children older than one year of age. Design Two parallel design pilot randomised controlled trials (RCTs). Methods Children attending an Immunisation Drop-in Clinic at a children's hospital in Australia participated in one of two pilot RCTs: 1) a double-blinded RCT of 33% sucrose compared to water in toddlers receiving their 12- or 18-month immunisation or 2) a non-blinded RCT of lollypop compared to standard care (active distraction using bubble and pin wheel blowing) in pre-school children aged 3-5 years. Primary outcomes included cry incidence and duration and pain score using the FLACC. Results Interventions, standard care and all aspects of the study were acceptable to children, parents and immunisation nurses. More toddlers in the sucrose group received their 12-month immunisation and more injections (n=35) compared to toddlers randomised to water (n=26). There were no significant differences in crying time or pain scores between intervention and control groups in either pilot RCT. Conclusion The study interventions are acceptable to children and parents. Full-scale trials would be feasible to conduct. Implications for clinical practice Toddlers receiving their 12-month immunisation should be the focus of future full-scale RCTs.

Tracking of maternal self-efficacy for limiting young children's television viewing and associations with children's television viewing time: a longitudinal analysis over 15-months

BACKGROUND: Mothers' self-efficacy for limiting their children's television viewing is an important correlate of this behaviour in young children. However, no studies have examined how maternal self-efficacy changes over time, which is potentially important during periods of rapid child development. This study examined tracking of maternal self-efficacy for limiting young children's television viewing over 15-months and associations with children's television viewing time. METHODS: In 2008 and 2010, mothers (n = 404) from the Melbourne InFANT Program self-reported their self-efficacy for limiting their child's television viewing at 4- and 19-months of age. Tertiles of self-efficacy were created at each time and categorised into: persistently high, persistently low, increasing or decreasing self-efficacy. Weighted kappa and multinomial logistic regression examined tracking and demographic and behavioural predictors of change in self-efficacy. A linear regression model examined associations between tracking categories and children's television viewing time. RESULTS: Tracking of maternal self-efficacy for limiting children's television viewing was low (kappa = 0.23, p < 0.001). Mothers who had persistently high or increasing self-efficacy had children with lower television viewing time at 19-months (β = -35.5; 95 % CI = -54.4,-16.6 and β = 37.0; 95 % CI = -54.4,-19.7, respectively). Mothers of children with difficult temperaments were less likely to have persistently high self-efficacy. Mothers who met adult physical activity guidelines had 2.5 greater odds of increasing self-efficacy. CONCLUSIONS: Interventions to increase and maintain maternal self-efficacy for limiting children's television viewing time may result in lower rates of this behaviour amongst toddlers. Maternal and child characteristics may need to be considered when tailoring interventions.

Does playing a sports active video game improve young children's ball skill competence?

OBJECTIVES: Actual and perceived object control (commonly ball) skill proficiency is associated with higher physical activity in children and adolescents. Active video games (AVGs) encourage whole body movement to control/play the electronic gaming system and therefore provide an opportunity for screen time to become more active. The purpose of this study was to determine whether playing sports AVGs has a positive influence on young children's actual and perceived object control skills. DESIGN: Two group pre/post experimental design study. METHODS: Thirty-six children aged 6-10 years old from one school were randomly allocated to a control or intervention condition. The Test of Gross Motor Development-3 assessed object control skill. The Pictorial Scale of Perceived Competence for Young Children assessed perceived object control skill. The intervention consisted of 6×50min lunchtime AVG sessions on the Xbox Kinect. Two to three sport games were chosen for participants to play each session. General linear models with either perceived object control or actual object control skill as the outcome variables were conducted. Each base model adjusted for intervention status and pre-score of the respective outcome variable. Additional models adjusted for potential confounding variables (sex of child and game at home). RESULTS: No significant differences between the control and intervention groups were observed for both outcomes. CONCLUSIONS: This study found that playing the Xbox Kinect does not significantly influence children's perceived or actual object control skills, suggesting that the utility of the Xbox Kinect for developing perceived and actual object control skill competence is questionable.

How important is young children's actual and perceived movement skill competence to their physical activity?

OBJECTIVES: To determine the associations between young children's actual and perceived object control and locomotor skills and physical activity and whether associations differ by sex. DESIGN: Cross sectional study. METHODS: A total of 136 children consented. Children had actual skill (Test of Gross Motor Development-2), perceived skill (Pictorial Scale of Perceived Movement Skill Competence for Young Children), and moderate- to vigorous-intensity physical activity (MVPA) (accelerometers) assessed. Independent t-tests assessed sex differences. A regression (with MVPA as the outcome) was performed with all predictor variables (i.e. Actual Object Control, Actual Locomotor, Perceived Object Control, and Perceived Locomotor). Model 2 also adjusted for age, sex, accelerometer wear time and whether the child was from an English speaking background. Interaction terms between the respective actual or perceived skill factor and sex were added to assess sex differences. RESULTS: Analyses were conducted on 109 children (59 boys, 50 girls; mean age=6.5 years, SD=1.0). Boys had higher actual and perceived object control skill and were more active by an average of 19min per day. There were no sex differences in locomotor skills. There were no associations between skill factors and MVPA, except for girls, where locomotor skill was a significant predictor of MVPA (B=3.66, p=0.016). CONCLUSIONS: Actual rather than perceived skill competence was more important to MVPA in this sample. Locomotor skill competence may be more important than object control skill competence for girls as they may engage in types of physical activity that do not require object control mastery.

Normative data for the strengths and difficulties questionnaire for young children in Australia

AIM: The aim of this study was to report normative data for the parent-reported Strengths and Difficulties Questionnaire (SDQ) from a large population cohort of young children aged 4-6 years from Victoria, Australia, to establish age- and sex-specific cut-off values for future use, and to determine the scale reliability of the SDQ for children aged 4-6 years. METHODS: Parents of children (n = 53 372) entering their first year of school in Victoria in 2010 completed a survey via a 15-page School Entrant Health Questionnaire reporting on the physical and emotional well-being of their child (including the SDQ), use of child health and other support services, and a range of socio-demographic variables. Reliability was assessed and norms generated. Appropriate cut-off values for each SDQ scale and total difficulties scale were generated for each age group separately for each sex. RESULTS: The five scales of the SDQ and total difficulties scale generally had acceptable internal reliability. Mean SDQ scale scores differed for both sex and age, although only a narrow age range is examined in this study. Cut-off values were marginally higher for girls (lower for prosocial) and generally increased with age. CONCLUSIONS: This study has utilised a large Australian population sample of children to generate age- and sex-specific cut-off values that define SDQ scores as 'normal', 'borderline' or 'abnormal' for Australian children aged 4-6 years.