The first report in Brazil of severe infection caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emergent pathogen in Brazil. However, there are no data on the prevalence of CA-MRSA. We report here the first well-characterized case of severe life-threatening CA-MRSA infection in a child living in Rio de Janeiro city. The patient had many complications including hematogenous osteomyelitis and involvement of multiple sites requiring drainage of soft-tissue abscess, and pleural and pericardial empyema. The MRSA isolates recovered were genotyped using PFGE, SCCmec typing and multilocus sequence typing. Disk diffusion tests were performed following Clinical and Laboratory Standards Institute recommendations. In addition, the presence of Panton-Valentine leukocidin (PVL) was assessed by PCR amplification, using specific primers for lukF-pv (encoding for the F subunit of the PVL). The bacterial isolates were related to the ST30-SCCmecIV lineage (Oceania Southwest Pacific clone), a PVL producer CA-MRSA previously detected in Porto Alegre, RS, Brazil. Also, the isolates analyzed were susceptible to all non-β-lactam antibiotics tested. The present report demonstrates that disseminated CA-MRSA disease is also occurring in Rio de Janeiro. Thus, the empirical treatment of moderate or severe infections suspected of being associated with CA-MRSA needs to be reviewed in order to allow prompt initiation of an effective therapy that also covers these microorganisms.

A speculative systems model of the dynamic interaction among students, faculty and administration in the community college, with particular reference to intrinsic motivation and the teacher-administrator interface

The challenge the community college faces in helping meet the needs of the living open system of society is examined in this study. It is postulated that internalization student outcomes are required by society to reduce entropy and remain self-renewing. Such behavior is characterized as having an intrinsically motivated energy source and displays the seeking and conquering of challenge, the development of reflective knowledge and skill, full use of all capabilities, internal control, growth orientation, high self-esteem, relativistic thinking and competence. The development of a conceptual systems model that suggests how transactions among students, faculty and administration might occur to best meet the needs of internalization outcomes in students, and intrinsic motivation in faculty is a major purpose of this study. It is a speculative model that is based on a synthesis of a wide variety of variables. Empirical evidence, theoretical considerations, and speculative ideas are gathered together from researchers and theoretici.ans who are working on separate answers to questions of intrinsic motivation, internal control and environments that encourage their development. The model considers the effect administrators·have on faculty anq the corresponding effect faculty may have on students. The major concentration is on the administrator--teacher interface.For administrators the model may serve as a guide in planning effective transactions, and establishing system goals. The teacher is offered a means to coordinate actions toward a specific overall objective, and the administrator, teacher and researcher are invited to use the model to experiment, innovate, verify the assumptions on which the model is based, and raise additional hypotheses. Goals and history of the community colleges in Ontario are examined against current problems, previous progress and open system thinking. The nature of the person as a five part system is explored with emphasis on intrinsic motivation. The nature, operation, conceptualization, and value of this internal energy source is reviewed in detail. The current state of society, education and management theory are considered and the value of intrinsically motivating teaching tasks together with "system four" leadership style are featured. Evidence is reviewed that suggests intrinsically motivated faculty are needed, and "system four" leadership style is the kind of interaction-influence system needed to nurture intrinsic motivation in faculty.

Active living in municipal parks and recreation : a case study

If quality of life is an important recreation outcome, then municipal parks and recreation management's efforts have to change because:· Over one-third of all the little kids in schools will be diabetic in their lifetime if the trends we are looking at continue. The average loss of life is about 15 years, and there is an average reduction in quality oflife by about 20 years (Jackson, 2007). This thesis is about municipal parks and recreation, an agency that controls and limits physical activity opportunity. It is also about active living; from an ecological perspective, a multi-disciplinary approach to incorporate physical activity into more 111 people's daily lives. In particular, this thesis examines one case --'. the Donutville Case - . with the intent of providing an explanation of how municipal parks and recreation can advance its management efforts to improve health outcomes of people suffering from daily physical activity deficits. More specifically, how can the tension between external and internal environments to municipal parks and recreation be better balanced to affect the change needed? Given that changing the current social reality is through making decisions, decision-making functions connected with systems theory helps identify how recreation authorities can more effectively influence environmental physical activity determinants. , Sallis et al.' (2006) ·social ecological model provides the a priori focus on active living decision-making. An integrated analogous emerging logic model is developed and presented as an efficacious strategy for how municipal parks and recreation decisionmakers can affect change. Keywords: physical activity, benefits outcomes, healthy livable community, quality of life, systems thinking, social ecological model, deci~ion-making, logic modeling, municipal parks and recreation, active living.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Developing an Understanding of Cultural Diversity: How an Experience Living in a Multicultural Nation and an Experience Teaching Abroad Contribute to Southern Ontario Teachers' Identities

This is a narrative design study focusing on the understandings that a group of 6 Southern Ontario teachers have of cultural diversity and how these understandings integrated into their development of teacher identity. Given the high culturally diverse population of Canada and its national multicultural values, conducting this study on Canadian pre-service and in-service teachers offers an interesting contribution to the field. In efforts to explore the participants’ understandings, the research examined a teaching abroad experience. The aim was to investigate how these participants gained insight from their experiences with cultural diversity and whether these insights stimulated a greater culturally conscious teacher identity. Narratives provided a description of the lived experiences of these 6 teachers and identified meanings made from these experiences. Participants included 2 pre-service teachers who were in a teacher education program at the time of the interview, and 4 certified teachers who graduated from a teacher education program within the past 5 years. One on one interviews focused on lived experiences within a participant’s home, school community, and teaching abroad. The researcher used grounded theory during the data analysis to assist in identifying themes, and then compared these themes among participants. Overall, this study suggests that even though these participants live in a multicultural nation, experiences varied greatly based on contributing factors such as heritage and exposure to cultural diversity through their home and school life. Despite their varying level of cultural competence, all participants gained insight from their teaching abroad experience, contributing to a teacher identity that considered inclusive practices. This study suggests that there are some important factors to consider when preparing teachers to teach in a multicultural society.

Understanding the Integration of Living Skills Through the Context of Health and Physical Education: A Case Study of Educators’ Experiences

The research presented is a qualitative case study of educators’ experiences in integrating living skills in the context of health and physical education (HPE). In using semi-structured interviews the study investigated HPE educators’ experiences and revealed their insights relative to three major themes; professional practice, challenges and support systems. Professional practice experiences detailed the use of progressive lesson planning, reflective and engaging activities, explicit student centered pedagogy as well as holistic teaching philosophies. Even further, the limited knowledge and awareness of living skills, conflicting teaching philosophies, competitive environments between subject areas and lack of time and accessibility were four major challenges that emerged throughout the data. Major supportive roles for HPE educators in the integration process included other educators, consultants, school administration, public health, parents, community programs and professional organizations. The study provides valuable discussion and suggestions for improvement of pedagogical practices in teaching living skills in the HPE setting.

Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

The BRAD group is composed of/ Le groupe BRAD est composé de : Sylvie Belleville, Gina Bravo, Louise Demers, Philippe Landreville, Louisette Mercier, Nicole Paquet, Hélène Payette, Constant Rainville, Bernadette Ska and René Verreault.

Community remoteness and birth outcomes among First Nations in Quebec

OBJECTIF: Chez les Autochtones, la relation entre le degré d'éloignement et les issues de naissance est inconnue. L’objectif de cette étude est d’évaluer cet impact parmi les Premières Nations du Québec. MÉTHODE : Nous avons utilisé les données vitales de Statistique Canada pour la province du Québec pour la période 1991-2000. L’ensemble des naissances géocodées parmi les communautés des Premières Nations groupées en quatre zones en se basant sur le degré d'éloignement a été analysé. Nous avons utilisé la régression logistique multi-niveaux pour obtenir des rapports de cotes ajustés pour les caractéristiques maternelles. RESULTATS : Le taux de naissances prématurées varie en fonction de l’éloignement de la zone d’habitation (8,2% dans la zone la moins éloignée et 5,2% dans la Zone la plus éloignée, P<0,01). En revanche, plus la zone est éloignée, plus le taux de mortalité infantile est élevé (6,9 pour 1000 pour la Zone 1 et 16,8 pour 1000 pour la Zone 4, P<0,01). Le taux élevé de mortalité infantile dans la zone la plus éloignée pourrait être partiellement expliqué par le fort taux de mortalité post-natale. Le taux de mort subite du nourrisson est 3 fois plus élevé dans la zone 4 par rapport à la zone 1. Cependant la mortalité prénatale ne présente pas de différences significatives en fonction de la zone malgré une fréquence élevée dans la zone 4. La morbidité périnatale était semblable en fonction de la zone après avoir ajusté pour l’âge, l’éducation, la parité et le statut civil. CONCLUSIONS : Malgré de plus faibles taux d’enfants à haut risque (accouchements prématurés), les Premières Nations vivant dans les communautés les plus éloignées ont un risque plus élevé de mortalité infantile et plus spécialement de mortalité post-néonatale par rapport aux Premières Nations vivant dans des communautés moins éloignées. Il y existe un grand besoin d’investissement en services de santé et en promotion de la santé dans les communautés les plus éloignées afin de réduire le taux de mortalité infantile et surtout post-néonatale.

Service users’ participation in mental health community-based organizations

Une grande proportion de personnes aux prises avec des problèmes de santé mentale vit dans l’isolement social. Les infirmières en santé communautaire sont interpellées au premier rang pour accompagner ces personnes dans leur processus de rétablissement et pour atténuer leur isolement social. La participation au sein d’organismes communautaires optimise l’expérience de rétablissement, diminue l’isolement social et renforce les réseaux sociaux de personnes ayant des problèmes de santé mentale. Toutefois, la participation des personnes utilisatrices de services dans la structure d’organisation des organismes communautaires est encore peu documentée. Afin de pallier cette lacune, cette étude avait pour objectifs de documenter, décrire la nature de la participation des personnes utilisatrices de services en santé mentale et d’explorer des facteurs facilitatants et des barrières à cette participation. Un devis de méthodes mixtes, qualitatif et quantitatif, a été utilisé. Dans le premier de deux volets, une enquête impliquant la réalisation d’entretiens semi-dirigés a été menée auprès de douze directeurs d’organismes communautaires œuvrant dans le domaine des services en santé mentale. Une version française du questionnaire « Adapted User Involvement » (Diamond, Parkin, Morris, Bettinis, & Bettesworth, 2003) a été administrée afin de documenter l’étendue de la participation des personnes utilisatrices de services dans les organismes visés. Pour le deuxième volet, deux organismes communautaires ont été sélectionnés à partir des résultats du questionnaire et de l’analyse documentaire de documents publics de ces organismes. Les scores obtenus au questionnaire ont ainsi permis de sélectionner des organismes présentant des résultats contrastés en matière de participation des personnes utilisatrices de services. Les entretiens semi-dirigés ont été menés avec différents groupes de répondants (membres de conseil d’administration, personnes utilisatrices de services, employés, directeurs) afin de recueillir de l’information sur les thèmes suivants: la nature de la participation des personnes utilisatrices de services, ainsi que les facteurs facilitants et les défis qui y sont associés. Les résultats de l’analyse montrent que: (1) les facteurs qui favorisent la participation des personnes utilisatrices sont: l’accès à un espace de participation pour les personnes utilisatrices et l’accompagnement de celles-ci par les intervenants de diverses disciplines pendant leur participation au sein des organismes communautaires, (2) les barrières de la participation des personnes utilisatrices au sein des organismes communautaires sont la stigmatisation sociale et les caractéristiques personnelles reliées aux problèmes de santé mentale chez les personnes utilisatrices, et (3) les avantages principaux de la participation des personnes utilisatrices de services se déclinent en services mieux adaptés à leurs besoins et leurs demandes, en leur appropriation du pouvoir (dans leur participation dans l’organisme communautaire) et en leur sentiment d’appartenance à l’organisme. À la lumière des ces constats, l’accompagnement des personnes utilisatrices de services dans leur participation apparaît une avenue prometteuse pour les infirmières en santé mentale communautaire afin de faciliter leur appropriation du pouvoir et d’améliorer leur bien-être.

Health, Education and Employment in a Forward-Backward Dichotomy Based on Standard of Living Index for the Tribes in Kerala

The Paper unfolds the paradox that exists in the tribal community with respect to the development indicators and hence tries to cull out the difference in the standard of living of the tribes in a dichotomous framework, forward and backward. Four variables have been considered for ascertaining the standard of living and socio-economic conditions of the tribes. The data for the study is obtained from a primary survey in the three tribal predominant districts of Wayanad, Idukki and Palakkad. Wayanad was selected for studying six tribal communities (Paniya, Adiya, Kuruma, Kurichya, Urali and Kattunaika), Idukki for two communities (Malayarayan and Muthuvan) and Palakkad for one community (Irula). 500 samples from 9 prominent tribal communities of Kerala have been collected according to multistage proportionate random sample framework. The analysis highlights the disproportionate nature of socio-economic indicators within the tribes in Kerala owing to the failure of governmental schemes and assistances meant for their empowerment. The socio-economic variables, such as education, health, and livelihood have been augmented with SLI based on correlation analysis gives interesting inference for policy options as high educated tribal communities are positively correlated with high SLI and livelihood. Further, each of the SLI variable is decomposed using Correlation and Correspondence analysis for understanding the relative standing of the nine tribal sub communities in the three dimensional framework of high, medium and low SLI levels. Tribes with good education and employment (Malayarayan, Kuruma and Kurichya) have a better living standard and hence they can generally be termed as forward tribes whereas those with a low or poor education, employment and living standard indicators (Paniya, Adiya, Urali, Kattunaika, Muthuvans and Irula) are categorized as backward tribes

Community Participation in Ecotourism: An Inclusive Development Option for Kerala

The inferences obtained from the study are presented in coherent area-specific levels so as to understand the ecotourism and its sub-sector areas for the researchers and policy makers about the issues, importances and potentialities of the sector. An analysis of the tourism sector in Kerala has shown tremendous growth both in terms of tourist arrivals and in terms of revenue generation from direct and indirect sources. The foreign tourist visitors in Kerala in 2014 was 9,23,336 which shows 7.60 percent increase from the last year and the domestic tourist visitors were 1,16,95,411 which again shows 7.71 percent increase, is a clear evidence of its potential. In 2014 the industry contributed revenue of 24885.44 crores from direct and indirect sources giving rise to an increase of 12.11 percent from the last year. A dichotomy of tourists and ecotourists shows that tourists in the ecotourism destinations come to 42.6 percent of the total, shows the scope, significance and its potential. Correlation of zone-wise tourist arrivals based on the ecotourism destinations highlights the fact that with only 19 of the 64 destinations that come in the central zone are the most preferred centres (around 54 percent) for the domestic as well as foreign tourists. The north zone encompassing 6 districts with rich biodiversity shows that the tourists‟ arrival patterns exhibit less promising results. Though the north zone has 31 ecotourism destinations of the state receives only 6.19 percent of the foreign visitors. The ecotourism activities in the state are primarily managed by the Eco-Development Committees (EDCs) and the Vana Samrakshana Samithies (VSS) under the Forest Development Agency of Kerala. Social class-wise categorization of membership shows that 13142 families have membership in 190 EDCs with SC (28 percent), ST (33 percent) and other marginalised communities (39 percent). But this in the VSS shows that 400 VSS have 59085 members actively engaged in ecotourism activities and social category of the VSS makes clear that majority are from the other marginalized fringe households with 62 percent where as the participation of SC is 12 percent and ST is 26 percent. An evaluation of the socio-economic and demographic matrix of the community members involved in ecotourism activities brings out region specific differences. About 75.70 percent of the respondents are males and the rest are females. Majority of the respondents (about 60 percent) are in the age group of 20 to 40 years, followed by the age group of 40-50 (20 percent). The average age of respondents in the three zones is between 35 and 37 years. The majority of the respondents are married, a few are unmarried. Average family size is 4-5 members and differences are identified among zones. Average number of adults per household is 3 and child per household is 2. Majority have an education of 10th class and below i.e. about 60 percent of the sample have only basic school education like primary, secondary and high school (i.e. up to SSLC but not passed) level. About 18 percent are SSLC passed, 10 percent are undergraduates whereas 6 percent constitute respondents having qualification of graduation and above. Majority of the „graduates and above‟ are from south and central zone. Inter-zone differences in educational profile are also identified with lesser number of „graduates and above‟ are identified in the north zone compared to the other two zones. Investigating into the income and livelihood options of the respondents gives insight about the prominence of ecotourism as an employment and livelihood option for the community members, as more than 90 percent of the respondents have cited tourism sector as their main employment option. Most (49.30 percent) of respondents get 100 percent income from tourism related activities, followed by 37.30 percent of community members have income between 75-99 percent from tourism whereas the rest (13 percent) have less than 74 percent of their income from tourism and there exists difference between zones and percentage of income. Financial habit shows that about 49.7 percent hold active bank accounts, 61 percent have savings behaviour and 73.8 percent have indebtedness. Analysis about the ownership of house brings to light that 37 percent of respondents live in their own house followed by 25.7 percent in government funded/provided house and 21 percent in their parent‟s house and 3.5 percent in rented house. About 12 percent of the respondents have other kinds of accommodation facilities such as staff quarters, etc. But in the case of north zone majority i.e. 52 percent primarily depend on the government funded house indicating the effectiveness of government housing programme. Standard of living measured in SLI frameworks shows that majority of the respondents have medium SLI values (42.3 percent); the remaining 47.7 percent have low SLI and 10 percent have high SLI. The community members have been benefitted immensely from forest and its resources. Since the ecotourism destinations are located amidst the wildlife settings, majority of them depend on forest for their livelihood. The information on the tourist‟s demographic characteristics like age, sex, educational qualification and annual income show that the age category of domestic and foreign tourists falls below the age group of less than 35 years (about 65 percent), whereas only 16 percent of tourists are aged above 46 years. The age group below 25 years consists of more international tourists (31.3 percent) compared to the proportion of domestic tourists (12.5 percent). Male-female ratio shows that the males constitute 56 percent of the sample and females with 44 percent. The factors determining the impact of ecotourism programmes in the community was evaluated with the aid of a factor analysis with 12 selected statements. The worries and concerns of the community members about the impact of ecotourism on the environment are well understood from this analysis. It can be drawn that environment protection and the role of ecotourism in improving the income and livelihood options of the local communities is the most important factor concerning the community members.

Continuation and discontinuation of local institution in community based natural resource management

Currently the push toward frontier areas, which until twenty years ago were still largely untouched by commercial agriculture, is taking place on a massive scale. This push is being driven not the least by global economic developments, such as the price increase of agriculture commodities like coffee and cocoa. In most cases the indigenous communities become trapped between the state monopoly in natural resource management and the competition for resources by external actors. In this processes the indigenous communities start to lose their access to resources. Another victim in this process is the environment where the natural resources are imbedded. International and national organizations working to conserve environment have became conscious of the important role that indigenous people could fulfill as partners in this endeavour. This partnership in struggle has produced a new discourse on the relationship between indigenous people and their environment. As a further consequence, programs were set up to develop what became known as Community Based Natural Resource Management (CBNRM) with its numerous variations. Based on a case study in a village on the eastern border of the Lore Lindu National Park in Central Sulawesi, this study questioned the basic assumption behind the concept of Community Based Natural Resource Management (CBNRM). Namely the assumption that communities living at the margin of forest are socially and culturally homogenous, still more or less egalitarian, and basically living in harmony with their natural environment. This study was inspired by the persistent critique – although still a minority – on the basic assumption the CBNRM from academicians and practitioners working through the Entitlement perspective. Another inspiration was the mounting critique toward the participatory approach. In its effort the study explore further the usefulness of certain approaches. One of the approach much relied on in this study was the local history of the community studied, through exerting oral and local written documents on local history, legends and local stories. These sources proofed quite capable in bringing the local history into the light. Another was the actor oriented approach, which later came to be supported by the concept of Social Pool Resources. The latter concept proofed to be useful as analytical instrument to integrate social institutions and the common pool resources, as a field of action for the different actors as human agencies.

Effects of grassland conversion and tillage intensities on soil microbial biomass, residues and community structure

Agricultural intensification has a strong impact on level of soil organic matter (SOM), microbial biomass stocks and microbial community structure in agro-ecosystems. The size of the microbial necromass C pool could be about 40 times that of the living microbial biomass C pool in soils. Due to the specificity, amino sugar analysis gives more important information on the relative contribution of fungal and bacterial residues to C sequestration potential of soils. Meanwhile, the relationship between microbial biomass and microbial necromass in soil and its ecological significance on SOM are not fully understood and likely to be very complex in grassland soils. This thesis focuses on the effects of tillage, grassland conversion intensities and fertilisation on microbial biomass, residues and community structure. The combined analyses of microbial biomass and residue formation of both fungi and bacteria provided a unique opportunity to study the effect of tillage, grassland conversion and fertilisation on soil microbial dynamics. In top soil at 0-30 cm layer, a reduction in tillage intensity by the GRT and NT treatments increased the accumulation of saprotrophic fungi in comparison with the MBT treatment. In contrast, the GRT and NT treatments promoted AMF at the expense of saprotrophic fungi in the bottom soil layer at 30-40 cm depth. The negative relationship between the ergosterol to microbial biomass C ratio and the fungal C to bacterial C ratio points to the importance of the relationship between saprotrophic fungi and biotrophic AMF for tillage-induced changes in microbial turnover of SOC. One-season cultivation of winter wheat with two tillage events led to a significant loss in SOC and microbial biomass C stocks at 0-40 cm depth in comparison with the permanent grassland, even 5 years after the tillage event. However, the tillage induced loss in microbial biomass C was roughly 40% less in the long-term than in the short-term of the current experiment, indicating a recovery process during grassland restoration. In general, mould board tillage and grassland conversion to maize monoculture promoted saprotrophic fungi at the expense of biotrophic AMF and bacteria compared to undisturbed grassland soils. Slurry application promoted bacterial residues as indicated by the decreases in both, the ergosterol to microbial biomass C ratio and the fungal C to bacterial C ratio. In addition, the lost microbial functional diversity due to tillage and maize monoculture was restored by slurry application both in arable and grassland soils. I conclude that the microbial biomass C/S ratio can be used as an additional indicator for a shift in microbial community. The strong relationships between microbial biomass and necromass indices points to the importance of saprotrophic fungi and biotrophic AMF for agricultural management induced effects on microbial turnover and ecosystem C storage. Quantitative information on exact biomass estimates of these two important fungal groups in soil is inevitably necessary to understand their different roles in SOM dynamics.

Effect of Community of Residence on Neurobehavioral Development in Infants and Young Children in a Flower-Growing Region of Ecuador

In this study we compared neurobehavioral development in Ecuadoran children living in two communities with high potential for exposure to organophosphate (OP) and carbamate pesticides to that of children living in a community with low potential for exposure. Residence in communities with high potential for exposure to OP and carbamate pesticides was associated with poorer neurobehavioral development of the child even after controlling for major determinants of delayed development. Malnourished populations may be particularly vulnerable to neurobehavioral effects of pesticide exposure.

Living with ASD: how do children and their parents assess their difficulties with social interaction and understanding?

Social interaction and understanding in autistic spectrum disorder (ASD) are key areas of concern to practitioners and researchers alike. However, there is a relative lack of information about the skills and competencies of children and young people with ASD who access ordinary community facilities including mainstream education. In particular, contributions by parents and their children have been under-utilized. Using two structured questionnaires, 19 children with ASD reported difficulties with social skills including social engagement and temper management and also reported difficulties with social competence, affecting both friendships and peer relationships. Parents rated the children's social skill and competence as significantly worse than did the children themselves, but there was considerable agreement about the areas that were problematic. Using an informal measure to highlight their children's difficulties, parents raised issues relating to conversation skills, social emotional reciprocity and peer relationships. The implications for assessment and intervention are discussed.