Nurturing attachments in looked after children: a feasibility study of a group-based programme for carers

Introduction: The attachment related difficulties of Looked after Children are well recognised in literature with difficulties linked to early experiences hypothesised to be perpetuated by experiences of the care system itself. Recent policy guidelines have emphasised the importance of relationships for children in care, one of the most important being with their primary carer. Golding (2014) published a group format training resource entitled ‘Nurturing Attachments’ which aims to promote ‘therapeutic parenting’; however there is limited knowledge on the feasibility of this intensive approach.
Aims: To assess the feasibility of Nurturing Attachments through exploring (i.) recruitment, retention and attrition, (ii.) initial outcomes, (iii.) acceptability and (iv.) ability of the programme to be delivered in line with the manual content and structure.
Method Two Health and Social Care Trusts in NI participated in the study by facilitating a Nurturing Attachments group in each site with adoptive parents, foster carers and kinship carers (N = 26). Carers completed pre and post measures to explore initial outcome, completing an evaluation questionnaire to explore acceptability. Acceptability was also explored with Trust stakeholders and group facilitators through focus group and interview. To explore if the manual can be delivered as intended, each group completed debrief tools.
Results: The overall response rate for uptake was 13.9%, which impacted on engagement for a ‘treatment as usual’ group. Once engaged in the programme, attrition was low and attendance was high. Initial outcomes have shown positive effects for both young person and carers. Feedback suggests a positive response regarding acceptability with limited expressed concern. The manual can be delivered in a standardised way; however can be flexible enough to allow for group processes.
Conclusions: Further research is needed to continue to explore efficacy, however the current study has provided supporting evidence that Nurturing Attachments as an intervention has positively impacted on many levels of the LAAC system.

Healthcare Staff Experience of Providing End-of-Life Care to Children: A Mixed Method Review

Background: Staff who provide end-of-life care to children not only have to deal with their own sense of loss, but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges.
Aim: The aim of this review is to explore the experiences of health care professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families.
Data sources: Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO, and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care.
Design: This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data.
Results: The 16 qualitative, six quantitative, and eight mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff’s personal and professional lives, coping strategies, and key approaches to help support staff in their role.
Conclusions: Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing are key strategies for improving healthcare staffs’ experiences, and as such the quality of care they provide.

(Re)examining the relationship between children's subjective wellbeing and their perceptions of participation rights

In recent years wellbeing has been linked increasingly with children’s rights, often characterised as central to their realisation. Indeed it has been suggested that the two concepts are so intertwined that their pairing has become something of a mantra in the literature on childhood. This paper seeks to explore the nature of the relationship between wellbeing and participation rights, using a recently developed ‘rights-based’ measure of children’s participation in school and community, the Children’s Participation Rights Questionnaire (CPRQ), and an established measure of subjective wellbeing – KIDSCREEN-10. The data for the study came from the Kids’ Life and Times (KLT) which is an annual online survey of Primary 7 children carried out in Northern Ireland. In 2013 approximately 3,800 children (51% girls; 49% boys) from 212 schools participated in KLT. The findings showed a statistically significant positive correlation between children’s overall scores on the KIDSCREEN-10 subjective wellbeing measure and their perceptions that their participation rights are respected in school and community settings. Further, the results indicated that it is the social relations/autonomy questions on KIDSCREEN-10 which are most strongly related to children’s perceptions that their participation rights are respected. Exploration of the findings by gender showed that there were no significant differences in overall wellbeing; however girls had higher scores than boys on the social relations/autonomy domain of KIDSCREEN-10. Girls were also more positive than boys about their participation in school and community. In light of the findings from this study, it is suggested that what lies at the heart of the relationship between child wellbeing and children’s participation rights is the social/relational aspects of both participation and wellbeing.

Systematic Review of the Measurement Properties of Tools Used to Measure Behaviour Problems in Young Children with Autism

Background
Behaviour problems are common in young children with autism spectrum disorder (ASD). There are many different tools used to measure behavior problems but little is known about their validity for the population.

Objectives
To evaluate the measurement properties of behaviour problems tools used in evaluation of intervention or observational research studies with children with ASD up to the age of six years.

Methods
Behaviour measurement tools were identified as part of a larger, two stage, systematic review. First, sixteen major electronic databases, as well as grey literature and research registers were searched, and tools used listed and categorized. Second, using methodological filters, we searched for articles examining the measurement properties of the tools in use with young children with ASD in ERIC, MEDLINE, EMBASE, CINAHL, and PsycINFO. The quality of these papers was then evaluated using the COSMIN checklist.

Results
We identified twelve tools which had been used to measure behaviour problems in young children with ASD, and fifteen studies which investigated the measurement properties of six of these tools. There was no evidence available for the remaining six tools. Two questionnaires were found to be the most robust in their measurement properties, the Child Behavior Checklist and the Home Situations Questionnaire—Pervasive Developmental Disorders version.

Conclusions
We found patchy evidence on reliability and validity, for only a few of the tools used to measure behaviour problems in young children with ASD. More systematic research is required on measurement properties of tools for use in this population, in particular to establish responsiveness to change which is essential in measurement of outcomes of intervention.

PROSPERO Registration Number

CRD42012002223

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: An evidence synthesis

DESIGN We will address our research objectives by searching the published and unpublished literature and conducting an evidence synthesis of i) studies of the effectiveness of psychosocial interventions provided for children and adolescents who have suffered maltreatment, ii) economic evaluations of these interventions and iii) studies of their acceptability to children, adolescents and their carers. SEARCH STRATEGY: Evidence will be identified via electronic databases for health and allied health literature, social sciences and social welfare, education and other evidence based depositories, and economic databases. We will identify material generated by user-led,voluntary sector enquiry by searching the internet and browsing the websites of relevant UK government departments and charities. Additionally, studies will be identified via the bibliographies of retrieved articles/reviews; targeted author searches; forward citation searching. We will also use our extensive professional networks, and our planned consultations with key stakeholders and our study steering committee. Databases will be searched from inception to time of search. REVIEW STRATEGY Inclusion criteria: 1) Infants, children or adolescents who have experienced maltreatment between the ages of 0 17 years. 2) All psychosocial interventions available for maltreated children and adolescents, by any provider and in any setting, aiming to address the sequelae of any form of maltreatment, including fabricated illness. 3) For synthesis of evidence of effectiveness: all controlled studies in which psychosocial interventions are compared with no-treatment, treatment as usual, waitlist or other-treated controls. For a synthesis of evidence of acceptability we will include any design that asks participants for their views or provides data on non-participation. For decision-analytic modelling we may include uncontrolled studies. Primary and secondary outcomes will be confirmed in consultation with stakeholders. Provisional primary outcomes are psychological distress/mental health (particularly PTSD, depression and anxiety, self-harm); ii) behaviour; iii) social functioning; iv) cognitive / academic attainment, v) quality of life, and vi) costs. After studies that meet the inclusion criteria have been identified (independently by two reviewers), data will be extracted and risk of bias (RoB) assessed (independently by two reviewers) using the Cochrane Collaboration RoB Tool (effectiveness), quality hierarchies of data sources for economic analyses (cost-effectiveness) and the CASP tool for qualitative research (acceptability). Where interventions are similar and appropriate data are available (or can be obtained) evidence synthesis will be performed to pool the results. Where possible, we will explore the extent to which age, maltreatment history (including whether intra- or extra-familial), time since maltreatment, care setting (family / out-of-home care including foster care/residential), care history, and characteristics of intervention (type, setting, provider, duration) moderate the effects of psychosocial interventions. A synthesis of acceptability data will be undertaken, using a narrative approach to synthesis. A decision-analytic model will be constructed to compare the expected cost-effectiveness of the different types of intervention identified in the systematic review. We will also conduct a Value of information analysis if the data permit. EXPECTED OUTPUTS: A synthesis of the effectiveness and cost effectiveness of psychosocial interventions for maltreated children (taking into account age, maltreatment profile and setting) and their acceptability to key stakeholders.

Cross-readings and ecoliteracy in children's pop-up books

The purpose of this text is to analyse two recently been published pop-up books aimed at children, by Anouck Boisrobert e Louis Rigaud, Popville (2009) and Dans la forêt du paresseux [Wake up, Sloth!, En el bosque del perezoso] (first published in 2009 and 2012, accompanied with texts by Joy Sorman and Sophie Strady, respectively). These books were published originally in France by Hélium Editions, but they can now be found in several western countries and in many languages (Catalan, French, Dutch, English, German, Italian, Portuguese and Spanish, at least). The objective is to analyse their verbal text and their visual aspects produced by a sophisticated paper engineered to question how they achieve what seems to be one of their goals, the promotion of the readers' ecoliteracy (Orr, 1992) by his involvement in the reading process. This issue seems to be one of the main trends on children's literature in western societies nowadays, transcending the traditional and almost omnipresent role of scenario that nature plays in many children's narratives.

Environmental risk factors for the initial acquisition of Pseudomonas aeruginosa in young children with cystic fibrosis

Thesis (Ph.D.)--University of Washington, 2013

Supporting the Supporter: Social Support, Stress, and Well-being among Caregivers of Children with Severe Disabilities

Thesis (Ph.D.)--University of Washington, 2014

Reciprocal relations across time between basic values and value-expressive behaviors: A longitudinal study among children

Tracing children’s values and value-expressive behavior over a sixth-month period, we examined stability and change of values and behavior and the reciprocal relations between them. Three hundred and ten sixth-grade students in Italy completed value and value-expressive behavior questionnaires three times in three-month intervals during the scholastic year. We assessed Schwartz's (1992) higher-order values of conservation, openness to change, self-enhancement, and self-transcendence, as well as their respective expressive behaviors. Reciprocal relations over time between values and behaviors were examined using a cross-lagged longitudinal design. Results showed that values and behaviors had reciprocal longitudinal effects on one another, after the stability of the variables was taken into account (i.e., values predicted change in behaviors, but also behaviors predicted change in values). Our findings also revealed that: (1) values were more stable over time than behaviors, and (2) the longitudinal effect of values on behaviors tended to be stronger than the longitudinal effect of behaviors on values. Findings are discussed in light of the recent developmental literature on value change.

An educator's perspective of Dr. Feingold's K-P (Kaiser- Permanents) elimination diet for hyperkinetic children and others

Do evaluation of the literature and a regional observational report support Dr. Feingold's claim that the K-P (Kaiser-Permanente) elimination diet improves the behaviours of hyperkinetic children, and others? Dr. Feingold suggests that some hyperkinetic children, and other children as well, are genetically predisposed to intolerance of food additives, particularly food colours and flavours. He claims that the K-P diet, that eliminates salicylates and artificial food colours and flavours, improves the hyperkinetic child's behaviour, muscle co-ordination, and scholastic performance. Public acceptance of the K-P diet has outstripped acceptance in the medical and scientific communities. Evaluation of available data and additional studies are needed to arrive at a conclusion of acceptance or rejection of the K-P diet for hyperkinetic children and others. My interest in the K-P elimination diet for hyperkinetic children is educational. My experience as an elementary school teacher in special education and in the classroom from K-8 has taught me that attentiveness is crucial to learning. Hyperkinesis appears to impair a child's ability to attend. Learning problems appear, followed by behavioural and social problems. l If we accept the possibility of a relationship between diet and attentiveness, and attentiveness and school behaviours, then the diet-behaviour link could be of lay importance. For instance, if a diet such as the K-P diet could do what is claimed, substantial benefits could accrue to the child. One could, for example, improve a child's behaviours. One could identify attending disturbances early in the child's education, possibly minimizing, or eliminating future difficulties in school. Finally, the greatest benefit may be the fulfillment of the basic goal of our Ontario schools, that the eh~ld-,lIla1p.evelop happily and competently within our educational framework. 2 This thesis reports evidence from the literature and from a regional observational investigation to determine the possibility of a link between the behaviours of children and Dr. Feingold's K-P elimination diet. The literature research examines (1) Dr. Feingold's concept of H-LD, (2) his K-P elimination diet, and (3) the response from three sectors, medicine, science, and the public. The regional investigation examines the observed behaviours of nine children in Regional Niagara during a nine-month period on the K-P diet.

Effectiveness of instructional strategies based on schema theory on attention deficit disorder children

A review of the literature reveals that there are a number of children in the educational system who are characterized by Attention Deficit Disorder. Further review of the literature reveals that there are information processing programs which have had some success in increasing the learning of these children. Currently, an information processing program which is based on schema theory is being implemented in Lincoln County. Since schema theory based programs build structural, conditional, factual, and procedural schemata which assist the learner in attending to salient factors, learning should be increased. Thirty-four children were selected from a random sampling of Grade Seven classes in Lincoln County. Seventeen of these children were identified by the researcher and classroom teacher as being characterized by Attention Deficit Disorder. From the remaining population, 17 children who were not characterized by Attention Deficit Disorder were randomly selected. The data collected were compared using independent t-tests, paired t-tests, and correlation analysis. Significant differences were found in all cases. The Non-Attention Deficit Disorder children scored significantly higher on all the tests but the Attention Defici t Disorder children had a significantly higher ratio of gain between the pretests and posttests.

The effectiveness of a multisensory writing program in improving cursive writing ability in children with sensorimotor difficulties

It is estimated that five to ten percent of children experience sensory motor difficulties that result in various learnlng disabilitiies , among them. inabllity to output Information on paper in the appropriate manner (Ayres ,1985). The relationship between sensorimotorabillty and handwriting is well documented in the literature (Freeman,1917; Townsend , 1951; Nlkola-Ll sa, 1987). While much of the literature is inconclusive, there are findings to suggest that muitisensory handwriting programmes are an effective approach to improvlng writing abIlity in these chlldren. For a number of years, Occupational Therapists have been involved in the remediation of handwriting utllizing , amongst other approaches . multisensory programmes. While subjective assessments of effectiveness have been extremerly positive. scientIfic evaluation has been minimal . If further intervention in this area is to occur, it Is essential that the profession be able to justify the existence of such programmes . The purpose of this study was to examine what effects a multlsensory writing prog~am would have on the curslve writing ability of chlldren with sensorimotor dlfficulties. A single case with multiple baselines across be havlours design was used , with the behavlours being cursive writing abilIty of fIve distInct letter groups. The fIve groups were taught in random order, one group every two weeks , In a one-hour session. Repeated measurements of writing speed and qualIty for each letter group were made. This design was repeated over three other cases . Results of the study yielded statistical signifi cance in trend changes In specIfic letter groups for all of the chlldren following interventlon. One child achieved statistical significance In the overall change In quality , while none of the children achieved overall statistical significance In speed score changes . Teacher reports and an assessment of written language prior to and following the program suggest that Intervention may have had a positive effect on self-confidence in written output, and on the maturlty of written expression in some of the cases . Further research in this field is needed to validate the continual use of multisensory writing programmes by Occupational Theraplsts worklng with this specific population and to provide some directlon with regards to the Integration of multlsensory writing programmes within the regular academic remedial programme .

Investigating the association between motor proficiency and body satisfaction in grade 5 children

The inverse relationships between motor proficiency and overweight, and between overweight and body satisfaction have been well documented. However, the association between motor proficiency and body satisfaction has been largely neglected in the literature. Knowledge of the influence that low motor proficiency may have on body satisfaction is essential if the full burden that those children with poor motor abilities face is to be fully recognized, as low body satisfaction has been linked to an increased risk for low self-esteem, depression, and disordered eating. The cohort investigated in this report included 1907 (971 males, 936 female) Grade 5 students from the Physical Health Activity Study Team (PHAST) project in the Niagara Region of Southern Ontario. Children were grouped as overweight or healthy weight (using BMI cut offs for age and gender), and as low motor proficiency or normal motor proficiency (cut-off set at lowest 10% Bruininks Oseretsky Test of Motor Proficiency-short form (BOTMPsf). It was apparent from analyses of variance (ANOVAs) by gender that boys demonstrated significantly higher motor proficiency scores. As a result separate multiple logistic regressions by gender were used to determine the relationship between body satisfaction, BMI, and motor proficiency. There was a significant relationship between BMI and body satisfaction for both genders (p<0.01) and for males a significant relationship between motor proficiency and body satisfaction (p<0.03). Overweight females were less likely to be satisfied with their bodies with an odds ratio (OR) of 0.33 (CI: 0.23-0.47). The same trend was found in overweight males (OR: 0.42, CI: 0.29-0.59). Males with low motor proficiency were significantly less satisfied with their bodies (OR: 0.53, CI: 0.29-0.97). Males with poor motor proficiency were at greater risk for low body satisfaction regardless of their overweight status. Overweight is known to be prevalent among children with low motor proficiency and, these results indicate that low body satisfaction is also a significant concern. These findings confirm that attention needs to be paid to perceptions of body satisfaction among children with low motor proficiency. This is particularly true for boys, as their bodies may fail them in two common societal expectations, shape and skill and for whom their risk of low body satisfaction is heightened by their poor motor proficiency.

Global migration : patriarchy, propoganda and the well- being of women and children

This critical analysis explores the conflicted position of women as ''trailing spouses" and the effects on families who relocate globally under the auspices of a multinational corporation, by utilizing a discursive analysis of two contemporary films and available literature. Current portrayals of women and children in contemporary media provide emotional yet conflicting images of the perfect woman, wife, mother, child and family. The basic tenets of a North American patriarchal economic system are being televised around the world. Technological advancements have made it possible to advertise political agendas on a global television screen. Much of what we see is propaganda couched in films and advertisements that are designed to romantic~e the practice of deriving profits from the unpaid labor of woman and invisibility of children and child rearing. I intend to show that the materiality of trailing a spouse globally conflicts with these romanticized images and supports feminist literature that asserts the notion that mothers and children are oppressed and managed for the benefit of capital.

Physical Activity and Fitness in Children with Developmental Disorder

Introduction: Developmental coordination disorder (DCD) is a prevalent condition characterized by poor motor proficiency that interferes with a child‟s activities of daily living. Children with DCD often experience compromised health-related fitness components such as cardiorespiratory fitness (CRF). Purpose: To better understand the physical activity and fitness characteristics of children with probable DCD (pDCD), with a particular focus on CRF. Specifically: (1) to present a synopsis of current literature; (2) to determine the longitudinal trajectories of CRF; (3) to compare the submaximal CRF of children with and without pDCD. Methods: A comprehensive, systematic literature review was conducted of the recent available data on fitness and physical activity and pDCD (Chapter 2). This review provided the background for the other two studies included in this thesis. In Chapter 3, a prospective cohort design was used to assess how CRF in children with pDCD changes over time (56 months) relative to a group of typically developing controls. Using a nested-case control design, 63 subjects with pDCD and 63 matched controls from the larger sample were recruited to participate in the lab-based component of the study (Chapter 4). In this investigation CRF was examined using the oxygen cost of work (VO2) during an incremental test on a cycle ergometer. Results: The literature review showed that fitness parameters, including CRF and physical activity levels, were consistently reduced in children with pDCD. Chapter 3 demonstrated that the difference in CRF between children with pDCD and typically developing children is substantial, and that it tends to increase over time. Results from VO2 assessments showed that children with pDCD utilized more oxygen to sustain the same submaximal workloads compared to typically developing children. Conclusions: Findings from this thesis have made several important contributions to our understanding of children with pDCD. Since differences in CRF between children with and without pDCD tend to worsen over time, this adds to the argument that interventions intended to improve CRF may be appropriate for children with motor difficulties. This thesis also presented the first evidence suggesting that DCD involves higher energy expenditure, and could help explain why children with pDCD perform poorly on tasks requiring CRF.