Adherence to treatment in children and adolescents with cystic fibrosis:a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms

Background: Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence. Methods: A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results: Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence. Conclusions: Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children.

Developing a tool to support communication of parental concerns when a child is in hospital

The involvement of parents in their child’s hospital care has been strongly advocated in paediatric healthcare policy and practice. However, incorporating parental worries about their child’s condition into clinical care can be difficult for both parents and healthcare professionals. Through our “Listening To You” quality improvement project we developed and piloted an innovative approach to listening, incorporating and responding to parental concerns regarding their child’s condition when in hospital. Here we describe the phases of work undertaken to develop our “Listening To You” communications bundle, including a survey, literature review and consultation with parents and staff, before findings from the project evaluation are presented and discussed.

Parent emotional functioning, parent responsiveness, and child adjustment

Over the past two decades, interest in the psychological development of children has steadily increased (Beg, Casey, & Saunders, 2007), presumably because statistics describing childhood psychological illness are alarming. Certain parent interaction styles or behaviors are known to influence child adjustment. According to attachment theory, the reason for these findings is that interaction with a caregiver informs an individual’s construction of an internal working model (IWM) of the self in relation to others in the environment. The purpose of this study was to gain a greater understanding of the factors contributing to child adjustment by examining the influence of parents’ emotional functioning and parent responsiveness to children’s bids for interaction. This dissertation tested a multivariate model of attachment-related processes and outcomes with an ethnically diverse sample. Results partially supported the model, in that parent emotional intelligence predicted some aspects of child adjustment. Overall, the study adds to knowledge about how parent characteristics influence child adjustment and provides support for conceptualizing emotional intelligence as a concrete and observable manifestation of the nonconscious attachment IWM.

The Effectiveness of an Online Workshop on Behavior Management as a Professional Development Tool for Teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development.

Comparison of parental perception and therapist interpretation of child's performance of the Peabody Fine Motor Scale

Public Law 102-119 (Individuals with Disabilities Education Act of 1991), mandates that family members, if they wish, participate in developing a plan of treatment for their child. Traditionally, therapist have not relied on parental assessments based upon the assumption that parents overestimate their child's abilities. The present study compared parental perceptions about the developmental status of their child's fine motor abilities to the therapist's interpretation of a standardized assessment using the Peabody Developmental Motor Scale (Fine Motor). Thirty seven children, enrolled in an early intervention program, and their parents were recruited for the study. The results indicated that the parents and the therapist estimates were highly correlated and showed no significant differences when paired t-tests were computed for developmental ages and scaled scores. However, analyses of variances were significantly correlated for gender and number of siblings.

The ecocultural context and child behavior problems: A qualitative analysis in rural Nepal.

Commonly used paradigms for studying child psychopathology emphasize individual-level factors and often neglect the role of context in shaping risk and protective factors among children, families, and communities. To address this gap, we evaluated influences of ecocultural contextual factors on definitions, development of, and responses to child behavior problems and examined how contextual knowledge can inform culturally responsive interventions. We drew on Super and Harkness' "developmental niche" framework to evaluate the influences of physical and social settings, childcare customs and practices, and parental ethnotheories on the definitions, development of, and responses to child behavior problems in a community in rural Nepal. Data were collected between February and October 2014 through in-depth interviews with a purposive sampling strategy targeting parents (N = 10), teachers (N = 6), and community leaders (N = 8) familiar with child-rearing. Results were supplemented by focus group discussions with children (N = 9) and teachers (N = 8), pile-sort interviews with mothers (N = 8) of school-aged children, and direct observations in homes, schools, and community spaces. Behavior problems were largely defined in light of parents' socialization goals and role expectations for children. Certain physical settings and times were seen to carry greater risk for problematic behavior when children were unsupervised. Parents and other adults attempted to mitigate behavior problems by supervising them and their social interactions, providing for their physical needs, educating them, and through a shared verbal reminding strategy (samjhaune). The findings of our study illustrate the transactional nature of behavior problem development that involves context-specific goals, roles, and concerns that are likely to affect adults' interpretations and responses to children's behavior. Ultimately, employing a developmental niche framework will elucidate setting-specific risk and protective factors for culturally compelling intervention strategies.

The Perspectives of Gay, Bisexual, and Queer Adolescent Males with Parent-Child Sex Communication

Problem: Gay, bisexual, and queer (GBQ) adolescent males are disproportionately affected by negative sexual health outcomes compared to their heterosexual counterparts. Their sex education needs are not sufficiently addressed in the home and the larger ecological systems. The omission of their sex education needs at a time when they are forming a sexual identity during adolescence compels GBQ males to seek information in unsupervised settings. Evidence-based interventions aimed at ensuring positive sexual health outcomes through sex communication cannot be carried out with these youth as research on how parents and GBQ males discuss sex in the home has been largely uninvestigated.

Methods: This naturalistic qualitative study focused on the interpretive reports of 15- to 20-year-old GBQ males’ discussions about sex-related topics with their parents. From a purposive sample of 30 male adolescents who self-identified as GBQ, participants who could recall at least one conversation about sex with their parents were recruited for one-time interviews and card sorts. This strategy revealed, using Bronfenbrenners’ Bioecological Theory, their perceptions about sex communication in the context of their reciprocal relationship and the ecological systems that GBQ males and their parents navigate.

Results: Parents received poor ratings as sex educators, were generally viewed as not confident in their communication approach, and lacked knowledge about issues pertinent to GBQ sons. Nevertheless, participants viewed parents as their preferred source of sex information and recognized multiple functions of sex communication. The value placed by GBQ youth on sex communication underscores their desire to ensure an uninterrupted parent-child relationship in spite of their GBQ sexual orientation. For GBQ children, inclusive sex communication is a proxy for parental acceptance.

Results show that the timing, prompts, teaching aids, and setting of sex communication for this population are similar to what has been reported with heterosexual samples. However, most GBQ sons rarely had inclusive guidance about sex and sexuality that matched their attraction, behavior, and identities. Furthermore, the assumption of heterosexuality resulted in the early awareness of being different from their peers which led them to covertly search for sex information. The combination of assumed heterosexuality and their early reliance on themselves for applicable information is a missed parental opportunity to positively impact the health of GBQ sons. More importantly, due to the powerful reach of new media, there is a critical period of maximum receptiveness that has been identified which makes inclusive sex communication paramount in the pre-sexual stage for this population. Our findings also indicate that there are plenty of opportunities for systemic improvements to meet this population’s sexual education needs.

All in the Family? Parental Roles in the Epidemic of Childhood Obesity

Childhood obesity is a serious global health challenge. Families and consumption are at the nexus of the problem, as childhood weight issues depend significantly on family-related influences (genetic predispositions, physical activities, and household food consumption practices). This article focuses on how a family socializes a child toward or away from obesity. It advances a family consumer socialization framework to characterize key elements and processes. Biological predispositions, parent/family inputs, elements of child development, parent-child interactions, and intergenerational transfer are all major contributors to weight status and life course potentials. Time is also a crucial component, here represented in two forms -- linear and cyclical. Drawing on extensive research from other disciplines and related consumer research, five “Foundational Properties” are distilled, representing fundamental tenets underpinning the family’s role in this problem. Each property is then used to chart promising opportunities for consumer researchers and others interested in advancing knowledge on this pressing concern.

Cortisol Awakening Response in Preschoolers and Depression Risk: Relations with Maternal History of Depression and Child Temperament

Increasing research suggests that elevations in the cortisol awakening response (CAR), the natural increase of cortisol 30 to 40 minutes after waking, may serve as a vulnerability marker for depression. However, existing studies have focused on adolescence and adulthood; very little is known about the CAR in early childhood and the factors that are associated with it. The current study aimed to examine the validity of the CAR as a potential early-emerging vulnerability marker for depression in a sample of preschool-age children. We examined associations between the CAR and two well-established risk factors for depression: maternal psychopathology and early child temperament (high negative emotionality (NE) and/or low positive emotionality (PE)). The sample consisted of 146 preschool-age children, of whom 71 (49.3%) had a biological mother with a history of depression and 65 (45.5%) had a biological mother with a history of anxiety. To assess the CAR, salivary cortisol samples were collected from the child upon waking, 30 and 45 minutes post-waking on two weekdays. Children’s CAR was examined as the total volume of cortisol secreted (AUCg) and the total increase in cortisol (AUCi) across waking. Evening cortisol was collected 30 minutes before bedtime. Child temperament was assessed using observational laboratory measures. Maternal depression and anxiety were assessed with clinical interviews. Associations with children’s CAR, as indicated by AUCg or AUCi, appeared to be specific to maternal current psychopathology and symptoms of anhedonia. Additionally, we observed significant interactions for both maternal lifetime and current depression and anxiety, in combination with child NE and PE, on elevated evening cortisol levels and flattened diurnal cortisol rhythms, indicating altered patterns of basal cortisol activity in offspring. Our study contributes to the limited but growing knowledge on the development of the CAR in preschool age children and as a marker of early risk. Findings suggest that there is a complex interplay between familial risk, affective vulnerability, and their joint effects on neuroendocrine dysfunction in young children, and highlight the need for future research to examine which aspects of the early diurnal rhythm predict the emergence of later depressive illness.

The effectiveness of an online workshop on behavior management as a professional development tool for teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1 st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development. ^

Research Monograph: The role of community and lifestyle in the making of a knowledge city

Our brief is to investigate the role of community and lifestyle in the making of a globally successful knowledge city region. Our approach is essentially pragmatic. We start by broadly examining knowledge-based urban development from a number of different perspectives. The first view is historical. In this context knowledge work and knowledge workers are seen as vital parts of a new emergent mode of production reliant on the continual production of abstract knowledge. We briefly develop this perspective to encompass the work of Richard Florida who has, notedly, claimed: “Wherever talent goes, innovation, creativity, and economic growth are sure to follow.” Our next perspective examines concepts of knowledge and modes of its production to discover knowledge is not an unchanging object but a human activity that changes in form and content through history. The suggestion emerges that not only is the production of contemporary ‘knowledge’ organised in a specific (and new) manner but also the output of this networked production is a particular type of knowledge (i.e. techné). The third perspective locates knowledge production and its workers in the contemporary urban context. As such, it co-ordinates the knowledge city in the increasingly global structure of cities and develops a typology of different groups of knowledge workers in their preferred urban environment(s). We see emerging here a distinctive geography of knowledge production. It is an urban phenomenon. There is, in short, something about the nature of cities that knowledge workers find particularly attractive. In the next, essentially anthropological, perspective we start to explore the needs and desires of the individual knowledge worker. Beyond the needs basic to any modern human household an attempt is made to deduce, from a base understanding of knowledge work as mental labour, the compensatory cultural needs of the knowledge worker when not at work - and the expression of these needs in the urban fabric. Our final perspective consists of two case studies. In a review of the experiences of Austin, Texas and Singapore’s one-north precinct we collect empirical data on, respectively, a knowledge city that has sustained itself for over 50 years and an urban precinct newly launched into the global market for knowledge work and knowledge workers. Interwoven The Role of Community and Lifestyle in the Making of a Knowledge City Urban Research Program 8 through all perspectives, in the form of apposite citation, is that of ‘expert opinion’ gathered in a rudimentary poll of academic and industry sources. This opinion appears in text boxes while details of the survey can be found in Appendix A. In the conclusion of the report we interpret the wide range of evidence gathered above in a policy frame. It is our hope this report will leave the reader with a clearer picture of the decisive organisational, infrastructural, aesthetic and social dimensions of a knowledge precinct.

Fathers as informants of children’s fears and worries

The recognition of excessive fears and worries in children is important for early intervention. Despite current knowledge about the important contribution fathers make to their children’s emotional, social and cognitive development, more emphasis is often given to the views of mothers in both research and practice. This paper reports on a community study of 220 families. Fathers, mothers and children reported on children’s fears and worries using three different methods. While father and mother ratings were moderately correlated on two of the measures, there was relatively poor parent-child agreement. Implications for the role of fathers in the assessment of childhood fears and worries are discussed.

Grandparenting a child with a disability: An emotional rollercoaster.

Objectives: As our knowledge about the experiences of grandparents when their grandchild has a disability is extremely limited, the purpose of this research was to explore the emotional journey of Australian grandparents. Method: This qualitative research utilised purposive sampling and semi-structured in-depth interviews to explore the experiences of 22 Australian grandparents, whose grandchild had been diagnosed with a disability. Results: Three key themes characterised grandparent’s emotional journey: Adjusting (the transition from anger to acceptance), The ‘Double Grief’ (sadness about what might have been for both their child and grandchild) and Pride in Family (pride in family’s ability to adjust to the challenges of the situation). Conclusion: As the first Australian study to explore the experiences of grandparents when their grandchild has a disability, the research provides important new knowledge about the emotional journey for grandparents. Unlike overseas research, Australian grandparents view themselves as being there to support their own children, rather than ‘holding the family together’. The findings will inform current policy debates about the role of grandparents and highlight the importance of support services that help facilitate grandparent’s role within their family

A decision support system for sustainable urban development : the integrated land use and transportation indexing model

The broad definition of sustainable development at the early stage of its introduction has caused confusion and hesitation among local authorities and planning professionals. The main difficulties are experience in employing loosely-defined principles of sustainable development in setting policies and goals. The question of how this theory/rhetoric-practice gap could be filled will be the theme of this study. One of the widely employed sustainability accounting approaches by governmental organisations, triple bottom line, and applicability of this approach to sustainable urban development policies will be examined. When incorporating triple bottom line considerations with the environmental impact assessment techniques, the framework of GIS-based decision support system that helps decision-makers in selecting policy option according to the economic, environmental and social impacts will be introduced. In order to embrace sustainable urban development policy considerations, the relationship between urban form, travel pattern and socio-economic attributes should be clarified. This clarification associated with other input decision support systems will picture the holistic state of the urban settings in terms of sustainability. In this study, grid-based indexing methodology will be employed to visualise the degree of compatibility of selected scenarios with the designated sustainable urban future. In addition, this tool will provide valuable knowledge about the spatial dimension of the sustainable development. It will also give fine details about the possible impacts of urban development proposals by employing disaggregated spatial data analysis (e.g. land-use, transportation, urban services, population density, pollution, etc.). The visualisation capacity of this tool will help decision makers and other stakeholders compare and select alternative of future urban developments.

Nature's experiment? Handedness and early childhood development

In recent years a large body of research has investigated the various factors affecting child development and the consequent impact of child development on future educational and labour market outcomes. In this article we contribute to this literature by investigating the effect of handedness on a child and given recent research demonstrating that child development strongly affects adult outcomes. Using a large nationally representative sample of young children we find that the probability of a child being left-handed is not significantly related to child health at birth, family composition, parental employment or household income. We also find robust evidence that left-handed (and mixed handed) children perform significantly worse in nearly all measures of development than right-handed children with the relative disadvantage being larger for boys than girls. Importantly these differentials cannot be explained by different socioeconomic characteristics of the household, parental attitudes or investments in learning resources.