Management of nut allergy influences quality of life and anxiety in children and their mothers

Nut allergy is known to impact on the quality of life (QoL) and anxiety of both the allergic child and their parents, but little is known about how the management of food allergy is associated with these variables. To investigate the impact of nut allergy on QoL and anxiety in mothers and children with nut allergy in order to identify management strategies that may influence these factors. Forty-one nut allergic children (age 6–16 yrs) and their mothers completed questionnaires to assess maternal and children’s QoL (PedsQL™, WHOQOL-BREF, FAQL-PB), anxiety (SCAS, STAI) and perceived stress scale (PSS). Children also completed a nut allergy specific QoL questionnaire. Demographic data, details of previous reactions, test results and management plans were collected using parent-report questionnaires and hospital notes. Children with nut allergy had poorer emotional (p = 0.004), social (p = 0.043), and psychological (p = 0.006) QoL compared to healthy normative data. Maternal and child QoL and anxiety were not influenced by the severity of previous reactions. Mother and child reported lower anxiety (p = 0.043 and p < 0.001 respectively) when the child was prescribed an epinephrine auto-injector. Anxiety was not associated with whether the child carried the auto-injector or whether they strictly avoided traces of nuts in foods. Prescribing auto-injectors is associated with reduced anxiety for food allergic children and their mothers, but is not associated with improved adherence with medical management or reduced risk-taking behavior.

Inducing preschool children's emotional eating:relations with parental feeding practices

Background: Children's emotional eating is related to greater body mass index and a less-healthy diet, but little is known about the early development of this behavior. Objective: This study aimed to examine the relations between preschool children's emotional eating and parental feeding practices by using experimental manipulation of child mood and food intake in a laboratory setting. Design: Twenty-five 3–5-y-old children and their mothers sat together and ate a standard meal to satiety. Mothers completed questionnaires regarding their feeding practices. Children were assigned to a control or negative mood condition, and their consumption of snack foods in the absence of hunger was measured. Results: Children whose mothers often used food to regulate emotions ate more cookies in the absence of hunger than did children whose mothers used this feeding practice infrequently, regardless of condition. Children whose mothers often used food for emotion regulation purposes ate more chocolate in the experimental condition than in the control condition. The pattern was reversed for children of mothers who did not tend to use food for emotion regulation. There were no significant effects of maternal use of restriction, pressure to eat, and use of foods as a reward on children's snack food consumption. Conclusions: Children of mothers who use food for emotion regulation consume more sweet palatable foods in the absence of hunger than do children of mothers who use this feeding practice infrequently. Emotional overeating behavior may occur in the context of negative mood in children whose mothers use food for emotion regulation purposes. This trial was registered at clinicaltrials.gov as NCT01122290.

Relationships between sensory sensitivity, anxiety and selective eating in children

The present study examines whether parental reports of child selective eating are associated with child anxiety and sensitivity to sensory stimuli in their environment. Parents of 95 children aged 5-10 completed questionnaires about child eating behavior, child anxiety and sensory sensitivity. Results indicated that both anxiety and sensory sensitivity were associated with selective eating. In addition, child sensory sensitivity fully mediated the relationship between anxiety and selective eating in children suggesting that it is greater sensitivity to sensory information which explains why more anxious children are more likely to be selective eaters. Further research is necessary to better understand these relationships and indicate whether gradual exposure interventions with children who are sensory sensitive may help to prevent or reduce selective eating. © 2012 Elsevier Ltd.

Maternal mind-mindedness during infancy, general parenting sensitivity and observed child feeding behavior:a longitudinal study

Maternal mind-mindedness, or the tendency to view the child as a mental agent, has been shown to predict sensitive and responsive parenting behavior. As yet the role of mind-mindedness has not been explored in the context of feeding interactions. This study evaluates the relations between maternal mind-mindedness at 6 months of infant age and subsequently observed maternal sensitivity and feeding behaviors with children at age 1 year. Maternal mind-mindedness was greater in mothers who had breast-fed compared to formula-fed. Controlling for breast-feeding, mind-mindedness at 6 months was correlated with observations of more sensitive and positive feeding behaviors at 1 year of age. Mind-mindedness was also associated with greater general maternal sensitivity in play and this general parenting sensitivity mediated the effect of mind-mindedness on more sensitive and positive feeding behaviors. Interventions to promote maternal tendency to consider their child's mental states may encourage more adaptive parental feeding behaviors. © 2014 Taylor & Francis.

Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.

Blood Lead Levels in Children and Environmental Lead Contamination in Miami Inner City, Florida

Studies have shown that the environmental conditions of the home are important predictors of health, especially in low-income communities. Understanding the relationship between the environment and health is crucial in the management of certain diseases. One health outcome related to the home environment among urban, minority, and low-income children is childhood lead poisoning. The most common sources of lead exposure for children are lead paint in older, dilapidated housing and contaminated dust and soil produced by accumulated residue of leaded gasoline. Blood lead levels (BLL) as low as 10 μg/dL in children are associated with impaired cognitive function, behavior difficulties, and reduced intelligence. Recently, it is suggested that the standard for intervention be lowered to BLL of 5 μg /dl. The objectives of our report were to assess the prevalence of lead poisoning among children under six years of age and to quantify and test the correlations between BLL in children and lead exposure levels in their environment. This cross-sectional analysis was restricted to 75 children under six years of age who lived in 6 zip code areas of inner city Miami. These locations exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Using the 5 μg/dL as the cutoff point, the prevalence of lead poisoning among the study sample was 13.33%. The study revealed that lead levels in floor dust and window sill samples were positively and significantly correlated with BLL among children (p < 0.05). However, the correlations between BLL and the soil, air, and water samples were not significant. Based on this pilot study, a more comprehensive environmental study in surrounding inner city areas is warranted. Parental education on proper housecleaning techniques may also benefit those living in the high lead-exposed communities of inner city Miami.

Impact of Water Supply and Sanitation on Diarrheal Morbidity among Young Children in the Socioeconomic and Cultural Context of Rwanda (Africa)

This project studied the frequency and of water contamination at the source, during transportation, and at home to determine the causes of contamination and its impact on the health of children aged 0 to 5 years. The methods used were construction of the infrastructure for three sources of potable water, administration of a questionnaire about socioeconomic status and sanitation behavior, anthropometric measurement of children, and analysis of water and feces. The contamination, first thought to be only a function of rainfall, turned out to be a very complex phenomenon. Water in homes was contaminated (43.4%) with more than 1100 total coliforms/100 ml due to the use of unclean utensils to transport and store water. This socio-economic and cultural problem should be ad- dressed with health education about sanitation, The latrines (found in 43.8% of families) presented a double-edged problem. The extremely high population density reduced the surface area of land per family, which resulted in a severe nutritional deficit (15% of the children) affecting mainly young children, rendering them more susceptible to diarrhea (three episodes/child/year).

Constructing literacy: Disadvantaged Irish mothers' attempts at developing literacy with their preschool children during storybook reading and jigsaw puzzle building

Early childhood research beginning in the 1960s has focused on the literacy experiences of preschool children in the home and the contribution of those experiences to later school success. Decades of research since then have investigated learning experiences of preschool children as they interacted with caregivers, siblings or peers prior to formal schooling (Durkin, 1966; Heath, 1983). ^ In this qualitative investigation into early literacy events that occur between disadvantaged Irish mothers and their children, four research questions were investigated. (1) How do disadvantaged Irish mothers engage their preschool children in literacy events such as storybook reading and jigsaw puzzle building? (2) How does the mother's previous school experience affect her role as the child's first teacher? (3) How does the culture of the neighborhood affect the child's developing literacy? (4) What risk factors inhibit literacy development in these Irish children? ^ This study examined the conversational exchanges between three disadvantaged Irish mothers and their preschool children living near Dublin, Ireland, as the mothers read a storybook to their children and assisted them in jigsaw puzzle building. Conversations were recorded, transcribed and analyzed into reading skill and teaching strategy categories for the purpose of determining the mothers' literacy intent during her turn. Journal notes, field notes and interviews with the mothers recorded other information and allowed for triangulation of data. ^ The results of this investigation indicated four findings. The first finding was that these disadvantaged mothers employed many of the same techniques that classroom teachers use during the reading lesson. They attempted high-level and low-level questions, teaching strategies, and other interactions that are so familiar in the classroom. The second finding was that jigsaw puzzle building produced a richer literacy interaction than storybook reading. The third finding was that the environment of the disadvantaged neighborhood posed many risks to children's literacy development. A final finding was that the mothers used thinking out loud behavior to vocalize their inner thoughts during literacy interactions. ^ Future research suggests studying mother/child dyads in other socio-economic environments and cultures to determine if other mothers practice the same skills and strategies as these mothers. ^

Family and group cognitive behavior therapy: Evaluation of treatment outcome and treatment specificity

This dissertation examined the efficacy of family cognitive behavior treatment (FCBT) and group cognitive behavior treatment (GBCT) for reducing anxiety disorders in children and adolescents using several approaches: clinical significant change, equivalence testing, and analyses of variance. It also examined treatment specificity in terms of targeting family/parents (in FCBT) and peers/group (in GCBT) contextual variables using two main approaches: analyses of variance and structural equation modeling (SEM). The sample consisted of 143 children and their parents who presented to the Child Anxiety and Phobia Program housed within the Child and Family Psychosocial Research Center at Florida International University. Diagnostic interviews and questionnaires were administered to assess youth anxiety. Questionnaires were administered to assess child and parent views of family/parents and peers/group contextual variables. In terms of clinical significant change, results indicated that 84.6% of youth in FCBT and 71.2% of youth in GBCT no longer met diagnostic criteria for their primary/targeted anxiety disorder. In addition, results from analyses of variance indicated that FCBT and GCBT were both efficacious in reducing anxiety disorders in youth across both child and parent ratings. Results using both analyses of variance and structural equation modeling also indicated that there was no meaningful treatment specificity between FCBT and GCBT in terms of either family/parents or peers/group contextual variables. That is, child social skills improved in GCBT in which these skills were targeted and in FCBT in which these skills were not targeted; parenting skills improved in FCBT in which these skills were targeted and in GCBT in which these skills were not targeted. Clinical implications and future research recommendations are discussed.

Evaluating the external validity of comorbid disorders in youth using rating scales and behavior observations

To evaluate the theoretical underpinnings of current categorical approaches to classify childhood psychopathological conditions, this dissertation examined whether children with a single diagnosis of an anxiety disorder (ANX only) and children with an anxiety diagnosis comorbid with other diagnoses (i.e., anxiety + anxiety disorder [ANX + ANX], anxiety + depressive disorder [ANX + DEP], and anxiety + disruptive disorder [ANX + EXT]) could be differentiated using external validation criteria of clinical phenomenology (i.e., levels of anxiety, depression, and internalizing, externalizing and total behavior problems). This study further examined whether the four groups could be differentiated in terms of their interaction patterns with their parents and peers, respectively. The sample consisted of 129 youth and their parents who presented to the Child Anxiety and Phobia Program (CAPP) housed within the Child and Family Psychosocial Research Center at Florida International University, Miami. Youth were between the ages of 8 and 14 years old. A battery of questionnaires was used to assess participants' clinical presentation in terms of levels of anxiety, depression, and internalizing and externalizing symptoms. Family and peer interaction were evaluated through rating scales and through behavior observation tasks. Statistics based on the parameter estimates of the structured equation models indicated that all the comorbid groups were significantly different from the pure anxiety disorder group when it came to depression indices of clinical phenomenology. Further, significant differences appeared mainly in terms of the ANX + DEP comorbid group relative to the other comorbid groups. In terms of Parent-child interaction the ANX + EXT and the ANX + DEP comorbid groups were differentiated from the pure anxiety disorder and ANX + ANX comorbid group when it came to the appraisal of the parent/child relationship by the parent, and the acceptance subscale according to the mother report. In terms of peer-child interaction the ANX + EXT and the ANX + DEP comorbid groups were statistically significantly different from the pure anxiety disorder only when it came to the positive interactions and the social skills as rated by mother. Limitations and future research recommendations are discussed.

Children as Change Agents: The Influence of Integrating Environmental Education into Home Learning Projects on Families and Community Members

Environmental education focusing on sustainability should be integrated into the elementary curriculum. Learning experiences should include home learning projects that are relevant to the students, involve active participation, and stimulate discussions with their families. Students can use their knowledge and skills to influence the attitudes and behavior of their parents and other community members.

Hidden Communication Deficits in Children with Autism and Early Behavioral Interventions

Taking a behavioral systems approach to autism, early hidden communicative deficits are introduced as precursors of autistic development. This paper argues that early identification of communication (language and cognition) impairments followed by intensive behavioral interventions, as early as infancy, may have the most preventive effect on the development of autism.

The impact of friends on newly immigrant children's emotional and behavioral adjustment

Immigration disrupts an individual's support network; however, the stresses of the immigration process increase the need for social support. The presence of social support becomes essential for immigrant children and adolescents to cope with these important transitional circumstances. Friends are both sources of social support and models for behavior. Furthermore, friendship networks are known to have a significant influence on youths' functioning. Literature suggests that peer relations become more important in adolescence and friend support is related to child and adolescent well-being. Thus, friend relationships may be particularly important for immigrant youths who experience disruption in their friendship networks during the process of migration to another country. In addition to friendship networks and support, friend characteristics also need to be taken into consideration as important factors for immigrant youth adjustment. My study involved analyses of the effects of friend support and friend problem behaviors on emotional and behavioral functioning for elementary, middle, and high school age newly immigrant children and adolescents. ^ Immigrant children and adolescents (N = 503) were interviewed at schools by interviewers fluent in participants' languages. Structural Equation Modeling (SEM) analyses revealed that friend support and friend problem behaviors were related to children's self-esteem and externalizing behaviors. In addition, friend problem behavior alone predicted children's psychological symptoms and depression scores. Furthermore, age/grade was found to be a moderator for the relation between friend problem behavior and immigrant youth behavioral adjustment such that compared to elementary and high school cohorts, middle school youths showed more externalizing behaviors when they had friends performing problem behaviors. ^ Results supported the idea that both friend support and friend behavior are related to newly immigrant youths' emotional and behavioral adjustment. This study informs further research and interventions concerning the development of programs to facilitate immigrant youths' adjustment by revealing friendship factors related to their adaptation.^

Group cognitive -behavioral therapy for heterogeneous anxiety disorders in children and adolescents: A multiple baseline study

This study investigated the efficacy of Group Cognitive-Behavioral Therapy (GCBT) in the treatment of heterogeneous anxiety disorders in children. A partially nonconcurrent multiple baseline across groups design was used to assess the effects of the treatment on 12 clinically referred children and adolescents between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included Obsessive Compulsive Disorder, Simple Phobia, Separation Anxiety Disorder, Social Phobia, and Generalized Anxiety Disorder, with three of the children also presenting with school refusal behavior. Duration of baseline for each of the three groups varied and ran for one, two, or three weeks. Dependent measures included diagnostic status, child and parent-completed reports, and daily child and parent ratings of child anxiety severity. Results indicated that GCBT was efficacious in reducing anxious symptoms in children and adolescents treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders. ^

Operant and respondent procedures to establish social stimuli as reinforcers in children with autism

According to the DSM-IV- TR (American Psychiatric Association, 2000), one of the core deficits in autism is in the impairment of social interaction. Some have suggested that underlying these deficits is the reality that individuals with autism do not find social stimuli to be as reinforcing as other types of stimuli (Dawson, 2008). An interesting and growing body of literature supports the notion that symptoms in autism may be caused by a general reduction in social motivation (Chevallier et al., 2012). A review of the literature suggests that social orienting and social motivation are low in individuals with autism, and including social motivation as a target for therapeutic intervention should be pursued (Helt et al., 2008). Through our understanding of learning processes, researchers in behavior analysis and related fields have been able to use conditioning procedures to change the function of neutral or ineffective stimuli, including tokens (Ayllon & Azrin, 1968), facial expressions (Gewirtz & Pelaez-Nogueras, 1992) and praise (Dozier et al., 2012). The current study aimed to use operant and respondent procedures to condition social stimuli that were empirically shown to not be reinforcing prior to conditioning. Further, this study aimed to compare the two procedures in their effectiveness to condition social stimuli to function as reinforcers, and in their maintenance of effects over time. Using a multiple-baseline, multi-element design, one social stimulus was conditioned under each procedure to compare the different response rates following conditioning. Finally, the study sought to determine if conditioning social stimuli to function as reinforcers had any effect on the social functioning of young children with autism. Six children diagnosed with autism between the ages of 18 months and 3 years participated. Results show that the respondent procedure (pairing) resulted in more robust and enduring effects than the operant procedure (Sd procedure). Results of a social communication assessment (ESCS, Mundy et al., 2003) before and after conditioning demonstrate gains in all areas of social communication, particularly in the areas of initiating and responding to joint attention.^