The Cool Little Kids randomised controlled trial population-level early prevention for anxiety disorders

Background: The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful ‘efficacy’ trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry.
Methods/Design: This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child’s bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (costconsequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms.
Discussion: This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally.

Early peer play interactions of resilient children living in disadvantaged communities

Resilience for children is positive adaptation and a capacity to thrive despite challenging circumstances. Children demonstrating resilience are seen to have strong cognitive skills and have developed positive peer relationships. The ‘Supporting Resilience’ project is exploring the conditions and characteristics of resilience of young children and their families who live in rural, regional and metropolitan communities that are economically and socially disadvantaged. The aim of this paper was to report on pretend play and social competence within the early years’ cohort of the ‘Supporting Resilience’ project. Twenty-six children aged 4–6 years who were identified as resilient by their preschool teacher were involved in the study. Results obtained from the Child Initiated Pretend Play Assessment and the Penn Interactive Peer Play Scale when the children were at pre-school found significant relationships between object substitution and social interaction (r = .414, p < .05). Children who could elaborate play with unstructured objects were less likely to be socially disconnected (r = –.49, p < .05). There was no significant difference between geographical locations for play ability. Significant difference for social competence was found between geographical locations. By situating play as individual development within a socio-cultural environment the relationship between children's pretend play ability and social peer play interactions are considered within early childhood development and resilience literature.

Beginning the search for core principles underpinning literacy development in the early years

Providing opportunities for all people to become literate is now a global imperative (World Bank 2008). There are many and varied reasons underlying this emphasis including global, national, community and personal perspectives (Friere & Macedo 2000) and countries world-wide are investing more money into their early childhood programs and the development of associated policies (Oberhuemer 2005). From a socio-cultural view, literacy development is emergent, ongoing (Cook-Gumperz 2006) and multifaceted (New London Group 1999). Literacy involves far more than reading and writing and encompasses listening, speaking and critical thinking (Department of Education, Science and Training 2005, Luke & Freebody 1997). Literacy is not merely a curricular area, but an important empowering life skill (Harrison 2012, Friere & Macedo 2000). It seems logical then, to search for and identify if there are core principles underpinning early years literacy development.In seeking to identify core principles for emergent literacy development, the study reported here adopted Wiersma & Jurs' (2005) 'Four Step' Historical Research methodological approach involving the identification of a research problem, collection and evaluation of source materials, synthesis of information from the source materials and finally, the analysis, interpretation and the formulation of conclusions. The historical research approach requires creative interpretation (Keastle 1988) and is valued for its effectiveness in sourcing ideas, enlightening current debates, empowering decision-making (Stricker 1992) and influencing policy formation (Wiersma & Jurs 2005).This study involved analysis of Early Years Language and Emergent Literacy Research from the past decade, sourced via education and social sciences databases, as well as information gathered from correspondence with Australian government departments, their websites and policies. The findings from a synthesis of these data sources led to the identification of nine core principles viewed as underpinning children's emergent literacy development. Interested in exploring the relevance and application of these principles to the field of early childhood in Australia, additionally, the researcher has embarked upon a mapping exercise that reveals how the recently introduced Early Years Learning Frameworks align with these principles. Furthermore, in recognition of the importance of the early years as a crucial time in a child's literacy development (Cook-Gumperz 2006, Raban & Nolan 2005, Hall, Larson & Marsh 2003), it is argued that these literacy principles will be valuable to the development of a range of educational tools to be used by Pre-service and practicing Early years educators.

The reading stakes - making sense of early literacy

Dr. Sarah Ohi was interviewed by Emma Reeves from the Australian Family Magazine and asked to share her views on the importance of children's early literacy development.

Exploration of the Australian Early Development Index for children with language backgrounds other than English

The Australian Early Development Index (AEDI) is a teacher-administered measure that indicates if children are starting school with the developmental capacity to take advantage of the school learning environment. A key question that arises for schools, communities, and policy makers is how valid the AEDI is for children from a Language Background Other Than English (LBOTE). This study investigated how adequately the AEDI captures the cultural variety of different behaviours and different ways of learning. The study also examined the cultural inclusivity and relevance of the AEDI materials (e.g., teacher training guidelines; administration manual). Ten focus groups (n=84) and various community consultations were conducted with early childhood education and development professionals, representing key service providers, and school personnel. The findings from these studies led to the following recommendations: For LBOTE children, the AEDI should ideally be completed in collaboration, for example, between the child’s teacher and a multicultural consultant. The teacher guidelines for the AEDI need to be enhanced with respect to issues pertaining to LBOTE children, and the AEDI should include additional domains, such as cultural competence and home based/first language skills. Finally, teacher preparation and the AEDI administration guidelines need to clarify and emphasize the intent of the AEDI.

Airplane grows in the tummy of clouds: living through relations in the early years of life

Using a child's expression that illustrates his mental image of constituted relations of living things, the author conceptualizes relationality, an interrelated view of being, and its importance for early childhood education. The difference between relation and interaction, and the significance of inter-human relationship are discussed as significant aspects for early childhood teachers to understand as they work with children. In particular, this paper seeks to provide insights into the potential contribution of relationality towards early childhood teaching practice.

Integrated practice in the early years in Australia: The assumptions, omissions and contradictions of policy reform

The aim of this article is to examine current national early years’ policy reform, which emphasises the importance of service integration, national quality standards and a quality knowledge base for educators concerning the provision of early childhood education and care. Using Queensland, Australia, as an example, a policy discourse analysis identifies two problematics of implementing current national policy – the early childhood education and care problematic and the integration problematic. The article argues that speedy implementation of a national policy in order to meet national targets has unintended consequences for the knowledge base of educators and the possibility of collaboration within service provision. Although government commitment in this area is evident, these consequences and the current difficulties surrounding integration are the result of the lack of a specific integration strategy, and government investment focussed on the development of an integrated workforce.

Young children learning about well-being and environmental education in the early years: a funds of knowledge approach

Early childhood educators currently provide content focused learning opportunities for children in the areas of well-being and environmental education. However, these are usually seen as discrete content areas and educators are challenged with responding to children’s interests in popular-culture inspired food products given these influence their consumption of energy-dense, nutrient-poor and highly packaged food in the early childhood setting. This paper reports preliminary findings from a pilot randomised trial examining the interconnectedness of sustainability, well-being and popular-culture in early childhood education. Planning, assessment documentation and summaries from twenty-four learning experiences implemented by six educators over a six-week period were analysed using a deductive approach. Twenty well-being and environmental education topics were identified and shown to be generated by the educators when considering the children’s ‘funds of knowledge’ on popular-culture inspired food products. We argue that topics derived from children’s engagement with popular-culture may help educators to create an integrated approach to curriculum provision. This may impact child weight and facilitate obesity prevention and environmental sustainability as children create stronger connections between these content areas and their everyday choices and practices.

A Culture of Relationships: Early Care for Italian and American Children

A culture of childhood is a shared vision – an agreed upon vision – of the needs and rights of children, including ideas about how the people of the community can collectively nurture them and at the same time be renewed by them. In other words, it is a set of values, beliefs, and practices that people have created to guide their way of nurturing young children and their families. The vision is about investing in young children and investing in the supports and relationships that children need to learn and grow, both for the reason that children carry our future and because they carry our hopes and dreams for the future. These hopes and dreams begin with birth. Sensitive, emotionally available parents create the framework for interaction with their children by responding to the baby’s cues, engaging the baby in mutual gazes, and imitating the baby. The baby, born with a primary ability to share emotions with other human beings eagerly joins the relationship dance. The intimate family circle soon widens. Providers, teachers, and directors of early childhood programs become significant figures in children’s lives—implicit or explicit partners in a "relationship dance" (Edwards & Raikes, 2002). These close relationships are believed to be critical to healthy intellectual, emotional, social, and physical development in childhood and adolescence as well. These conclusions have been documented by diverse fields of science, ranging from cognitive science to communication studies and social and personality psychology. Close relationships contribute to security and trust, promote skill development and understanding, nurture healthy physical growth, infuse developing self-understanding and self-confidence, enable self-control and emotion regulation, and strengthen emotional connections with others that contribute to prosocial motivation (Dunn, 1993; Fogel, 1993; Thompson, 1996). Furthermore, many studies showing how relationship dysfunction is linked to child abuse and neglect, aggression, criminality, and other problems involving the lack of significant human connections (Shankoff & Meisels, 2000). In extending the dance of primary relationships to new relationships, a childcare teacher can play a primary role. The teacher makes the space ready--creating a beautiful place that causes everyone to feel like dancing. Gradually, as the dance between them becomes smooth and familiar, the teacher encourages the baby to try out more complex steps and learn how to dance to new compositions, beats, and tempos. As the baby alternates dancing sometimes with one or two partners, sometimes with many, the dance itself becomes a story about who the child has been and who the child is becoming, a reciprocal self created through close relationships.

[Experiences with the early treatment of osteogenesis imperfecta]

Between 1973 and 1988 twenty children with osteogenesis imperfecta were treated in the Department of Paediatric Surgery at the University of Berne, Switzerland. Our initial experience with the first 15 children, who had virtually no treatment during infancy and early childhood showed that they later developed severe soft tissue and skeletal deformities. Since resulting contractures and curvatures of the long bones are difficult to correct, we changed our therapeutic approach. Traditional therapy in OI was limited to the correction of bony malformations. Considering the fact, that the different elements of the locomotor system are part of a functional entity, we began early treatment combining physiotherapy and surgery.

Aromatase deficiency in a female who is compound heterozygote for two new point mutations in the P450arom gene: impact of estrogens on hypergonadotropic hypogonadism, multicystic ovaries, and bone densitometry in childhood

We report on a female who is compound heterozygote for two new point mutations in the CYP19 gene. The allele inherited from her mother presented a base pair deletion (C) occurring at P408 (CCC, exon 9), causing a frameshift that results in a nonsense codon 111 bp (37 aa) further down in the CYP19 gene. The allele inherited from her father showed a point mutation from G-->A at the splicing point (canonical GT to mutational AT) between exon and intron 3. This mutation ignores the splice site and a stop codon 3 bp downstream occurs. Aromatase deficiency was already suspected because of the marked virilization occurring prepartum in the mother, and the diagnosis was confirmed shortly after birth. Extremely low levels of serum estrogens were found in contrast to high levels of androgens. Ultrasonographic follow-up studies revealed persistently enlarged ovaries (19.5-22 mL) during early childhood (2 to 4 yr) which contained numerous large cysts up to 4.8 x 3.7 cm and normal-appearing large tertiary follicles already at the age of 2 yr. In addition, both basal and GnRH-induced FSH levels remained consistently strikingly elevated. Low-dose estradiol (E2) (0.4 mg/day) given for 50 days at the age of 3 6/12 yr resulted in normalization of serum gonadotropin levels, regression of ovarian size, and increase of whole body and lumbar spine (L1-L4) bone mineral density. The FSH concentration and ovarian size returned to pretreatment levels shortly (150 days) after cessation of E2 therapy. Therefore, we recommend that affected females be treated with low-dose E2 in amounts sufficient to result in physiological prepubertal E2 concentrations using an ultrasensitive estrogen assay. However, E2 replacement needs to be adjusted throughout childhood and puberty to ensure normal skeletal maturation and adequate adolescent growth spurt, normal accretion of bone mineral density, and, at the appropriate age, female secondary sex maturation.

Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts

BACKGROUND Among children with wheeze and recurrent cough there is great variation in clinical presentation and time course of the disease. We previously distinguished 5 phenotypes of wheeze and cough in early childhood by applying latent class analysis to longitudinal data from a population-based cohort (original cohort). OBJECTIVE To validate previously identified phenotypes of childhood cough and wheeze in an independent cohort. METHODS We included 903 children reporting wheeze or recurrent cough from an independent population-based cohort (validation cohort). As in the original cohort, we used latent class analysis to identify phenotypes on the basis of symptoms of wheeze and cough at 2 time points (preschool and school age) and objective measurements of atopy, lung function, and airway responsiveness (school age). Prognostic outcomes (wheeze, bronchodilator use, cough apart from colds) 5 years later were compared across phenotypes. RESULTS When using a 5-phenotype model, the analysis distinguished 3 phenotypes of wheeze and 2 of cough as in the original cohort. Two phenotypes were closely similar in both cohorts: Atopic persistent wheeze (persistent multiple trigger wheeze and chronic cough, atopy and reduced lung function, poor prognosis) and transient viral wheeze (early-onset transient wheeze with viral triggers, favorable prognosis). The other phenotypes differed more between cohorts. These differences might be explained by differences in age at measurements. CONCLUSIONS Applying the same method to 2 different cohorts, we consistently identified 2 phenotypes of wheeze (atopic persistent wheeze, transient viral wheeze), suggesting that these represent distinct disease processes. Differences found in other phenotypes suggest that the age when features are assessed is critical and should be considered carefully when defining phenotypes.