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Objective: Management of personal leaves represents an important component of diversity, equity, and inclusion (DEI) initiatives. This study aims to understand the ways in which both training directors and fellows in neuropsychology training programs understand, perceive, communicate about, and plan for personal leaves during fellowship training. We also aim to provide empirically based recommendations for training directors communicating with fellows about personal leaves. Method: Training directors ( N  = 40) and postdoctoral fellows ( N  = 51) were recruited to complete surveys examining their knowledge and perspectives on personal leaves through a professional listserv. Results: While most training directors reported that their programs offer paid personal leave options, a substantial minority did not. There were discrepancies between training directors' and fellows' knowledge about leave policies and perceptions of the professional implications of taking a personal leave, such that fellows reported less knowledge and a greater perception that taking a leave during training may have a negative professional impact. Conclusions: Findings suggest that training directors in neuropsychology should clearly communicate institutional leave policies early in, or even before the start of, the fellowship period and work to cultivate a culture of openness around both broad issues of work-life balance and specific issues related to personal leaves with trainees.

Background: Although revision surgery is part of the reconstructive process for children with cleft lip and/or cleft palate, the indications for revision vary, and the extent to which surgeons and families agree on appearance is unclear. The authors sought to understand the extent to which children with cleft lip and/or cleft palate, surgeons, caregivers, and control observers agree on satisfaction with appearance and the desire for revision., Methods: Children with cleft lip and/or cleft palate (n = 100) and their caregivers (n = 100) were surveyed regarding satisfaction with appearance using the Cleft Evaluation Profile. Surgeons (n = 10) and control observers (n = 10) rated photographs of these children using questions analogous to the Cleft Evaluation Profile. General linear model repeated measures analysis of variance were used to detect significant differences between raters, with an alpha of 0.05., Results: The children reported greater satisfaction with appearance across all domains compared with surgeons (nose, 7.77 versus 5.51, p < 0.001; lip, 7.94 versus 5.90, p < 0.001; maxilla, 8.16 versus 6.56, p < 0.001) and general observers (nose, 7.78 versus 6.00, p < 0.001; lip, 7.80 versus 6.12, p < 0.001; maxilla, 8.16 versus 7.40, p < 0.001). Children and caregivers expressed similar degrees of satisfaction with appearance of the lip (5.48 ± 1.69 versus 5.6 ± 1.49, p > 0.5) and maxilla (6.08 ± 1.1 versus 5.8 ± 1.2, p = 0.07). There was no significant relationship between children and surgeons in terms of the desire for revision surgery (p = 0.44)., Conclusions: All groups expressed differing levels of satisfaction with cleft-specific aspects of appearance. Importantly, children were more satisfied than all other groups. Care must be taken to evaluate perceptions of all stakeholders before moving forward with cleft revision surgery.

Background: Individuals with intellectual disabilities (ID) are at increased risk for depression and anxiety disorders; however, there is a paucity of research that pertains to associative factors for these mental health disorders in this population. The objective of this investigation was to determine factors associated with depression and anxiety problems in children with ID., Methods: Children 6-17 years with ID (n = 423; 63% male) from the 2016 National Survey of Children's Health were included in this cross-sectional study. Outcome measures included depression and anxiety problems. Predictor variables included sociodemographics, ID severity, co-morbid conditions (autism spectrum disorders, epilepsy, cerebral palsy, Down syndrome and attention-deficit/hyperactivity disorder), physical factors (i.e. physical activity, sleep duration and pain) and social factors (e.g. participation in activities and bully victimisation). Multivariable logistic regression was performed to determine the association between all factors and depression and/or anxiety problems among children with ID., Results: The prevalence of depression and/or anxiety problems was 35.4%. After adjusting for sociodemographics, Hispanic race was associated with lower odds [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.8] of depression and/or anxiety problems. After adjusting for race, co-morbid conditions, and physical and social factors, autism spectrum disorders (OR, 4.4; 95% CI, 1.1-10.1), Down syndrome (OR, 0.2; 95% CI, 0.1-0.8), attention-deficit/hyperactivity disorder (OR, 5.9; 95% CI, 2.5-14.3), pain (OR, 7.0; 95% CI, 2.9-17.1) and bully victimisation (OR 2.3; 95% CI, 1.0-5.3) were each associated with depression and/or anxiety problems., Conclusions: The present study identified both treatable and modifiable, as well as unmodifiable, factors associated with depression and/or anxiety problems in children with ID., (© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Purpose: Depression and anxiety are growing global public health issues and affect millions of children and adolescents in the United States. Although individuals with neurologic disorders (NDs) are at increased risk of adverse mental health disorders, they represent a minority of the population. The purpose of this study was to characterize the national prevalence of depression and anxiety problems in children and adolescents by the presence of various NDs., Methods: Parent-reported data from the 2016 National Survey of Children's Health were analyzed in children and adolescents with and without NDs aged 6-17 years., Results: The prevalence of depression and anxiety problems varied by the type of ND (0%-18.5% and 2.8%-62.5%, respectively). In the combined group of children and adolescents with NDs (weighted estimate: 1,998,654), the prevalence of depression and anxiety problems was 15.3% and 37.9%, respectively, whereas in children and adolescents without NDs (weighted estimate: 47,644,055), the prevalence was 3.4% and 7.3%, respectively. Children and adolescents with NDs represented 4.0% of the total sample, but 15.7% and 17.7% of the overall sample with depression and anxiety problems, respectively., Conclusions: Children and adolescents with NDs contribute to a considerable portion of the overall prevalence of depression and anxiety problems despite only representing 4% of the population., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD)., Design: Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female). Children and caregivers both completed the activities subscale of the Occupations, Activities, and Traits-Attitudes Measure (C/OAT-AM). Children completed selected items from the Parent Perception Inventory (PPI). Caregivers completed the nurturance subscale of the Parenting Dimensions Inventory-Short Form (PDI-S) and the Parenting Stress Scale (PSS)., Setting: Participants were recruited from an outpatient program at an academic medical center., Results: There were no significant relationships among the participant demographics and the study variables, with the exception that more complex CFD diagnoses were correlated with increased parenting stress. General linear modeling showed that parents with more flexible gender attitudes reported more nurturing parenting behaviors. There was also a positive association between parental flexibility in gender views and child-reported parent-child relationship quality. An interaction showed that the relationship between parental flexibility in gender views and child-reported relationship quality was stronger for females and nonsignificant for males., Conclusions: Caregivers with more flexible gender attitudes perceived themselves as more nurturing and were seen more positively by their daughters with a CFD. This pattern may inform parenting interventions for CFD populations.

Background: The association between perception of speech and health-related quality of life (HRQOL) among patients with cleft palate is not well understood. The purpose of this study was to determine: the agreement between patient and parent perception of speech, the correlation between patient/parent speech perception and objective analysis by a speech-language pathologist (SLP), and the relationship between objective speech analysis and HRQOL among children with cleft lip with or without palate (CLCP)., Methods: The authors surveyed 108 CLCP patients who received treatment at a large tertiary medical center from 2013 to 2014. Patients and parents were queried regarding their difficulty with speech, and an SLP performed perceptual speech analysis with each patient. Patient-reported survey instruments were used to assess anxiety, depression, anger, peer relationships, stigma, and overall psychosocial health. The authors assessed the agreement between patients and SLP analysis as well as association between speech and HRQOL., Results: Patient and parent-reported speech quality demonstrated moderate agreement regarding the quality of the child's speech (r = 0.46-0.64). Parent and patient speech perception was not well associated with SLP analysis (V = 0.06-0.30). Patient speech perception was correlated with depression (P = 0.03), while SLP analysis was correlated with anger (P = 0.03, P = 0.004), depression (P = 0.007), and difficulty with peer relationships (P = 0.02)., Conclusions: Patients and parents have different perceptions of the quality of the child's speech, and their ratings differ from SLP perceptual speech analysis. Both patient speech perception and SLP analysis are correlated with important aspects of quality of life, and should be considered when evaluating children with CLCP.

Background: Although children with craniofacial anomalies appear to have relatively high self-esteem, research has identified gender differences in psychosocial outcomes, including self-concept, suggesting that girls with craniofacial anomalies may be at an increased risk. In addition, though parents make important medical and aesthetic decisions for their children, it is unclear whether they are attuned to their children's perceptions of their appearance., Methods: The current study assessed self-ratings and parent proxy ratings of child satisfaction with the appearance of both the face and the body among 74 children with craniofacial anomalies (50 percent boys). Data were collected in a multidisciplinary clinic setting., Results: The authors identified that ratings provided by parents and children, and particularly parents and daughters, were uncorrelated. Furthermore, whereas girls' dissatisfaction with the appearance of their faces was associated with negative psychosocial outcomes, these associations were not significant among boys. Finally, results obtained for satisfaction with the appearance of the face were largely replicated for satisfaction with appearance of the body, suggesting that children with craniofacial anomalies and their parents may apply more holistic criteria to evaluating their appearance., Conclusion: Considered together, the findings of this study highlight the importance of engaging both parents and children in discussions about craniofacial anomalies and possible reconstruction and suggest the need for future research on the intersection of gender and craniofacial anomalies in child psychosocial functioning.

Background: Children with craniofacial anomalies are at risk for social exclusion, bullying, and psychological symptoms, all of which are associated with poor developmental and health outcomes. The National Institutes of Health-developed Patient Reported Outcomes Measurement Information System instruments may be useful tools for monitoring psychosocial functioning in clinical settings and for integrating patient and parent perspectives., Methods: The current study included 74 children (50 percent male) with craniofacial anomalies recruited through a multidisciplinary clinic. The authors obtained child self-report and parent-proxy ratings of depression, anxiety, and peer relationship quality using National Institutes of Health Patient Reported Outcomes Measurement Information System instruments. The authors compared sample means to Patient Reported Outcomes Measurement Information System instruments norms and analyzed the reliability of parents' and children's reporting of psychosocial variables., Results: All reliability statistics were satisfactory (α values ranging from 0.74 to 0.96) and sample standard deviations were similar to those obtained in a general population, suggesting that Patient Reported Outcomes Measurement Information System instruments are reliable among children with craniofacial anomalies. In general, children and parents did not report unusual levels of psychological distress; however, they did report poorer peer relationship quality relative to normed data, a trend that was particularly pronounced among boys., Conclusions: National Institutes of Health Patient Reported Outcomes Measurement Information System instruments are efficient and accurate tools for monitoring psychosocial adjustment among children with craniofacial anomalies. It may be especially important to monitor social functioning, particularly among boys.