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Purpose: The purpose of this paper is to describe the implementation of evidence‐based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT‐A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. Design and Methods: A retrospective chart review was conducted for children receiving BoNT‐A injections at a Physical Medicine clinic pre‐ and post‐implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. Results: Post‐implementation of coping care plans, children experienced improved cooperation during BoNT‐A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. Practice Implications: CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT‐A injections. [ABSTRACT FROM AUTHOR]

Delirium is a serious complication of pediatric critical illness. Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation is one proposed cause of delirium. Children admitted to the pediatric intensive care unit (PICU) experience multiple environmental exposures with the potential to disrupt sleep. Although researchers have measured PICU light and sound exposure, sleep, and delirium, these variables have not yet been fully explored in a single study. Furthermore, caregiving patterns have not often been included as a component of the PICU environment. Measuring the light and sound exposure, caregiving patterns, and sleep of critically ill children requires continuous PICU bedside data collection. This presents multiple methodological challenges. In this paper, we describe the protocol for an observational pilot study of the PICU environment, sleep, and delirium experienced by a sample of 10 critically ill children 1–4 years of age. We also evaluate and discuss the feasibility (i.e., acceptability, implementation, practicality) of the study protocol. Light and sound exposure were measured with bedside sensors. Caregiving was quantified through video recording. Sleep was measured via actigraphy and confirmed by video recording. Delirium screening with the Cornell Assessment of Pediatric Delirium was conducted twice daily, either in person or via video review. This study provides a refined measurement framework to inform future, large‐scale studies and the development of nurse‐driven sleep promotion interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND Delirium is associated with poor outcomes in adults but is less extensively studied in children. OBJECTIVES To describe a quality improvement initiative to implement delirium assessment in a pediatric intensive care unit and to identify barriers to delirium screening completion. METHODS A survey identified perceived barriers to delirium assessment. Failure modes and effects analysis characterized factors likely to impede assessment. A randomized case-control study evaluated factors affecting assessment by comparing patients always assessed with patients never assessed. RESULTS Delirium assessment was completed in 57% of opportunities over 1 year, with 2% positive screen results. Education improved screening completion by 20%. Barriers to assessment identified by survey (n = 25) included remembering to complete assessments, documentation outside workflow, and "busy patient." Factors with high risk prediction numbers were lack of time and paper charting. Patients always assessed had more severe illness (median Pediatric Index of Mortality 2 score, 0.90 vs 0.36; P < .001), more developmental disabilities (moderate to severe pediatric cerebral performance category score, 54% vs 32%; P = .007), and admission during lower pediatric intensive care unit census (median [interquartile range], 10 [9-12] vs 12 [10-13]; P < .001) than did those never assessed (each group, n = 80). Patients receiving mechanical ventilation were less likely to be assessed (41.0% vs 51.2%, P < .001). CONCLUSIONS Successful implementation of pediatric delirium screening may be associated with early use of quality improvement tools to identify assessment barriers, comprehensive education, monitoring system with feedback, multidisciplinary team involvement, and incorporation into nursing workflow models. [ABSTRACT FROM AUTHOR]

Background/Objectives: The primary objective of this research was to assess age differences in the associations between cyberbullying victimization and bystanding and depression among 234 elementary school students (4th and 5th graders; 51% female), 363 middle school students (6th to 8th grades; 53% female), and 341 high school students (9th to 12th grades; 51% female) as well as the moderating effect of parental mediation in these relationships. Methods: Participants completed self-report questionnaires on their cyberbullying victimization and bystanding, as well as depressive symptoms. Results: The findings revealed that high levels of instructive mediation buffered against depression associated with cyberbullying victimization and bystanding across all age groups, with the strongest effects found for middle school students. Lower levels of instructive mediation and higher levels of restrictive mediation increased the positive relationships between cyberbullying victimization and bystanding and depression. Co-viewing mediation did not moderate any of the associations. Conclusions: Parental mediation of technology use has the potential to alleviate the negative consequences associated with cyberbullying victimization and bystanding. The findings highlight the importance of tailoring prevention and intervention strategies to specific age groups and to parents. [ABSTRACT FROM AUTHOR]

School-based universal screening in the social, emotional, and behavioral (SEB) domains allows for the early identification of students in need of SEB support. Importantly, equitable assessment in universal screening for the SEB domains is critical to engage in accurate and ethical data-based decision-making. Measurement invariance is one method for examining potential inequities in assessment tools, permitting the ability to evaluate which assessments or assessment items perform differently across groups. As such, this study utilized multi-group confirmatory factor analysis to evaluate the extent of measurement invariance for a commonly used universal screening tool for the SEB domains: the Social, Academic, and Emotional Behavior Risk Screener - Teacher Rating Scale (SAEBRS-TRS). The sample consisted of 1949 students in kindergarten through fourth grade in a Midwest, suburban school district. Examination of factor structures indicated the bifactor model yielded adequate fit and was utilized for measurement invariance testing. Multi-group confirmatory factor analysis results provided preliminary evidence that the SAEBRS-TRS displays invariance across a variety of student characteristics. Specifically, results supported configural and metric/scalar invariance of the bifactor model across the student characteristics of racial or ethnic identity, sex assigned at birth, and eligibility for free or reduced-price lunch. Yet, future research is needed to corroborate these findings. Limitations, implications for practice, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

This paper explores associations between two demographic characteristics (i.e., sex and grade level) and the peer network features (i.e., size, density, and demographic homophily) of 144 third through eighth grade students (ages 8—15) in an urban, US elementary school with considerable diversity in race and socioeconomic status. The results offer only partial support for the two cultures theory, as sex differences in network size attenuated with increasing grade levels. The findings also highlight developmental trends, including a curvilinear effect of grade on network density and grade-level increases in cross-sex and same-race relationships. Finally, the paper includes a discussion of the importance of opportunity structures for, and the joint consideration of sex and developmental influences on, children’s peer social networks. [ABSTRACT FROM PUBLISHER]

Teacher-level factors are theoretically linked to student outcomes in data-based instruction (DBI; Lembke et al., 2018). Professional development and ongoing support can increase teachers' knowledge, skills, and beliefs related to DBI, as well as their instructional fidelity (McMaster et al., 2020). However, less is known about how each of these teacher-level factors influences student progress during an intervention. The purpose of this study was to examine the association between several important teacher-level factors—teachers' writing instruction fidelity, knowledge and skills related to DBI, explicit writing orientation, and writing instruction self-efficacy—and students' writing growth. Participants were 49 U.S. elementary teachers and their 118 students struggling with early writing skills. Using hierarchical linear modeling, we found a significant positive relation between DBI knowledge and skills and student writing growth, but no relation was found between writing instruction fidelity, writing orientation, or self-efficacy and student writing growth. Implications for writing instruction fidelity measurement in DBI and professional development related to teachers' DBI knowledge and skills are discussed. [ABSTRACT FROM AUTHOR]

This paper applies a sociology of childhood approach to the study of the sexual socialisation of young children in the USA. It examines both children's and parents' active participation in this dynamic and collaborative process through conversations between 49 parents and their 54 preschool children that were audio-recorded while they read books about ‘where babies come from’. Parents also participated in a brief survey. The authors found that, while parents do foreclose such conversations as previous research has indicated, they also use a variety of other tactics, including adding information and emotion management. These findings illustrate children's active engagement in their own sexual socialisation through their questions, confusions and distractions, which affected the amount and type of information that was elicited. [ABSTRACT FROM PUBLISHER]

Preschool-age children identified as at risk for later reading difficulties can benefit from supplemental, small-group emergent literacy intervention. As such interventions become commercially available and marketed to preschool programs, it is important to understand their impacts when implemented by intended end users under routine conditions. In this study, we examined the effects of the Nemours BrightStart! (NBS!) intervention on children's emergent literacy skills when implemented by teachers and community aides in authentic preschool classrooms. We randomly assigned 98 classrooms to one of three conditions (NBS! teacher-implemented, NBS! community aide-implemented, or control). Children enrolled in these classrooms who met eligibility criteria and were identified as at risk via an early literacy screener (n = 281) completed pretest and posttest emergent literacy assessments; those assigned to NBS! conditions received intervention from their classroom teacher or a community aide affiliated with a local kindergarten-readiness initiative. Intent-to-treat analyses showed no significant impacts of NBS! on any outcome, and an instrumental variable, as-treated approach showed one significant intervention effect on letter writing. Consequently, we did not replicate results of prior highly controlled efficacy trials. Findings have implications for revising the NBS! theory of change, conducting dosage and as-treated analyses, and moving research-based interventions toward scale-up. [ABSTRACT FROM AUTHOR]

The Adoption and Safe Families Act of 1997 was developed with the goal of increasing the safety, permanency, and well‐being of children involved in U.S. child welfare systems. A growing number of unaccompanied immigrant children (UC) are being served in long‐term foster care (LTFC) under the auspices of the Office of Refugee Resettlement (ORR). UC are placed in care because an appropriate sponsor is not available pending immigration hearings. Yet, the research literature has been silent on how outcomes for UC can be articulated and operationalized to guide policy and practice. This study fills this gap by exploring how safety, permanency and well‐being may be defined for this population. Seventy‐nine service providers working unaccompanied children in the Midwestern and Northeastern United States participated in 22 focus groups. Findings indicated that safety, permanency, and well‐being are fundamental for UC but include different aspects, such as emotional safety in addition to physical safety, the nuances of legal permanency and placement stability in addition to family reunification, and cultural integration as a factor of well‐being and mental health. This study's results can inform organizational data collection procedures, culturally relevant assessments, and a deeper understanding of the experiences of UC in foster care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to compare the accuracy and predictive validity of pH, bilirubin, and CO2 in identifying gastric tube placement errors in children. Design and Methods After the tube was inserted into 276 children, the CO2 monitor reading was obtained. Fluid was then aspirated to test pH and bilirubin. Results Lack of ability to obtain tube aspirate was the best predictor of NG/ OG placement errors with a sensitivity of 34.9% and a positive predictive value of 66.7%. Measuring pH, bilirubin, and CO2 of tube aspirate was less helpful. Practice Implications Healthcare providers should suspect NG/ OG tube misplacement when no fluid is aspirated. [ABSTRACT FROM AUTHOR]

Impairments in empathic responding are related to decreased social interactions and fewer friendships for adolescents with autism spectrum disorder (ASD). Teaching adolescents to respond empathetically during conversation may promote the development of healthy social relationships. The current study examined the effectiveness of an affective empathy video feedback intervention package to teach empathic communication to four adolescents with ASD (11–14 years old) using a multiple baseline across participants design. Two out of the four participants met mastery criterion, maintained empathy skills up to 4 weeks after intervention, and generalized empathy to a different conversational partner. Effects and implications of the intervention and results are discussed as well as future directions for research. [ABSTRACT FROM AUTHOR]

Approximately 20% of American 9 to 18 year olds are obese, and most carry their excess adiposity, with its associated increased risk for cardiovascular disease, into adulthood. We studied cardiovascular disease risk markers changes associated with 3 healthy eating patterns (HEPs) in 96 9 to 18 year olds with a body mass index >95% in a Midwestern health system 1-year randomized trial. All HEPs were associated with similar statistically significant (P <.05 to <.001) cardiovascular disease risk marker improvements in weight, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, and myeloperoxidase. Time required was the only identified significant (P <.001) deterrent from enrolling in study. These HEPs had characteristics common to most HEPs: encouraging whole foods, fruits and vegetables, whole grains, beans other legumes, and limiting added salt, saturated fatty acids, added sugars, red meat, processed meats, and other processed foods. Further research on initiatives to ease the time burden, and increase implementation of established healthy eating principles is needed. [ABSTRACT FROM AUTHOR]

Children in two communities of a large city in the Midwestern United States have higher rates of asthma than other areas of the city. The communities have barriers to accessing care, including high rates of unemployment and being uninsured and undocumented. A mobile van provides no-cost asthma care to children at schools in these communities, but use of these services has decreased more than 50% over the past 5 years. School nurses have the potential to improve asthma outcomes by collaborating with health-care providers. The purpose of the program was to increase the number of appointments scheduled and attended on the asthma van at both schools. For this program, we (a) implemented an unaccompanied minor consent, (b) enhanced care coordination, and (c) improved a respiratory health survey tool. Results showed an increased number of appointments scheduled and attended on the asthma van. The program was successful even though community-specific barriers existed. [ABSTRACT FROM AUTHOR]

Background: The restraining of children is a pervasive but controversial practice that has resulted in the injury and death of children. Despite this threat of harm, little research has explored what factors contribute to the risk of a child becoming injured during a restraint event. Objective: This study examined multiple child and restraint factors to better understand what predicts the injury of a child during a restraint event. Methods: Longitudinal data (794 youth, 13,339 restraint events) from six residential treatment centers in the Midwest were utilized to predict injury associated with restraint using nested hierarchical logistic regression models. Results: Injuries to the child are a frequent outcome following the use of restraints on a child. Findings show that a child being male and older contributed to the likelihood of an injury, but the race of the child did not predict injury. In addition, three physical hold types—prone, supine, and settle—were associated with a greater likelihood of injury. Conclusions: Results suggest those who use restraints on children should reevaluate their behavior management plans to reduce their risk of hurting children by restraints. Eliminating or greatly reducing the use of prone, supine, and settle holds will likely lead to a drop in injuries of children. [ABSTRACT FROM AUTHOR]

Although the negative impact of child maltreatment on child development is well-established in the literature, little research has explored potential developmental differences in the impact of child maltreatment on child outcomes. The primary aim of this qualitative study was to explore the impact of child maltreatment from the perspective of practitioners who serve maltreated children, including variation in impact and manifestation due to the developmental stage of the child. In this study, 27 in-depth interviews were conducted with practitioners who directly serve maltreated children in an urban Midwestern city in the United States. Thematic analysis was used to analyze the data. The four themes of developmental differential on the impact of maltreatment included (1) impact manifestation; (2) behavioral expression; (3) locus of control; and, (4) complexity. The findings from this study offer valuable insight to inform developmentally-appropriate interventions for children who have experienced child maltreatment. Our discoveries encourage agencies and those working with maltreated children to consider the child's developmental level to acknowledge how the child will process and react to the maltreatment. [ABSTRACT FROM AUTHOR]

Supportive maternal and paternal caregiving have been found to be associated with children's effortful control abilities. However, many studies did not assess both maternal and paternal parenting in the same analytic model, making it difficult to parse out the unique contributions of mothers versus fathers. Thus, we aimed to simultaneously assess the role of parent gender in associations between observations of supportive caregiving in the preschool years and observations of children's effortful control abilities in the early school-age years. At approximately age 3 years, children (N = 113) participated in videotaped father–child and mother–child interactions, as well as a battery of effortful control tasks. At approximately age 6 years, children participated in another battery of effortful control tasks. Covariates included parental education, child age, child preschool-age effortful control, and child gender. Structural equation modeling revealed that maternal and paternal supportive caregiving behaviors in the preschool years were independently associated with children's school-age effortful control abilities. In sum, we found that supportive caregiving in the preschool years was associated with children's early school-age effortful control abilities, regardless of parent gender. Findings have implications for the development of interventions aimed at improving children's effortful control abilities through improvements in both paternal and maternal parenting. Highlights: Mothers and fathers engaged in similar types of supportive caregiving behaviors in early childhood. Observed supportive caregiving was associated with children's effortful control skills 3 years later. Associations between supportive caregiving and children's effortful control were significant for both mothers and fathers. [ABSTRACT FROM AUTHOR]

This study evaluates early outcomes of a program in the Midwest United States adhering to the Equine Assisted Growth and Learning Association (EAGALA) model of equine-assisted psychotherapy (EAP) involving a licensed mental health professional, an equine specialist, and horses or donkeys in the service provision. Designed to impact social behavior in children and adolescents struggling with issues of mental health diagnosis and/or family-home issues, the topics central to the program include skill building such as leadership, listening, emotional self-control, problem-solving, setting boundaries, and self-awareness. Data from the Behavior Assessment System for Children (BASC-2), Second Edition, was collected for 19 participants, from both their parents and teachers, following participation in the 10-week program. Overall, results are mixed with several promising findings that require more exploration. Paired-samples t-tests indicate that some participants demonstrated significant improvement in both primary and composite scales that served as a framework for pre and post testing (Reynolds and Kamphaus in BASC-2: Behavioral assessment system for children. Minneapolis, MN, Reynolds, C., & Kamphaus, R. W. (2004). BASC-2: Behavioral assessment system for children. Minneapolis, MN) and included: anxiety, social skills, study skills, anger control, aggression. The authors discuss ways to augment the effectiveness of program evaluation in EAP. [ABSTRACT FROM AUTHOR]

The article presents 2020 midwest Nursing Research Society award winning abstracts. Topics include genetic correlates of patient-reported fatigue in individuals with end-stage renal disease; supporting male victims of sexual assault that involves the role of Authentic Empathy (AE) in Stigma Management Practices as being narrated by Victim Service Providers (VSP); and determinants of length of stay after Neonatal Cardiac Surgery using a path analysis.

Health care professionals' (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs' initial awareness of a child's impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a "delicate dance of figuring out" key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families. [ABSTRACT FROM AUTHOR]

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Objective: To determine the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers in a Midwestern city. Methods: Case–control samples were drawn from 2 separate first‐grade cohorts (combined N = 4,047) in every city school using different methods. In Cohort Sample 1, all consented small children (≤25th centile on height, weight, and/or head circumference) entered the study along with a random sample from all enrolled students. Cohort Sample 2 was drawn totally at random. Child growth, dysmorphology, and neurobehavior were assessed using the Collaboration on FASD Prevalence (CoFASP) criteria, and mothers were interviewed. Results: For the samples combined, 891 children received dysmorphology examinations, and 692 were case‐conferenced for final diagnosis. Forty‐four children met criteria for FASD. Total dysmorphology scores differentiated diagnostic groups: fetal alcohol syndrome (FAS), 16.7; partial FAS, 11.8; alcohol‐related neurodevelopmental disorder (ARND), 6.1; and typically developing controls, 4.2. Neurobehavioral tests distinguished children with FASD from controls, more for behavioral problems than cognitive delay. Children with ARND demonstrated the poorest neurobehavioral indicators. An adjusted regression model of usual prepregnancy drinking indicated that maternal reports of 3 drinks per drinking day (DDD) were significantly associated with a FASD diagnosis (p = 0.020, OR = 10.1, 95% CI = 1.44 to 70.54), as were 5 or more DDD (p < 0.001, OR = 26.47, 95% CI = 4.65 to 150.62). Other significant maternal risk factors included the following: self‐reported drinking in any trimester; smoking and cocaine use during pregnancy; later pregnancy recognition and later and less prenatal care; lower maternal weight, body mass index (BMI), and head circumference; and unmarried status. There was no significant difference in FASD prevalence by race, Hispanic ethnicity, or socioeconomic status at this site, where the prevalence of FASD was 14.4 to 41.2 per 1,000 (1.4 to 4.1%). Conclusion: This city displayed the lowest prevalence of FASD of the 4 CoFASP sites. Nevertheless, FASD were common, and affected children demonstrated a common, recognizable, and measurable array of traits. [ABSTRACT FROM AUTHOR]

We explored whether and how cognitive measures of executive function (EF) can be used to help classify academic performance in Kindergarten and first grade using nonparametric cluster analysis. We found that EF measures were useful in classifying low-reading performance in both grades, but mathematics performance could be grouped into low, average, and high groups without the use of EF tasks. Membership in the high-performing groups was more stable through first grade than membership in the low or average groups, and certain Kindergarten EF tasks differentially predicted first-grade reading and mathematics cluster membership. Our results suggest a stronger link between EF deficits and low performance than between EF strengths and high performance. We highlight the importance of simultaneously using academic and cognitive skills to classify achievement, particularly since existing classification schemes have been largely based on arbitrary cutoffs using limited academic measures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine if offspring physical activity may affect the relationship between maternal overweight and offspring fatness and blood pressure (BP). Subjects included 144 maternal-child pairs (n = 74 boys and 70 girls, mean age = 7.3 yrs). Maternal prepregnancy BMI was determined by self-report. Offspring characteristics included resting systolic and diastolic BP, body fatness by dual energy x-ray absorbtiometry, and moderate-to-vigorous physical activity (MVPA) using the Actigraph accelerometer. Children whose mothers were overweight or obese prepregnancy (Prepreg OW) were significantly larger and fatter than children from mothers with a normal prepregnancy BMI (Prepreg NORM). Prepreg OW children also had higher mean arterial pressure than Prepreg NORM children. BP values were not different across maternal Prepreg BMI/ MVPA groups. Percent fat was significantly different across Prepreg BMI/MVPA groups. Prepreg OW children that did not meet the daily recommended value of MVPA were the fattest. Prepreg OW children that attained 360 min of MVPA/ day had a mean percent body fat that was similar to Prepreg NORM children of either MVPA group. [ABSTRACT FROM AUTHOR]

Despite increased effort to respond to human trafficking at national and state levels, very little empirical research has been conducted on domestic child sex trafficking. This study retrospectively examines associations between multiple risk factors and domestic child sex trafficking (i.e., entry into the commercial sex industry under the age of 18) in a sample of individuals aged 16 and older currently involved in the commercial sex industry (N = 273). Two primary research questions are addressed: (1) What set of risk factors, prior to entering the commercial sex industry, are associated with domestic child sex trafficking and (2) what group differences, if any, exist in risk factors between current or former domestic child sex–trafficking victims and non-trafficked adults engaged in the commercial sex industry? A cross-sectional survey was administered using Respondent-Driven Sampling (RDS) in five cities in one Midwestern state. Overall, 115 participants (48.3%) were identified as current or former domestic child sex–trafficking victims. Bivariate results suggest that childhood emotional and sexual abuse, rape, ever running away from home, having family members in sex work, and having friends who purchased sex were significantly associated with domestic child sex trafficking. Multivariate results indicate that domestic child sex trafficking victims were significantly more likely to have ever run away and to be a racial/ethnic minority than non-trafficked adults engaged in the commercial sex industry. Findings can inform state-level policies on human trafficking and assist child protection and juvenile justice agencies in developing prevention and intervention responses to commercial sexual exploitation. [ABSTRACT FROM AUTHOR]

Aromatherapy is an integrative intervention that uses essential oils to address symptom management, potentially as a first-line intervention or as a complement to other medical treatments. Aromatherapy is gaining widespread acceptance and increased scientific evidence of efficacy. Integrative and holistic nursing care uses integrative therapies such as aromatherapy and the principle of moving from a less invasive intervention to a more invasive intervention according to patient needs, symptoms, and preferences. Aromatherapy is often provided as a minimally invasive, independent, and integrative nursing intervention. This article describes the process used to introduce essential oils into practices at a large Midwestern academic medical center. [ABSTRACT FROM AUTHOR]

Background: No controlled trials in children with end-stage kidney disease have assessed the benefits of more frequently administered hemodialysis (HD). Methods: We conducted a multicenter, crossover pilot trial to determine if short, more frequent (5 days per week) in-center HD was feasible and associated with improvements in blood pressure compared with three conventional HD treatments per week. Because adult studies have not controlled for the weekly duration of dialysis, we fixed the total treatment time at 12 h a week of dialysis during two 3-month study periods; only frequency varied from 5 to 3 days per week between study periods. Results: Eight children (median age 16.7 years) consented at three children's hospitals. The prespecified primary composite outcome was a sustained 10% decrease in systolic blood pressure and/or a decrease in antihypertensive medications relative to each study period's baseline. Among the six patients completing both study periods, five (83.3%) experienced the primary outcome during HD performed 5 days per week but not 3 days per week; one of the six (16.7%) achieved that outcome during 3-day but not 5-day ( p = 0.22) per week HD. During 5-day HD, all patients had significantly more treatments during which their pre-HD systolic ( p = 0.01) or diastolic ( p = 0.01) blood pressure was 10% lower than baseline. Conclusions: We observed that more frequent HD sessions per week was feasible and associated with improved blood pressure control, but barriers to changing thrice-weekly standard of care include financial reimbursement and the time demands associated with more frequent treatments. [ABSTRACT FROM AUTHOR]

High levels of psychotropic medication use and polypharmacy are common for emotionally and behaviorally troubled youth entering residential care. Polypharmacy has often been characterized as an especially serious problem in this vulnerable population. Latent Class Analysis was used to identify medication subgroups for 636 youth in an intensive residential program. Additionally, auxiliary analyses (e.g., diagnoses, demographics, expressed problem behaviors) were used to identify the personal and behavioral attributes associated with individuals in each of the latent classes. Three distinct medication patterns emerged: low/no psychotropic medication, the combination of antidepressant and antipsychotic medications, and multiple psychotropic medications. The latent classes were significantly different from one another on 12 of the 14 variables, helping explicate how patient and clinical characteristics underlie patterns of psychotropic medication use. Findings of this study, combined with additional research, hold promise for leading to improved, youth-centered prescribing practices. Our findings also highlight the need for careful monitoring of the types and range of medications that some youth are prescribed, and research on how youth with certain background characteristics are more likely to get prescribed multiple psychotropic medications. For youth experiencing higher levels of psychotropic polypharmacy, medication regimens need thoughtful reassessment using the principle of sufficiency as the foundation for medication management. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine the moderating role of emotional impact on the relationship between teasing frequency and self-worth in a community sample of youth. Participants included a community sample of 405 youth (M age = 10.22) who completed self-report measures of the frequency and emotional impact of teasing and self-worth. Latent moderated structural equation modeling indicated that emotional impact moderated the association between teasing frequency and self-worth (β = −.15, p = .04). Probing of the interaction revealed that among youth who experienced frequent teasing, self-worth was lower when emotional impact was high (β = −.25, t = 2.34, p = .02). Findings demonstrate that emotional impact moderated the relationship between teasing frequency and self-worth. Intervention designed to reduce teasing and its associated negative outcomes may benefit from intervention components designed to address the emotional impact of teasing. [ABSTRACT FROM AUTHOR]

Youth in residential care have significant mental health needs, which require regular progress monitoring; however, very few emotional or behavioral assessments have been examined with this unique, high-risk population. This study examined the psychometrics of the Symptoms and Functioning Severity Scale (SFSS), a brief 24-item measure designed to assess the emotional and behavioral status of youth. This study examined the SFSS ratings from 143 youth with a disruptive behavior diagnosis living in a group-home facility in the Midwest and 52 of their service providers. Overall, the findings suggest that the psychometrics of the SFSS, when rated by staff or youth, were similar to the original outpatient clinical samples. More specifically, the Rasch analyses indicate that the SFSS items and the overall scale are performing adequately, and the confirmatory factor analyses replicated the two-factor structure for staff. However, the fit of the two-factor model was less compelling for youth ratings. In all, the brief SFSS seems a promising measure for assessing problem severity for youth in residential care. [ABSTRACT FROM AUTHOR]

Recommended practices for Part C early childhood special education home visitors encourage use of caregiver coaching strategies to enhance learning opportunities within the natural routines of infants and toddlers. The purpose of this study was to evaluate the effects of a multicomponent professional development intervention on home visitors’ use of specific caregiver coaching strategies and range of routines utilized during home-based intervention. The professional development intervention systematically tested the effects of two brief workshops followed by 6 weeks of coaching via performance feedback that was based on videotaped home visits and delivered via email. A multiple-baseline design across three home visitors and caregiver/child dyads was used to evaluate home visitors’ use of caregiver coaching strategies and natural routines. Findings provide support for the use of individualized coaching via performance feedback delivered in electronic format as a means to enhance home visitors’ use of caregiver coaching strategies during home visits. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the effect of an alternative dental workforce program -- Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health. Methods. We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. Results. The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P=.014), restorations (P=.002), and treatment urgency (P=.038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). Conclusions. Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services. [ABSTRACT FROM AUTHOR]

Social acceptance, a foundation for friendship development and social inclusion, occurs when there is equal status among individuals, regardless whether the individual has a disability or not. Disability-specific residential camps for youth with similar life experiences may be one environment where social acceptance occurs. The purpose of this study was to examine the relationship between social acceptance and health-related quality of life for youth attending a residential summer camp specifically designed for people with hearing impairments who have cochlear implants or hearing aids. Results indicated disability specific residential camps may have an impact on social acceptance and perceived health related quality of life. [ABSTRACT FROM AUTHOR]

The Autism Detection in Early Childhood (ADEC) is a brief, play-based screening tool for the assessment of autism spectrum disorder (ASD) in children aged 12-36 months. We examined the psychometric properties of the ADEC in a clinical sample of toddlers ( n = 114) referred to a US pediatric hospital for assessment due to concerns of developmental delay or ASD. The ADEC (cutoff = 11) returned good sensitivity (.93-.94) but poorer specificity (.62-.64) for best estimate clinical diagnosis of ASD, and compared favorably with the ADOS-2. Internal consistency was acceptable, α = .80, and inter-rater reliability was high, ICC = .95. Results support the use of the ADEC as a clinical screen for ASD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to evaluate the efficacy of a phonological awareness (PA) intervention, designed for Tier 2 instruction in a Response to Intervention (RTI) model, delivered to small groups of preschoolers. Method: A multiple-baseline design across participants was used to evaluate the efficacy of the intervention on low-income preschool children's PA skills. A trained interventionist delivered small group sessions 3 to 4 days a week and ensured children received frequent opportunities to respond and contingent feedback. Participants received 28 to 36 lessons that lasted about 10 min each and focused on PA and alphabet knowledge. Initiation of intervention was staggered across 3 triads, and 7 children completed the study. Results: The intervention produced consistent gains on weekly progress monitoring assessments of the primary outcome measure for first sound identification (First Sound Fluency). Most children also demonstrated gains on other measures of PA and alphabet knowledge. Conclusions: Results provide support for the application of a small group intervention consistent with an RTI framework and document the potential benefits of the intervention to learners who need early literacy instruction beyond the core curriculum. [ABSTRACT FROM AUTHOR]

Children with Autism Spectrum Disorder (ASD) have deficits in social skills, and interaction with service dogs has been associated with increased social skills for children with ASD. In this telephone survey of 70 parents of children with ASD, children owning dogs had greater Mean scores for social skills, using the Social Skills Improvement System Rating Scale, while those with some type of pet (not excluding dogs) had significantly greater skills for subscale item 'assertion'. Parents described their children as attached to their dogs. Children owning dogs completed the Companion Animal Bonding Scale, and reported strong bonding with dogs. These findings suggest children with ASD may bond with their dogs, and pet ownership may be associated with increased social skills. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested that teachers' psychological attributes can be an indicator of teacher quality (Rimm-Kaufman and Hamre in Dev Psychol 45(4):958-972. doi:, ), and teachers' child-centered beliefs have been associated with children's academic achievement (Burchinal and Cryer in Early Child Res Q 18(4):401-426, ). The process underlying this link, however, has less been explored. One potential intervening factor can be children's behavioral self-regulation. Objective: The goal of this study was to explore the association between teachers' child-centered beliefs and children's academic achievement and the intervening role of children's behavioral self-regulation. Methods: We randomly selected 444 preschool children from 103 teachers and conducted path analysis, accounting for the nested nature of the data. Children's academic achievement variables measured by Peabody Picture Vocabulary Test, Phonological Awareness Literacy Screening for Preschool, and Woodcock Johnson-III were first regressed on teachers' child-centered beliefs and then children's behavioral self-regulation, as measured by Head-Toes-Knees-Shoulders, was entered as an intervening variable. Results: The results revealed that teachers' child-centered beliefs were not directly associated with children's literacy and math but indirectly through children's behavioral self-regulation. Conclusion: Teachers' child-centered beliefs can be considered an indicator of teacher quality. Future studies need to investigate how teachers with child-centered beliefs may promote children's self-regulation. Teacher professional development programs may need to target teachers' belief system as a way to improve teacher quality. [ABSTRACT FROM AUTHOR]

Background Many children with language impairment present with deficits in other areas, including executive functioning (EF), attention and behaviour. Similarly, many children receiving services for attention or behaviour problems have deficits in language ability. Aims To evaluate the relations among EF, language ability and behaviour problems in a sample of school-age children with a wide range of language and behaviour profiles. The following research questions were addressed: Does performance on EF tasks predict language ability? Do language ability and EF predict problems with attention, internalizing and/or externalizing? Methods & Procedures EF was defined as referring to the separable, yet related, processes of shifting, updating working memory and inhibition as specified in the latent variable model of EF. Children aged 8-11 years recruited from an urban school district completed standardized language and cognitive assessments and a computerized task assessing EF. Their parents completed standardized questionnaires assessing the children's EF and problem behaviours. Regression analyses were conducted. Outcomes & Results Regression analyses revealed that EF did not contribute to language ability beyond the variance accounted for by nonverbal reasoning. Language ability contributed to attention problems when entered as a single predictor, but was no longer significant when the EF measures were added to the model. Language ability did not significantly contribute to internalizing or externalizing behaviour problems. Parent-reported inhibition was a robust predictor of attention, internalizing and externalizing behaviour problems. Conclusions & Implications In this sample of school-age children, language ability was related to attention problems, but not to internalizing or externalizing. Children with behaviour problems may have particular difficulty with inhibition. [ABSTRACT FROM AUTHOR]

Background Previous research suggests that speakers are especially likely to produce manual communicative gestures when they have relative ease in thinking about the spatial elements of what they are describing, paired with relative difficulty organizing those elements into appropriate spoken language. Children with specific language impairment (SLI) exhibit poor expressive language abilities together with within-normal-range nonverbal IQs. Aims This study investigated whether weak spoken language abilities in children with SLI influence their reliance on gestures to express information. We hypothesized that these children would rely on communicative gestures to express information more often than their age-matched typically developing (TD) peers, and that they would sometimes express information in gestures that they do not express in the accompanying speech. Methods & Procedures Participants were 15 children with SLI (aged 5;6-10;0) and 18 age-matched TD controls. Children viewed a wordless cartoon and retold the story to a listener unfamiliar with the story. Children's gestures were identified and coded for meaning using a previously established system. Speech-gesture combinations were coded as redundant if the information conveyed in speech and gesture was the same, and non-redundant if the information conveyed in speech was different from the information conveyed in gesture. Outcomes & Results Children with SLI produced more gestures than children in the TD group; however, the likelihood that speech-gesture combinations were non-redundant did not differ significantly across the SLI and TD groups. In both groups, younger children were significantly more likely to produce non-redundant speech-gesture combinations than older children. Conclusions & Implications The gesture-speech integration system functions similarly in children with SLI and TD, but children with SLI rely more on gesture to help formulate, conceptualize or express the messages they want to convey. This provides motivation for future research examining whether interventions focusing on increasing manual gesture use facilitate language and communication in children with SLI. [ABSTRACT FROM AUTHOR]

Canonical babbling is a critical milestone for speech development and is usually well in place by 10 months. The possibility that infants with autism spectrum disorder (ASD) show late onset of canonical babbling has so far eluded evaluation. Rate of vocalization or 'volubility' has also been suggested as possibly aberrant in infants with ASD. We conducted a retrospective video study examining vocalizations of 37 infants at 9-12 and 15-18 months. Twenty-three of the 37 infants were later diagnosed with ASD and indeed produced low rates of canonical babbling and low volubility by comparison with the 14 typically developing infants. The study thus supports suggestions that very early vocal patterns may prove to be a useful component of early screening and diagnosis of ASD. [ABSTRACT FROM AUTHOR]

Individuals with autism spectrum disorder (ASD) have difficulty comprehending metaphors. However, no study to date has examined whether or not they understand conceptual metaphors (i.e. mappings between conceptual structures), which could be the building blocks of metaphoric thinking and understanding. We investigated whether 13 participants with ASD (age 7;03-22;03) and 13 age-matched typically developing (TD) controls could comprehend lexicalized conceptual metaphors (e.g., Susan is a warm person) and novel ones (e.g., Susan is a toasty person). Individuals with ASD performed at greater than chance levels on both metaphor types, although their performance was lower than TD participants. We discuss the theoretical relevance of these findings and educational implications. [ABSTRACT FROM AUTHOR]

Background This study represents an effort to advance our understanding of the nature of school readiness among children with language impairment (LI), a population of children acknowledged to be at risk of poor academic achievement. The academic, social-emotional, and behavioural competencies with which children arrive at kindergarten affect the nature of their future educational experiences, and their overall academic achievement. Aims To examine whether there are reliable profiles that characterize children with LI just prior to kindergarten entrance, and the extent to which profile membership is associated with characteristics of children's homes and preschool experiences. Questions addressed were twofold: (1) To what extent are there reliable profiles of children with LI with respect to their school readiness? (2) To what extent is children's profile membership associated with characteristics of their homes and preschool classrooms? Methods & Procedures Participants were 136 children with LI from early childhood special education classrooms. We utilized latent class analysis (LCA) to classify individuals into profiles based on individual responses on school readiness measures. We then used multilevel hierarchical generalized linear models to examine the relations between profile membership and children's home/classroom experiences. Outcomes & Results LCA analyses revealed that a four-profile solution was the most appropriate fit for the data and that classroom experiences were predictive of these profiles, such that children in classrooms with more instructional/emotional support were more likely to be placed in profiles characterized by higher school readiness skills. Conclusions & Implications These results suggest that the school readiness profiles of young children with LI are associated with the quality of children's classroom experiences, and that high-quality classroom experiences can be influential for ensuring that young children with LI arrive in kindergarten ready to learn. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to identify barriers and facilitators to children's use of speech-generating devices ( SGD). Design and Methods Interviews with 14 mothers were analyzed with content analysis to identify barriers and facilitators to SGD use. Results This study identified a number of specific barriers and facilitators to successful and sustained SGD use by children with complex communication disorders. Practice Implications Nurses can use the list of barriers and facilitators provided here as a springboard to discuss the families' experiences with device use. [ABSTRACT FROM AUTHOR]

Purpose: This study examined whether theme-related play increased subsequent engagement in storybook reading in preschool children with typical hearing and with hearing loss. Method: This study employed a counterbalanced experimental design. In all sessions, participants engaged in free play first and then were read a storybook. In the experimental condition, the play materials matched the theme of the book, and in the control condition it did not. Conditions were presented in random order. Storybooks had language at the early preschool level and had characters, plots, and illustrations. Twenty-three preschool-aged children participated, 12 with typical hearing and 11 with hearing loss. Engagement during storybook reading was measured using a modified Child Behaviour Rating Scale (CBRS; Mahoney,1998), consisting of five items: Attention to Activity, Involvement, Cooperation (Attention subscale), and Affect and Joint Attention (Socio-emotional scale). Results: Play that matched the theme of the storybook selectively enhanced engagement, particularly the Affect Item and the Socio-emotional Subscale of the CBRS, in participants with hearing loss. Conclusion: Thematically related play prior to reading leads to increased interaction with the reader and more positive emotion during reading for children with hearing loss. Implementing this approach is simple and fun for school and home settings. [ABSTRACT FROM PUBLISHER]

This study aimed to evaluate the Program for the Education and Enrichment of Relational Skills (PEERS: Laugeson et al. in J Autism Dev Disord 39(4):596-606, ). PEERS focuses on improving friendship quality and social skills among adolescents with higher-functioning ASD. 58 participants aged 11-16 years-old were randomly assigned to either an immediate treatment or waitlist comparison group. Results revealed, in comparison to the waitlist group, that the experimental treatment group significantly improved their knowledge of PEERS concepts and friendship skills, increased in their amount of get-togethers, and decreased in their levels of social anxiety, core autistic symptoms, and problem behaviors from pre-to post-PEERS. This study provides the first independent replication and extension of the empirically-supported PEERS social skills intervention for adolescents with ASD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the following: (i) associations among children's prior contact with people with disabilities and the three dimensions of children's attitudes towards people with disabilities: children's understanding of and their feelings about people with disabilities and their behavioural intentions to make inclusion decisions; (ii) the relation between children's behavioural intentions to make inclusion decisions and the demands of activity contexts and the types of disabilities; and (iii) the association between parents' attitudes and children's attitudes. Participants included 94 typically developing four- and five-year-old preschoolers. Children's understanding of disabilities and their prior contact with people with disabilities were found to be positively related to their feelings about people with disabilities; children's understanding of disabilities was a significant moderator of the relation between their behavioural intentions and activity contexts or types of disabilities. The hypothesized association between parents' attitudes and children's attitudes was not significant. Preschoolers may benefit from having more regular contact with people with disabilities to develop positive feelings towards their peers with disabilities, which is also related to their understanding of disabilities. Children's behavioural intentions to make inclusion decisions need to be understood in relation to their understanding of disabilities, the demand of activity contexts, and types of disabilities. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Our study examined the effects of Write Start, a classroom-embedded handwriting/writing program on handwriting and writing fluency for first grade students, co-taught by occupational therapists and teachers. Two first grade classrooms received the Write Start and two received standard handwriting instruction. This co-taught program included specific feedback during handwriting practice, small group activities, student self-evaluation, and peer supports. The students were evaluated on handwriting legibility, fluency, and written expression at baseline, immediately after the program, and 6 months later. When performance was compared between the two groups, the students in the Write Start program improved significantly more in legibility ( d = .57) and fluency ( d = .75) than students who received standard instruction. Gains in handwriting speed ( d = .18), average legibility ( d = .26), and written expression ( d = .25) did not differ significantly between the two groups. A co-taught, inclusive handwriting/writing program can promote first grade students' achievement of lower case legibility and writing fluency. [ABSTRACT FROM AUTHOR]

The current study examined the incremental utility of rating scales, a structured diagnostic interview, and multiple informants in a comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD). The sample included 185 children with ADHD (Mage = 9.22, SD = 0.95) and 82 children without ADHD (Mage = 9.24, SD = 0.88). Logistic regressions were used to examine the incremental contribution of each method within an assessment of ADHD. Results indicated that information collected from a structured diagnostic interview was unable to significantly improve a prediction model including parent and teacher ratings (Block χ2 = 0.91, ρ = .64). Teacher ratings on symptom-based scales resulted in significant model improvement beyond parent ratings alone (Block χ2 = 48.47, ρ < .001). Exploratory analyses indicated that using behavioral rating scales correctly classified all participants by diagnosis. Clinical implications are highlighted, and future research directions are discussed. [ABSTRACT FROM PUBLISHER]

Purpose Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States. Methods Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States. Findings Multinomial logistic regression models were statistically significant for girls (χ2[20] = 42.73, P < .01), boys (χ2[20] = 50.44, P < .001), American Indian (χ2[20] = 36.67, P < .05), and white children (χ2[20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys. Conclusions Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children. [ABSTRACT FROM AUTHOR]