Child behaviour after anaesthesia: association of socioeconomic factors and child behaviour checklist to the Post-Hospital Behaviour Questionnaire

AIM: In the process of validation of the Swedish translation of the Post-Hospital Behaviour Questionnaire (PHBQ) to assess its relation to the Child Behaviour Checklist (CBCL) and to describe its relation to sociodemographic factors. METHOD: Three hundred and forty children 2-13 years studied in connection with elective procedures which included anaesthesia. Parents completed the CBCL forms before and after hospitalization as well as the PHBQ 2 weeks after hospitalization. RESULTS: In multivariate analysis of PHBQ total score independent risk factors were: age <5 (OR 2.4; CI 1.4-4.0), living in a one parent family (OR 4.4; CI: 1.6-12.6) and not living in a rural area (OR 1.6; CI: 1.0-2.6). The correlation between the total scores for PHBQ and CBCL for children aged 2-4 was moderate: (r = 0.38; p < 0.005). For children aged 4-7 there were significant correlations between PHBQ sleep anxiety and CBCL Other problems (r = 0.4; p < 0.01), PHBQ eating disturbances and CBCL total score (r = 0.3; p < 0.01), though none of these significant correlations were observed for children above 7 years of age. CONCLUSION: There is an association between PHBQ and CBCL which is weaker for older children. The reason for this might be that PHBQ is more sensitive in the younger age group and to minor changes in behaviour. Children younger than 5 years of age or living in a one parent family or not living in rural areas appear to have higher incidence of problematic behaviour in a 2 week follow up after anaesthesia.     

Child behaviour after anaesthesia: associated risk factors

AIM: To identify hospital care factors which are associated with problematic behaviours in children after hospitalization. METHOD: A cohort of 340 children ages 2-13 was studied in connection with elective procedures which included anaesthesia. Data collected: sociodemographic, type of procedure, anaesthesia induction technique and premedication. Staff and parents assessed child anxiety at induction of anaesthesia, pain, anxiety and nausea in recovery room and hospital ward. Parents assessed their child's pain and nausea and the behaviour measured with the Post Hospital Behavioural Questionnaire two weeks after hospitalization. RESULTS: One-third (34.4 %) of the children developed at least one problematic behaviour, measured by the PHBQ subscales. Multiple logistic regression identified the following risk factors: age <5, pain at home but not at hospital, nausea, child anxiety at anaesthesia induction, postoperative nausea, postoperative distress, previous hospitalizations, living in a one adult family and having some previous problematic behaviours. Moderate-to-severe pain at home, but not at hospital, was associated with the greatest risk (OR 6.39 CI: 3.53-11.6). Previous anaesthesia, midazolam use in premedication and living in rural areas seemed to be protective factors. CONCLUSION: Pain at home but not in hospital is a strong risk factor for the onset or worsening of problematic behaviour after childhood hospitalization, which included anaesthesia. Proactive interventions are suggested to prevent this by improving pain treatment at home.     

Behaviour problems in children with language impairment

BACKGROUND: Language impairment is often associated with behaviour problems. However, detailed relations between different types of language impairment and specific behaviour problems in children have yet to be demonstrated. The present study attempted to do just this with an eye to the implications to identify foci for early intervention. METHODS: The language abilities of 71 five-year-old children with language impairment were assessed via the administration of an extensive battery of language tests. The children's behaviour profile was assessed via administration of the Child Behaviour Checklist. RESULTS: Factor analyses confirmed the presence of four language factors: speech, syntax, semantics and phonology. Forty percent of the children displayed serious significant behaviour problems. The most frequently occurring behaviour problems were: withdrawn behaviour, somatic complaints, thought problems and aggressive behaviour. Behaviour problems were associated with three of the four language factors but not strongly associated with speech problems. CONCLUSIONS: Differential relations between specific types of language impairment and specific behaviour problems already exist at a young age. Phonological problems showed broad relations to problem behaviour; semantic language problems were especially related to internalizing behaviour problems. This finding suggests the need for specific therapies for both different types of language problems and different types of behaviour problems.     

Behaviour and Development of Stunted and Nonstunted Jamaican Children

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.     

Development of the Children's Eating Behaviour Questionnaire

Individual differences in several aspects of eating style have been implicated in the development of weight problems in children and adults, but there are presently no reliable and valid scales that assess a range of dimensions of eating style. This paper describes the development and preliminary validation of a parent-rated instrument to assess eight dimensions of eating style in children; the Children's Eating Behaviour Questionnaire (CEBQ). Constructs for inclusion were derived both from the existing literature on eating behaviour in children and adults, and from interviews with parents. They included responsiveness to food, enjoyment of food, satiety responsiveness, slowness in eating. fussiness, emotional overeating, emotional undereating. and desire for drinks. A large pool of items covering each of these constructs was developed. The number of items was then successively culled through analysis of responses from three samples of families of young children (N = 131; N = 187; N = 218), to produce a 35-item instrument with eight scales which were internally valid and had good test-retest reliability. Investigation of variations by gender and age revealed only minimal gender differences in any aspect of eating style. Satiety responsiveness and slowness in eating diminished from age 3 to 8. Enjoyment of food and food responsiveness increased over this age range. The CEBQ should provide a useful measure of eating style for research into the early precursors of obesity or eating disorders. This is especially important in relation to the growing evidence for the heritability of obesity, where good measurement of the associated behavioural phenotype will be crucial in investigating the contribution of inherited variations in eating behaviour to the process of weight gain.     

Social and behaviour change communication to improve child feeding practices in Ethiopia

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.     

Pattern of preschool behaviour problems in New Zealand, using the Behaviour Check List

Objective : The main aim of the study was to identify the pattern of behaviour problems in preschool children to enable early recognition and intervention.
Methodology : Three hundred and twenty children, in eight randomly selected preschool centres, aged between 2.5 and 5 years, were included in the study. Parents completed the Behaviour Check List (BCL), a screening measure for preschool behaviour problems.
Results : Dependency, temper tantrums, and being difficult to manage were the commonly rated symptoms when moderate-severe problems were examined. Developmental problems decreased with increasing age, while relationship problems and worries that were cognitively mediated worsened. There were no major differences in the patterns between boys and girls. On cross-cultural comparison, parents in New Zealand rated their children lower on the BCL compared to those in the UK. Factor analysis of the BCL yielded seven factors. The two main factors 'predominantly conduct' and 'predominantly emotional' consisted of a mixture of conduct (difficulty in managing, temper tantrums, sibling rivalry) and emotional (unhappy mood, worry, fears) problems. The other five factors were related to developmental problems.
Conclusions : These results help clinicians identify the emerging pattern of preschool behaviour problems that change with increasing age and vary with differing cultures. Categorical presentation of preschool behaviour problems support the view that they should be included in a classification system.     

Child use of dental services and receipt of dental care in New Zealand

AIM: To examine dental service use and dental care receipt by a range of factors among Maori, Pacific and New Zealand European or Other children in New Zealand. METHODS: Data were from the 2002 National Children's Nutrition Survey. Bivariate associations were calculated between three dental service use and dental care receipt measures, and 48 personal characteristics in five domains. Analyses took into account the complex sampling design. RESULTS: Some 3275 children participated; 37.4% Maori, 32.3% Pacific and 30.3% New Zealand European or Other. Irregular dental attendance was associated with children who were 11-14 years, Pacific, had not always lived in New Zealand, lived in rented accommodation, frequently watched television, consumed breakfast on the way to school, purchased lunch, consumed sugar-containing products or had food security issues. A higher proportion of children who were aged 11-14 years, Maori, had low household income, lived with 4+ children, regularly watched television, consumed breakfast on the way to school, frequently consumed high-sugar foods, had food security issues, experienced dental pain at night or had received dental care under a general anaesthetic had received a restoration. Extraction receipt was associated with children who were Pacific, had low household income, had a disability, purchased their lunch, regularly consumed high-sugar-containing products, had food security issues, had experienced dental pain at night or received dental care under a general anaesthetic. CONCLUSIONS: Material and behavioural factors all play a role in New Zealand child use of dental services and receipt of dental care.     

Confirmation that Child Behavior Checklist clinical scales discriminate juvenile mania from attention deficit hyperactivity disorder

OBJECTIVE: To determine whether boys meeting diagnostic criteria for juvenile mania and attention deficit hyperactivity disorder (mania-ADHD) may be distinguished from boys with ADHD alone on a range of clinical and family variables. METHODOLOGY: Boys aged 9-13 years with mania-ADHD (n = 25), ADHD alone (n = 99), or no psychiatric diagnosis (n = 27) were compared on parent and teacher report Child Behavior Checklists (CBCL) and Conners Questionnaires, self-report CBCLs, patterns of comorbidity, intellectual functioning, and family variables. RESULTS: Mania-ADHD subjects had significantly higher mean ratings than ADHD only subjects on the parent CBCL for the Withdrawn, Thought Problems, Delinquent Behavior and Aggressive Behavior scales and significantly higher rates of comorbid depression, anxiety and psychotic symptoms. Other variables did not distinguish the mania-ADHD and ADHD only groups. CONCLUSIONS: These data confirm previous research indicating that the CBCL may be used to assist in the clinical identification of manic children.     

Mother-child joint activity and behaviour problems of pre-school children

BACKGROUND: Behaviour problems are common among pre-school children, and a substantial proportion persist, causing significant burden to the family, schools and health services. Relatively little research has addressed the effects of positive parenting on behaviour disorder in pre-school children, particularly in larger population-based studies. METHOD: A cross-sectional postal survey of a representative, population-based sample of 800 mothers of 3 1/2-year-old children living in an outer London Borough was carried out to assess the association between mother-child joint activity and behaviour problems of pre-school children. The response rate was 70%. RESULTS: Lower levels of mother-child joint activity remained independently associated with behaviour problems of pre-school children both on a binary and a continuous scale after adjusting for a wide range of household, maternal and child circumstances. The association between low levels of mother-child joint activities and behaviour problems of the children was stronger in the presence of social problems in the family. CONCLUSION: Possible causal pathways and directions for future research and intervention are discussed.     

A Comparison of Twins and Singletons with Child Psychiatric Disorders: an Item Sheet Study

An important assumption underlying the twin method of comparing MZ and DZ twins is that results from twin samples can be generalized to the larger singleton population. This study uses Item Sheet data on child psychiatric patients to compare twins and singletons on demographic, diagnostic and symptomatic variables. Although little difference was found between the two groups, conduct disorders were significantly over-represented in the twin population. The significance of this finding is discussed. This study lends overall support for the use of the twin method in child psychiatric samples.     

Behaviour change communication for child feeding in social assistance: A scoping review and expert consultation

To increase the effectiveness of social assistance on child nutrition, programmes are increasingly combined with behaviour change communication for improved infant and young child feeding (BCC for IYCF). Unfortunately, there is limited knowledge about which BCC strategies are most effective when combined with social assistance. A systematic scoping review and an expert consultation was conducted to (1) describe the landscape of BCC for IYCF strategies used in social assistance within low‐ and middle‐income countries and (2) to examine the effects of these BCC strategies on IYCF practices and child nutrition. Ten quantitative, three qualitative and four mixed methods studies were reviewed and complemented by 12 expert consultations carried out between August and October 2020. In most of the studies attendance in BCC for IYCF was conditional for receiving social assistance, although experts agreed that this conditionality may be counterproductive. A variety of BCC strategies were used with two being most common—group sessions with pre‐determined topics and individual counselling. Context‐specific adaptation, interactive delivery and building on existing IYCF knowledge emerged as crucial but was perceived as economically infeasible in social assistance programmes. Given the variety of BCC strategies and inconsistency in outcomes, it is impossible to draw conclusions regarding effectiveness. Nevertheless, tentative evidence suggests that the promotion of existing nutrition services, educational group sessions and individual counselling may be effective in improving IYCF. BCC for IYCF can make social assistance more beneficial, but may increase costs, demands on beneficiaries, and deviate from the original focus of the programmes.     

Identifying determinants of effective complementary feeding behaviour change interventions in developing countries

As stunting moves to the forefront of the global agenda, there is substantial evidence that behaviour change interventions (BCI) can improve infant feeding practices and growth. However, this evidence has not been translated into improved outcomes on a national level because we do not know enough about what makes these interventions work, for whom, when, why, at what cost and for how long. Our objective was to examine the design and implementation of complementary feeding BCI, from the peer‐reviewed literature, to identify generalisable key determinants. We identified 29 studies that evaluated BCI efficacy or effectiveness, were conducted in developing countries, and reported outcomes on infant and young children aged 6–24 months. Two potential determinants emerged: (1) effective studies used formative research to identify cultural barriers and enablers to optimal feeding practices, to shape the intervention strategy, and to formulate appropriate messages and mediums for delivery; (2) effective studies delineated the programme impact pathway to the target behaviour change and assessed intermediary behaviour changes to learn what worked. We found that BCI that used these developmental and implementation processes could be effective despite heterogeneous approaches and design components. Our analysis was constrained, however, by the limited published data on how design and implementation were carried out, perhaps because of publishing space limits. Information on cost‐effectiveness, sustainability and scalability was also very limited. We suggest a more comprehensive reporting process and a more strategic research agenda to enable generalisable evidence to accumulate.     

Associations between cerebral blood-flow measured by single photon emission computed tomography (SPECT), electro-encephalogram (EEG), behaviour symptoms, cognition and neurological soft signs in children with attention-deficit hyperactivity disorder (ADHD)

Twenty-eight children with attention-deficit hyperactivity disorder (ADHD) were examined with SPECT (single photon emission computed tomography). Seven of the children had abnormal distribution of the regional cerebral blood-flow (rCBF) on visual evaluation and 10 had abnormal EEG findings. The only clinical finding that differentiated the group with normal from abnormal rCBF was behaviour symptom load. A factor analysis of the rCBF in different regions of interest yielded one factor with low rCBF in the temporal and cerebellar regions and high rCBF in the subcortical and thalamic regions, which was significantly associated with the degree of motor impairment and results on a cognitive test (WISC). Another factor consisting of high rCBF in frontal and parietal regions had a significant negative correlation with the degree of behaviour symptoms. There was a negative correlation between the rCBF in the right frontal regions and the degree of behaviour symptoms. The number of minor physical anomalies (MPA) was negatively correlated to the rCBF in the frontal lobes bilaterally. These results suggest that there may be at least two functional disturbances in ADHD, one specific neurodevelopmentally determined disturbance of the frontal lobes, especially of the right hemisphere, related to behaviour deviance, and another disturbance of the integration of the temporal lobes, the cerebellum and subcortical structures, related to motor planning and aspects of cognition.