Caregivers of Frail Elderly and Medically Fragile Children:

The purposes of this study were to compare the characteristics and support systems of caregivers of frail elderly and medically fragile children and to determine what factors discriminated between caregivers who could (and could not) continue to provide home health care. Caregivers of children were significantly more likely (X²= 52.30)2), p= < .0000) to report that they were managing OK than caregivers of frail elderly. They also reported receiving more support and assistance from formal and informal sources, although in general, less than 30% of the caregivers received any help. Five variables (Mental impairment of the elder, poor physical and mental health of the caregiver, high monthly caregiving-related expenses, and use of paid in-home assistance) explained 35% of the variance between caregivers of frail elderly who were managing OK and those who were unable to continue to manage. Six variables (physical and mental impairment of the child, physical health of the caregiver, feeling like there were no alternative providers, time demand and lack of assistance from others) explained 26.57% of the variance between caregivers of children who were managing OK and those who were unable to continue to manage. The findings suggest that a strong objective stressor, combined with a lack of personal and social resources are associated with caregivers' perceptions that they cannot continue to manage home health care.     

Parent-Child Interactions,Parenting Stress,and Developmental Outcomes at 4 Years

This study examined the relationship of father-child and mother-child interactions, perceptions of parenting stress, socioeconomic status, and prematurity to development of 44 healthy preterm and 49 full-term Canadian children at 4 years of age. Preterm or full-term birth, infant sex, and parental age accounted for 30-32% of the variance in cognitive and motor scores, respectively, on the McCarthy Scales of Children's Abilities. Parenting stress, father-child interactions at 12 months, and preterm and full-term birth accounted for 19% of the variance for expressive language on the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P). For receptive language on the CELF-P, mother-child interaction at 12 months, mother's spousal relationship, and preterm and full-term birth accounted for 13% of the variance. Addressing early parent-child interaction and perceptions of parenting stress may improve child language development.     

Parent-Child Interactions, Parenting Stress, and Developmental Outcomes at 4 Years

This study examined the relationship of father-child and mother-child interactions, perceptions of parenting stress, socioeconomic status, and prematurity to development of 44 healthy preterm and 49 full-term Canadian children at 4 years of age. Preterm or full-term birth, infant sex, and parental age accounted for 30-32% of the variance in cognitive and motor scores, respectively, on the McCarthy Scales of Children's Abilities. Parenting stress, father-child interactions at 12 months, and preterm and full-term birth accounted for 19% of the variance for expressive language on the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P). For receptive language on the CELF-P, mother-child interaction at 12 months, mother's spousal relationship, and preterm and full-term birth accounted for 13% of the variance. Addressing early parent-child interaction and perceptions of parenting stress may improve child language development.     

Preventing High-Risk Sexual Behavior in Early Adulthood with Family Interventions in Adolescence: Outcomes and Developmental Processes

Adolescent study participants who engaged in a brief, family-centered intervention (the Family Check-Up, FCU) were later assessed for the intervention’s effects on high-risk sexual behavior (HRSB) in early adulthood (age 22). Participants (N?=?998 adolescents and their families) were randomly assigned to a family-centered intervention in sixth grade and were offered a gated, multilevel intervention that included (a) a school-based family resource center, (b) the FCU, and (c) more intensive, family-based treatment. All services were voluntary, but high-risk families were actively recruited into the FCU. Approximately 23 % of the intervention families engaged in the FCU and approximately 18 % engaged in more intensive treatment. Using an intent-to-treat design, we found that the direct effect of the FCU on HRSB was not significant; however, an analysis of the developmental processes indicated that intervention families demonstrated improved family relationship quality when compared to control families, which in turn resulted in lower levels of HRSB in early adulthood. Furthermore, the significant effect of family relationship quality on HRSB was mediated by differences in parental monitoring and early sexual activity, and these effects varied as a function of gender and ethnicity. Indirect effects of the FCU on HRSB were significant via multiple different pathways. The implications of these findings for enhancing the impact of family-centered interventions are discussed.     

Preventing High-Risk Sexual Behavior in Early Adulthood with Family Interventions in Adolescence: Outcomes and Developmental Processes

Adolescent study participants who engaged in a brief, family-centered intervention (the Family Check-Up, FCU) were later assessed for the intervention’s effects on high-risk sexual behavior (HRSB) in early adulthood (age 22). Participants (N = 998 adolescents and their families) were randomly assigned to a family-centered intervention in sixth grade and were offered a gated, multilevel intervention that included (a) a school-based family resource center, (b) the FCU, and (c) more intensive, family-based treatment. All services were voluntary, but high-risk families were actively recruited into the FCU. Approximately 23 % of the intervention families engaged in the FCU and approximately 18 % engaged in more intensive treatment. Using an intent-to-treat design, we found that the direct effect of the FCU on HRSB was not significant; however, an analysis of the developmental processes indicated that intervention families demonstrated improved family relationship quality when compared to control families, which in turn resulted in lower levels of HRSB in early adulthood. Furthermore, the significant effect of family relationship quality on HRSB was mediated by differences in parental monitoring and early sexual activity, and these effects varied as a function of gender and ethnicity. Indirect effects of the FCU on HRSB were significant via multiple different pathways. The implications of these findings for enhancing the impact of family-centered interventions are discussed.

     

Children Who Are Medically Fragile in North Carolina: Using Medicaid Data to Estimate Prevalence and Medical Care Costs in 2004

Objectives: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0–19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. Methods: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. Results: 1,914 children ages 0–19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0–19. Conclusions: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.     

Children in Three Types of Day Care: Daily Experiences, Quality of Care and Developmental Outcomes

The effects of three different types of high and low quality child care were examined in the Canadian Victoria Day Care research project: Licensed family day care, unlicensed family day care and licensed center care. Several confounding factors made interpretation of results difficult (such as quality of care and quality of family life. Children from low-resource families (lower education, income and occupation levels) were enrolled in family day care homes with the lowest quality ratings, watched more television, and had fewer reading and informational activities. The variability of unlicensed family day care homes was the greatest. The mean language scores for children in high quality homes were higher than for children in low quality family day care homes.     

Children in Three Types of Day Care: Daily Experiences,Quality of Care and Developmental Outcomes 1

The effects of three different types of high and low quality child care were examined in the Canadian Victoria Day Care research project: Licensed family day care, unlicensed family day care and licensed center care. Several confounding factors made interpretation of results difficult (such as quality of care and quality of family life. Children from low‐resource families (lower education, income and occupation levels) were enrolled in family day care homes with the lowest quality ratings, watched more television, and had fewer reading and informational activities. The variability of unlicensed family day care homes was the greatest. The mean language scores for children in high quality homes were higher than for children in low quality family day care homes.

     

亲子互动量表的信度和效度检验

目的：检验亲子互动量表（Parent-Child Interaction Scales,PCI）的信度和效度。方法：于2020年11月—2021年1月在兰州市城区随机抽取814名0～3岁儿童及其家长进行调查,评价PCI中教育量表和喂养量表的信度和效度。结果：教育量表的Cronbach’sα系数为0.813,评分者信度为0.916,内部一致性信度为0.839,条目水平的内容效度指数（I-CVI）值为0.833～1.000,量表水平的内容效度指数（S-CVI/Ave）值为0.977,验证性因子分析结果显示拟合度良好;喂养量表的Cronbach’sα系数为0.912,评分者信度为0.873,内部一致性信度为0.923,条目水平的内容效度指数（I-CVI）值为0.833～1.000,量表水平的内容效度指数（S-CVI/Ave）值为0.991,验证性因子分析结果显示拟合度良好。结论：PCI量表具有良好的信度和效度,可以作为我国0～3岁儿童亲子互动质量的评估工具。     

Heterogeneous Friendship Affiliation, Problem Behaviors, and Emotional Outcomes among High-Risk Adolescents

Adolescent friendship groups are often heterogeneous and thus involve exposure to both deviant and nondeviant influences. This longitudinal study examined whether the addition of nondeviant peer influences in early high school protected against the negative socialization effects of deviant affiliation on both concurrent and future smoking, alcohol problems, and depressive symptomatology. Adolescents (9th and 10th grade students, N?=?1,128) completed self-report questionnaires at both a baseline and 24-month assessment. Nondeviant affiliation consistently reduced the effects of deviant influences on smoking and alcohol problems but not on depressive symptoms. Findings reinforce the complexity of adolescent friendship influences and the notion that distinct mechanisms may drive the associations between deviant affiliations and behavioral and emotional outcomes throughout adolescence. Implications for prevention are also discussed.     

For Parents and Children Only: A Parent-Child Education Library

A Parent-Child Education Library was developed at a children s hospital to help fill the gap in communication between staff and families The written materials supplement the staff's verbal explanations Materials include both medical and other child-related educational topics The library was approved by the medical staff and is funded by donations Counseling has become an appropriate adjunct to the library as parents and or children share their problems and feelings The library is a service provided by the Child Life Program.     

Adaptations of the Denver II Scoring System to Assess the Developmental Status of Children With Medically Complex Conditions

Determining the developmental status of children with medically complex conditions is important. This article examines the rationale for assessing the developmental status of such children using the Denver Developmental Screening Test II (Denver II; Frankenburg et al., 1990). The traditional method of scoring the Denver II is compared to a method the authors have adapted for use with children with medically complex conditions. This proposed adaptation of the Denver II scoring system can be used to determine children's variability in developmental skills between domains, assess their progress over time, and compare development in relation to other children.     

Early Intervention Referral Outcomes for Children at Increased Risk of Experiencing Developmental Delays

Objectives

The primary goal was to examine outcomes of Part C early intervention (EI) referrals from a high-risk infant follow-up program and factors associated with success. A secondary aim was to determine how many referred children not evaluated by EI would have likely qualified by either automatically meeting state eligibility criteria with a condition associated with “high-probability” for developmental delays or having test scores evidencing developmental delays.

Methods

Participants included 77 children referred directly to EI from a high-risk infant follow-up program. Scores on the Bayley Scales of Infant and Toddler Development-III, basic demographics, and medical variables were extracted from electronic medical records. Information regarding referral outcomes was gathered via follow-up phone calls to EI programs several months after referral.

Results

Results indicate 62% of EI referrals resulted in evaluation, with 69% of those evaluated being found eligible for services. Overall, 34% of referrals resulted in EI enrollment. Of those who were not evaluated, 71% were likely to have qualified based on state eligibility criteria. Follow-up phone call results indicated the majority of families not evaluated (64%) were never successfully contacted by the EI program.

Conclusions

Findings from the present study illustrate the extent of challenges in connecting families with needed EI services and indicate an opportunity for improvement in EI referral processes to increase enrollment for eligible children. Improved communication between referral sources and service providers could support enrollment with detailed documentation of prior testing and explicit reasons for referral. Follow-up calls to confirm receipt of referral may also be necessary.

     

For Parents and Children Only: A Parent-Child Educational Library

A Parent-Child Education Library was developed at a children s hospital to help fill the gap in communication between staff and families The written materials supplement the staff's verbal explanations Materials include both medical and other child-related educational topics The library was approved by the medical staff and is funded by donations Counseling has become an appropriate adjunct to the library as parents and or children share their problems and feelings The library is a service provided by the Child Life Program.     

Plasma B Vitamers: Population Epidemiology and Parent-Child Concordance in Children and Adults

Scope: B vitamers are co-enzymes involved in key physiological processes including energy production, one-carbon, and macronutrient metabolism. Studies profiling B vitamers simultaneously in parent–child dyads are scarce. Profiling B vitamers in parent–child dyads enables an insightful determination of gene–environment contributions to their circulating concentrations. We aimed to characterise: (a) parent–child dyad concordance, (b) generation (children versus adults), (c) age (within the adult subgroup (age range 28–71 years)) and (d) sex differences in plasma B vitamer concentrations in the CheckPoint study of Australian children. Methods and Results: 1166 children (11 ± 0.5 years, 51% female) and 1324 parents (44 ± 5.1 years, 87% female) took part in a biomedical assessment of a population-derived longitudinal cohort study: The Growing Up in Australia’s Child Health CheckPoint. B vitamer levels were quantified by UHPLC/MS-MS. B vitamer levels were weakly concordant between parent–child pairs (10–31% of variability explained). All B vitamer concentrations exhibited generation-specificity, except for flavin mononucleotide (FMN). The levels of thiamine, pantothenic acid, and 4-pyridoxic acid were higher in male children, and those of pantothenic acid were higher in male adults compared to their female counterparts. Conclusion: Family, age, and sex contribute to variations in the concentrations of plasma B vitamers in Australian children and adults.     

Fussy Eating among Children and Their Parents: Associations in Parent-Child Dyads,in a Sample of Children with and without Neurodevelopmental Disorders

Parents are important agents in shaping children’s eating habits. However, the associations between children’s and parents’ eating behaviors are complex and may be convoluted for various reasons, such as parenting feeding styles, stressful mealtimes, and children’s neurodevelopmental disorders (ND), such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this study was to analyze associations between parents and their children’s fussy eating, in a cross-sectional sample of children, with and without ND. Ninety-seven parents answered screening questionnaires prior to an intervention study. Associations were investigated using two-way ANOVAs and chi-square analyses. Overall, children with ND accepted fewer food items and consumed unhealthier foods more frequently than children without ND. Fussy eating parents had children who accepted fewer food items and consumed unhealthier foods more frequently than children whose parents were not fussy eaters. Interaction effects were not significant. A higher proportion of fussy eating parents, than non-fussy eating parents, had children who had difficulties with combined foods and hidden ingredients. The findings highlight the need for further investigation into the relationships between parents’ influence on their children’s eating behavior and food consumption, as well as possible reciprocal impacts.     

Developmental Disabilities and Socioeconomic Outcomes in Young Adulthood

ObjectiveWe assessed the associations between developmental disabilities and indicators of socioeconomic outcomes (i.e., educational attainment, employment status, occupation type, subjective perception of socioeconomic status [SES], income, and wage rate) among young U.S. adults aged 24–33 years.MethodsWe used data from the National Longitudinal Study of Adolescent Health (n=13,040), a nationally representative study of U.S. adolescents in grades 7–12 during the 1994–1995 school year. Young adult outcomes (i.e., educational attainment, employment status, income, occupation, and subjective SES) were measured in Wave IV (2008 for those aged 24–33 years). Multivariate methods controlled for sociodemographic characteristics and other relevant variables.ResultsNearly 12% of this sample presented with a physical or cognitive disability. Respondents with physical disabilities had lower educational attainment (odds ratio [OR] = 0.69, 95% confidence interval [CI] 0.57, 0.85) and ranked themselves in lower positions on the subjective SES ladder (OR=0.71, 95% CI 0.57, 0.87) than those without a physical disability. Compared with individuals without disabilities, young adults with a cognitive disability also had lower educational attainment (OR=0.41, 95% CI 0.33, 0.52) and, when employed, were less likely to have a professional/managerial occupation (OR=0.50, 95% CI 0.39, 0.64). Young adults with disabilities also earned less annually (–$10,419.05, 95% CI –$4,954.79, –$5,883.37) and hourly (–$5.38, 95% CI –$7.64, –$3.12) than their non-disabled counterparts.ConclusionThis study highlights the importance of considering multiple developmental experiences that may contribute to learning and work achievements through the transition from adolescence to young adulthood.Disabilities are prevalent conditions that result from interactions among health problems, environment, and personal factors, and can impose a large burden on affected individuals, their families, and society. Developmental disabilities, which can be defined as conditions caused by physical or mental impairments occurring by age 22, are of particular interest given their potential long-term impact on well-being.¹Several metrics suggest that the prevalence of disabilities is increasing, by as much as 7 percentage points (11.7% to 18.7%) from 1970 to 2005.² The increasing trend in prevalence is similar across various age groups^1–4 and is partially explained by the aging of the U.S. population.^1,3–5 Other contributing factors include advances in neonatal and pediatric care, which have significantly improved the survival of infants at greater risk of developing a disability, such as very preterm and low birthweight children.^6,7Adulthood is typically characterized by the achievement of specific milestones related to human capital accumulation, such as completing one''s education, getting a full-time job, and getting married or having a child.⁷ The transition into adulthood can be challenging for any adolescent, but for adolescents with disabilities and their families, this transition may be more difficult.⁶ Disabilities can adversely affect multiple socioeconomic outcomes, including educational achievement and attainment, employment, income, and other socioeconomic status (SES) indicators.⁸Education is a key determinant of economic performance that also affects long-term SES and quality of life.⁸ Children and adolescents with physical and cognitive disabilities typically have more limited access to formal education than their non-disabled peers.^9–11 Also, individuals with disabilities have poorer employment outcomes than their non-disabled peers, as reflected in lower-paying jobs, lower occupational status, and higher unemployment rates.^6,7,12,13Differences in learning and work performance for adults with disabilities compared with their non-disabled peers may be decreasing, as suggested by a 2012 review on transition to adulthood.¹⁰ However, the performance of individuals with disabilities on these socioeconomic outcomes continues below ideal levels.^11,12 A better understanding of socioeconomic achievements around the transition to adulthood for individuals who have lived with disabilities is needed to identify policies and early life interventions that can improve the outcomes of affected individuals.⁹Previous research on developmental disabilities has major limitations. First, adolescents and young adults are the least studied age group for any type of disability,¹⁴ and their needs are poorly understood and not adequately considered in educational programs and policies.¹⁵ Longitudinal studies using nationally representative samples to examine the transition of adolescents with disabilities into adulthood are few, and those that do exist have limitations, such as a focus on students in special secondary education and exclusion of individuals with severe disabilities.^2,15–17Using nationally representative data, we examined how early life disabilities are associated with human capital accumulation in young adulthood, focusing on educational attainment, employment status, occupation, income, wage rate, and subjective perception of social status. Given that previous studies have repeatedly reported that individuals with disabilities have worse performance on these outcomes, we hypothesized that (1) young adults with physical and cognitive disabilities would demonstrate lower educational and economic achievements compared with individuals without disabilities and (2) individuals with physical disabilities alone would perform better on these outcomes than individuals with cognitive disabilities. The second hypothesis was stated to allow the discussion on the differences of the impact of cognitive and physical disabilities on one''s life.