Examining the Unified Theory of Behavior Change Constructs Among Adolescents Taking Attention-Deficit/Hyperactivity Disorder Medicine: A Longitudinal Study

ObjectiveTo quantitatively validate the preintention factors, behavioral intentions, and implementation factors and examine the relationships theorized by the Unified Theory of Behavior Change (UTBC) model among adolescents with attention-deficit/hyperactivity disorder (ADHD).MethodsWe conducted longitudinal analyses of data from 40 adolescents with ADHD, aged 11 to 15 years old, and their parents, including self-report of UTBC constructs using standardized measures. We collected pharmacy dispensing records for adolescents for the 4 months that followed. We used bivariate correlations to examine relationships between medication continuity, behavioral intentions, preintention factors, and the implementation factors. We conducted paired sample t-tests to compare adolescent and parent responses on UTBC items.ResultsAdolescents (mean [standard deviation {SD}] age = 13.3 [1.2] years, 75% male, 77.5% non-Hispanic Black, 90% publicly insured) reported a mean total ADHD symptom score = 29.8/54 (SD = 10.94) and mean total impairment score = 18.7/52 (SD = 10.90) and had a mean percentage of days covered with medicine over 4 months = 0.21 (range = 0–0.97). Adolescent intention to take ADHD medicine every school day was significantly related to adolescents’ subsequent medication continuity (r = 0.37, P < .05). Adolescent self-concept/image and confidence taking ADHD medicine were the most important factors related to the intention to take ADHD medicine every school day. Adolescents reported less belief and intention to take ADHD medicine and more barriers to taking ADHD medicine compared to their parents.ConclusionThe UTBC model shed light on factors related to subsequent medication use, providing a plausible mechanism for additional research to intervene to promote future medication continuity.     

Consensus international sur le dépistage,le diagnostic et le traitement des adolescents avec un trouble du déficit de l’attention avec ou sans hyperactivité en cas de comorbidité avec des troubles de l’usage de substances

BackgroundChildhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.ObjectiveThe aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.MethodA modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.ResultsAfter 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the firstline treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion.ConclusionThis international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.     

Comparative analysis of the WISC-IV in a clinical setting: ADHD vs. non-ADHD

BackgroundThe Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) is a useful tool for revealing differences in cognitive ability. Using the WISC-IV, the study investigated the intelligence profile of Turkish children diagnosed with ADHD and compared their profile with that of a non-ADHD clinical sample.MethodOn the basis of the records of 257 drug-naïve patients (6–12 years of age), ADHD (n = 154) and non-ADHD (n = 103) clinical groups were compared with respect to sociodemographic variables and WISC-IV scores.ResultsThe non-ADHD clinical group had higher full scale, index, and subtest scores, except for their scores in the Comprehension subtest. The scores on Working Memory, Processing Speed Indices, Similarities, and Matrix Reasoning subtests were especially lower in the ADHD group than in the non-ADHD group. The Similarities, Matrix Reasoning, and Digit Span subtests classified 83% of the children as having ADHD and identified 43.7% of the non-ADHD clinical controls.ConclusionIn our study, we found differences in the WISC-IV profiles of the Turkish patients with ADHD. Moreover, the WISC-IV profile of the non-ADHD clinical group was different than that of the ADHD group. More prospective studies with larger groups of ADHD patients and further evaluations of executive function deficits can help clinicians better understand the differences in WISC-IV profiles.     

PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality

ObjectiveNo validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC).MethodsA national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20–10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers.ResultsThe final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0–10 scale) and median scores on specific quality items ranged from 31^-4 to 43^-4 (0–4 scale).ConclusionsPediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.     

Understanding Barriers and Facilitators of Attention-Deficit/Hyperactivity Disorder Treatment Initiation and Adherence in Black and Latinx Children

ObjectiveDespite evidence that consistent treatment is important for Attention-Deficit/Hyperactivity Disorder (ADHD) management, ADHD treatment initiation and adherence remains suboptimal in minoritized children. The goal of this study was to explore barriers and facilitators to ADHD treatment initiation/adherence for minoritized children to further inform development of our family navigation intervention.MethodsUsing a virtual platform, we completed 7 focus group sessions (total n.ß=.ß26) and 6 individual interviews with representatives from 4 stakeholder groups: experienced caregivers of children with ADHD, caregivers of children newly diagnosed with ADHD, family navigators, and clinicians who care for children with ADHD. All caregivers identified as Black and/or Latinx. Separate sessions were conducted for each stakeholder group and caregivers had the option to attend an English or Spanish session. Using a thematic analysis strategy, barriers and facilitators to ADHD treatment initiation and/or adherence were coded in focus group/interview data and themes were identified across groups.ResultsThe primary barriers to ADHD treatment initiation and/or adherence identified for minoritized children were lack of support from school/healthcare/family members, cultural barriers, limited resources, limited access, and treatmentconcerns, with variability in endorsement across participants. Reported facilitators included caretakers having experience with ADHD, strong support, access to resources, andwitnessing their child...s functional improvement with treatment.ConclusionsCaregiver experience with and knowledge about ADHD, support, and access to resources facilitate ADHD treatment in minoritized children. The results from this study have the potential to improve ADHD treatment initiation/adherence and outcomes for minoritized children through the development of culturally tailored, multipronged interventions.     

Do Pediatrician Interpersonal and Personality Characteristics Affect Patient Experience?

Background and ObjectivesPrevious studies have demonstrated associations between patient experience scores and physician's demographic characteristics such as gender and race. There is a paucity of data, however, on the effect of broader pediatrician characteristics on caregivers’ experience of their children's care. This study assessed pediatric caregiver experience of care ratings within a children's hospital and examined the effects of pediatricians’ interpersonal and personality traits on caregiver experience ratings.MethodsThis cross-sectional study included caregivers of children under 18 years old (n = 26,703) and physicians within children's hospital system (n = 65). Caregivers of children who received care from 2017 to 2019 provided their rating (0–10) of care experience via the standardized National Research Corporation Health Survey. Top box provider ratings were used for analyses. Physician's interpersonal and personality data were collected. Multilevel logistic regression analyses were used to examine the effects of physician interpersonal characteristics (empathy, compassion) and personality (perfectionism, Big Five personality traits [openness, conscientiousness, extraversion, agreeableness, neuroticism]) on experience of care rating.ResultsThe odds of caregivers of Spanish-speaking children to provide a high physician rating were 75% higher than the odds for non-Spanish-speaking patients. At the physician level, lower agreeableness (odds ratio [OR] = 0.63, P = .002), and lower narcissistic perfectionism (OR = 0.98, P = .016) were associated with an increased likelihood of a high care experience rating. The odds of nonemergency medicine pediatricians receiving high ratings were approximately 4.17 times higher than that of EM pediatricians.ConclusionsCurrent results may inform future interventions that address pediatrician personality characteristics associated with caregivers of children experience outcomes.     

Long-term follow-up on continuous intrathecal Baclofen therapy in non-ambulant children with intractable spastic Cerebral Palsy

BackgroundLittle is known about the long-term effects of Continuous intrathecal Baclofen (CITB) therapy in non-ambulant children with intractable spastic Cerebral Palsy (CP).AimTo determine whether short-term beneficial effects of CITB therapy are present at the long-term, and whether caregivers would choose CITB therapy for their child again considering the advantages and disadvantages encountered over the years.MethodsLong-term follow-up data were obtained of the children whom had previously participated in a RCT on CITB by the Dutch Study Group on Spasticity. Quality of life (QoL) was assessed by the Child Health Questionnaire (CHQ), current satisfaction with CITB was measured by use of a Visual Analogue Scale regarding previously set treatment goals, functioning in daily living was determined by a questionnaire concerning functioning of the child, and possible detrimental effects of CITB therapy encountered over the years were noted. All data were acquired via interview of the caregivers.ResultsAll 17 children of the former trial participated in this study. Previously identified significant positive effects on pain (CHQ 46.8 vs. 74.38, p = 0.002; VAS 2.4 vs. 8.01, p = 0.02), ease of care (VAS 2.0 vs. 7.26, p = 0.00), and mental health (CHQ 67.2 vs. 75.94, p = 0.010) were still present at the end of the trial. Novel significant positive effects were noted at six to nine years follow-up, i.e. significantly improved scores on the Parent Impact – Emotional subscale (CHQ 66.0 vs. 78.2, p = 0.008), Parent Impact – Time subscale (CHQ 68.9 vs. 91.72, p = 0.002), and the Physical Summary (CHQ 17.6 vs. 27.4, p = 0.019) compared to baseline. Ninety-four percent of the caregivers would choose CITB treatment again for their child again.ConclusionThe beneficial effects of CITB are present at the long term and caregiver satisfaction is high.     

Disparities in Mental and Behavioral Health Treatment for Children and Youth in Immigrant Families

Background and ObjectiveChildren and youth in immigrant families (CIF)—children and youth with at least 1 foreign-born parent—face unique psychosocial stressors. Yet little is known about access to mental and behavioral health (MBH) services for CIF. Among US CIF and non-CIF with MBH problems, we assessed access to MBH treatment.MethodsWe used the National Survey of Children's Health-2016, a nationally representative survey of predominantly English- or Spanish-speaking US parents. The sample included 2- to 17-year-olds whose parent reported at least 1 MBH problem. The primary outcome was prior-year receipt of MBH treatment (counseling, medication, or both).ResultsOf 50,212 survey respondents, 7164 reported a current MBH problem (809 CIF and 6355 non-CIF). The majority of CIF were Hispanic/Latinx (56% CIF vs 13% non-CIF, P < .001). CIF were less likely than non-CIF to have an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis (35% vs 59%, P < .001) and less likely to have received MBH medication and/or counseling (61% vs 71%, P = .02). This difference was pronounced for receiving medication (32% vs 50%, P < .001). When controlling for multiple covariates, differences in any MBH treatment were no longer statistically significant (adjusted odds ratios 0.76, 95% confidence interval 0.52–1.11), while the odds of receipt of medication remained significantly lower for CIF (adjusted odds ratios 0.61, 95% confidence interval 0.42–0.88).ConclusionsAmong children and youth with at least 1 parent-reported MBH problem, CIF, compared with non-CIF, were less likely to receive MBH treatment, specifically medication. This may be explained, in part, by differences in the proportion of CIF and non-CIF diagnosed with ADHD.     

Examining the Relationship Between Adverse Childhood Experiences and ADHD Diagnosis and Severity

ObjectiveAlthough prior research has examined the prevalence of ACEs among children with attention deficit-hyperactivity disorder (ADHD), little is known about the household and family settings of children with ADHD. Our study utilizes a recent nationally representative dataset to examine the association between adverse childhood experiences (ACEs), child and household characteristics, and ADHD diagnosis and severity.MethodsUsing the 2017–2018 National Survey of Children's Health (NSCH), our sample consisted of children three years of age or older, as this is the youngest age at which the NSCH begins to ask caregivers if a child has been diagnosed with ADHD (n = 42,068). Multivariable logistic regression was used to examine the association between ACE type, score, and ADHD and ADHD severity, controlling for child and household characteristics.ResultsChildren exposed to four or more ACEs had higher odds of ADHD (aOR 2.16; 95% CI 1.72–2.71) and moderate to severe ADHD (aOR 1.89; 95% CI 1.31–2.72) than children exposed to fewer than four ACEs. Other child characteristics positively associated with ADHD included age and public insurance; other Non-Hispanic races compared to Non-Hispanic White had lower odds of ADHD. Of children reported with ADHD, public insurance was also associated with caregiver-reported moderate to severe ADHD.ConclusionsChildren with ADHD have a higher prevalence of ACEs, making this study important for understanding the relationship between ACEs and ADHD at the population level.     

Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System

ObjectiveTo determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system.MethodsThis cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008–April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities.ResultsBlack caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24–0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16–0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18–0.89]) in the past year (all P< .05).ConclusionsFuture research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.     

Parental Factors Affecting Pediatric Medication Management in Underserved Communities

BackgroundMedication errors and adverse drug events are common in the pediatric population. Limited English proficiency and low health literacy have been associated with decreased medication adherence, increased medication errors, and worse health outcomes. This study explores parental factors affecting medication management in underserved communities.MethodsUsing qualitative methods, we identified factors believed to affect medication management among parents. We conducted focus group discussions between December 2019 and September 2020. We recruited parents and health care professionals from local community partners and a tertiary care children's hospital. Sessions were recorded and transcribed. Three investigators created the coding scheme. Two investigators independently coded each focus group and organized results into themes using thematic analysis.ResultsEleven focus groups were held (n = 45): 4 English-speaking parent groups (n = 18), 3 Spanish-speaking parent groups (n = 11), and 4 health care professional groups (n = 16). We identified 4 main factors that could impact medication delivery: 1) limited health literacy among parents and feeling inadequate at medication administration (knowledge/skill gap), 2) poor communication between caregivers (regarding medication delivery, dosage, frequency, and purpose) and between providers (regarding what has been prescribed), 3) lack of pediatric medication education resources, and 4) personal attitudes and beliefs that influence one's medication-related decisions.ConclusionsThe compounding effect of these factors – knowledge, communication, resource, and personal belief – may put families living in underserved communities at greater risk for medication errors and suboptimal health outcomes. These findings can be used to guide future interventions and may help optimize medication delivery for pediatric patients.     

Development of an instrument to measure parents' preferences and goals for the treatment of attention deficit-hyperactivity disorder

ObjectivesTo describe the development and validation of an instrument to measure parents’ attention deficit–hyperactivity disorder (ADHD) treatment preferences and goals.MethodsParents of children 6 to 12 years of age diagnosed with ADHD in the past 18 months were recruited from 8 primary care sites and an ADHD treatment center (autism excluded). A 16-item medication, 15-item behavior therapy preference scale and a 23-item goal scale, were developed after a review of the literature, 90 parent and clinician semistructured interviews, and input from parent advocates and professional experts were administered to parents. Parent cognitive interviews confirmed item readability, clarity, content, and response range. We conducted an exploratory factor analysis and assessed internal consistency and test-retest reliability and construct and concurrent validity.ResultsWe recruited 237 parents (mean child age 8.1 years, 51% black, 59% from primary care, 61% of children medication naive). Factor analyses identified 4 medication preference subscales (treatment acceptability, feasibility, stigma, and adverse effects, Cronbach’s α 0.74–0.87); 3 behavior therapy subscales (treatment acceptability, feasibility, and adverse effects, α 0.76–0.83); and 3 goal subscales (academic achievement, behavioral compliance, and interpersonal relationships, α 0.83–0.86). The most strongly endorsed goal was academic achievement. The scales demonstrated construct validity, concurrent validity (r = 0.3–0.6) compared with the Treatment Acceptability Questionnaire and Impairment Rating Scale and moderate to excellent test–retest reliability (intraclass coefficient = 0.7–0.9).ConclusionsWe developed a valid and reliable instrument for measuring preferences and goals for ADHD treatment, which may help clinicians more easily comply with new national treatment guidelines for ADHD that emphasize shared decision making.     

Self-Determination Theory and Preventive Medication Adherence: Motivational Considerations to Support Historically Marginalized Adolescents With Asthma

IntroductionUsing self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence.MethodData were from adolescents (n = 260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12–16 years) had physician-diagnosed persistent asthma or poor control.ResultsAdolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables.DiscussionMany factors interfere with adolescent medication-taking. Clinicians’ efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.     

Coparenting in Teen Mothers and Their Children's Fathers: Evidence From the Early Childhood Longitudinal Study–Birth Cohort

Objective(1) To describe coparenting among adolescent mothers and the biological fathers of their children. (2) To examine the effects of coparenting on young children's social–emotional development and whether these effects vary by father's residence status, parental education, and child characteristics.MethodsSecondary analysis was conducted with the Early Childhood Longitudinal Study-Birth Cohort, which is a nationally representative sample of U.S. children born in 2001. The subsample used in this study includes 400 children whose biological mothers, aged 15–19, participated when their children were 2 years and 4 years old and whose biological fathers (residential and nonresidential) participated at 4 years. Cooperative coparenting and coparenting conflict were measured at child age 2 years. Children's social skills and problem behavior were measured at child age 4 years.ResultsMother- and father-reported coparenting conflict were associated with child behavior problems, more strongly among boys (b = 1.31, P < .01) than girls (b = ?0.13, P > .05). Mother-reported coparenting conflict also predicted lower child social skills (b = ?1.28, P < .05); the association of father-reported coparenting conflict with social skills was moderated by child race and father education.ConclusionsCoparenting conflict between adolescent parents influences child adjustment. Practitioners working with teen mothers should encourage father participation at medical visits and other clinical contacts and should address the relationship between the parents, whether or not they are living together, as part of routine care.     

学龄前儿童听处理评估量表在注意缺陷多动障碍儿童中的应用研究

目的 利用学龄前儿童听处理评估量表(以下称“听处理评估量表”)探讨学龄前注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的听处理(auditory processing,AP)特征。方法 41例ADHD及41例典型发育(typically developing,TD)儿童进行听处理评估量表、SNAP-Ⅳ评定量表及学龄前持续性注意力测试(Conners’Kiddie Continuous Performance Test,K-CPT)评估，分析比较两组儿童听处理评估量表得分差异及其与SNAP-Ⅳ评定量表和K-CPT结果的相关性。结果 ADHD组儿童听处理评估量表总分及除视觉注意维度外的其他维度得分高于TD组(P<0.05)。ADHD儿童中，SNAP-Ⅳ评定量表的注意缺陷维度得分与听处理评估量表总分(r_{s 30条}=0.531;r_{s 27条}=0.627)及其听觉解码(r_s=0.628)、听觉注意(r_s=0.492)、沟通交流(r     

Prevalence and Characteristics of Providers’ Care Coordination Communication With Schools

ObjectivesCare coordination between schools and medical providers promotes child health, particularly for children with physical, emotional, and behavioral challenges. The purpose of this study was to assess caregivers’ reports of provider-school communication for their children. Further, the study assessed if communication rates varied by child demographic or health conditions.MethodsThis study was a cross-sectional analysis of the 2016–2017 National Survey of Children's Health focused on school-aged children (age 6–17 years; n = 18,160). Weighted frequencies overall and stratified by provider-school communication status are reported. Multivariable logistic regression examined associations of provider-school communication.ResultsOnly 23.5% of the total sample reported provider-school communication. The highest caregiver-reported communication prevalence was for children with diabetes (68.0%). Behavioral/mental health conditions, chronic physical health conditions or having increased medical complexity and needs were significantly associated with increased communication compared to those without these conditions. Odds Ratio (OR) and 95% Confidence Intervals (CI) for children with a behavioral/mental health condition were OR: 1.28; CI: 1.02 to 1.61, for children with a chronic physical health condition were OR: 1.37; CI: 1.15 to 1.63 and for children with special health care needs or with medical complexity were OR: 2.15; CI: 1.75 to 2.64 and OR: 1.77; CI: 1.09 to 2.87, respectively. Significant communication differences existed for every health condition (P < 0.05) except for children who had a blood disorder (P = 0.365).ConclusionsCaregiver perception of provider-school communication is low and differences in reported rates existed between health conditions and complexity status. Further work is needed to support provider-school-family communication for children with physical, mental, behavioral, and complex health conditions.     

Adaptation et validation française de l’ECJV : échelle de cognitions liées aux jeux vidéo

IntroductionMaladaptive cognitions – irrational beliefs and thoughts about the self, the real and virtual worlds – are part of the variables, which explain the development and the maintaining of gaming addiction. However, no French instrument had yet been fully designed and validated to assess these cognitions.ObjectiveThe present study aimed to adapt and validate, in French, such an instrument: the Internet Gaming Cognitions Scale (IGCS).Method and ResultsThis scale is composed of 24 items and 4 factors assessing maladaptive cognitions among players – beliefs about game reward value and tangibility, maladaptive and inflexible rules about gaming behaviour, over-reliance on gaming to meet self-esteem needs and, finally, gaming as a method of gaining social acceptance. In the present study, the IGCS was back-translated, adapted and validated in several steps. Firstly, two bilingual individuals back-translated the English scale. Committee analysis, clearness and validity assessing allowed us to design a clear and faithful French version. Secondly, exploratory factor analysis (n = 262) was conducted to determine the new structure of the scale, which was statistically and theoretically valid. Nine items had to be removed from the original version. Actually, five factors – with 15 items left – were identified: positive emotions, need of completion, cognitive salience, virtual comfort and need of social recognition. Thirdly, acceptable and/or satisfactory MacDonald's Omegas confirmed the identification and the relevance of these five factors. Fourthly, confirmatory factor analyses (n = 187) were conducted to validate the structure with satisfactory fit indices: RMSEA = .055, RMR = .027, GFI = .917, CFI = .939. Only Chi² was unsatisfactory, but was compensated for by good TLI (.92) and IFI (.94). Fifthly, correlations allowed us to conclude that our scale had a good construct validity showing previously demonstrated links with other variables (weekly gaming time, addiction). Convergent validity was also found with similar constructs. The latter were assessed through the assessment of cognitions, emotions, and behaviours involved in gaming. Finally, test–retest reliability was assessed (n = 27), concluding with a good consistence across time (r = .94, P < .001).ConclusionThe present study allowed us to design and validate a French scale, which assesses gamers’ maladaptive cognitions and shows good psychometric attributes. This scale would be very useful in research and practical fields, knowing how much maladaptive cognitions play a role in the development and the maintenance of gaming disorder.     

Amylase increases energy and nutrient density of Super Cereal Plus porridge as prepared and accepted by Rwandan caregivers

Adding amylase to Super Cereal Plus (SC+A) improves energy and nutrient intake as porridge energy density reaches 1.0 kcal/g, meeting the recommended ≥0.8 kcal/g for prepared foods for young children. Caregiver response to SC+A in terms of adjusting porridge preparation using printed pictogram instructions was not yet investigated. The study assessed (a) porridge preparation by caregivers; (b) porridge energy density; (c) sensory porridge acceptability; and (d) understanding of preparation instructions. An 8‐day follow‐up intervention study was conducted amongst caregivers of children aged 6–23 months (n = 238) in Rwanda. Caregivers prepared porridge using SC+A whilst referring to printed pictogram instructions at the study site on Days 1 and 8 and received flour for preparation at home on Days 2–7. At the site, data were collected on porridge preparation procedures, energy density, consistency, acceptability, and interviews (n = 12), and focus group discussions (n = 6) were conducted. Mean porridge dry matter (DM) increased from 21.3 ± 4.4% (Day 1) to 25.1 ± 4.8% (Day 8; p < 0.0005). Flour and water were mixed before cooking by 95% of the participants, as per printed instructions. Sensory porridge acceptability was high, and the printed instructions enabled caregivers to prepare an accepted and energy dense porridge. The preferred water/flour volume ratio was 2.5 instead of 3. In conclusion, Rwandan caregivers prepared well‐accepted SC+A porridges with a preferred consistency and mean DM content of 25.1% (1.0 kcal/g), after 1 week practicing at home. This supports introducing SC+A with the tested instructions at scale.     

Item hierarchy of the Chinese version of cerebral palsy quality of life for children

BackgroundThe Chinese Cerebral Palsy Quality of Life for Children (C CP QOL-Child) is the first instrument developed to measure quality of life of (QOL) children with cerebral palsy in Chinese speaking populations.ObjectiveThe aim of the study was to examine the psychometric properties of C CP QOL-Child using Item Response Theory Models. We were particularly interested to know how intervention strategies could be designed for individuals based on the item scores.Methods145 primary caregivers (mostly mothers; mean age: 39.2) of children with cerebral palsy aged 4–12 were invited to complete the 65-item C CP QOL-Child questionnaire. Data were analyzed using Rasch analysis.ResultsItem difficulty estimates were aligned with person ability values, indicating that the items in the scale generally demonstrated an appropriate depth and width for measuring QOL of persons in the target population. The results also showed that after dropping the 8 items in the dimension pain and impact of disability in the 65-item scale, the revised 57-item scale exhibits unidimensionality (separation index = 4.43, r = 0.95); hence the total score computed from the 57 items adequately reflects the level of QOL of the child as perceived by the caregiver. We further found that the Rasch item difficulty estimates demonstrated an overall item hierarchy; hence therapists can expect a pattern of performance by a child with CP that is based on the established order of item difficulty.ConclusionsThe hierarchical structure identified in the study may be useful for designing tailor-made interventions with an aim of improving QOL.