Izbirljivost u ishrani male dece s poremećajem iz spektra autizma

Odbijanje hrane je uobičajenost u razvojnom periodu, pri čemu 20 do 30% dece između dve i šest godina može imati poremećaje u ishrani i stroge preferencije prema hrani. Mala deca obično odbijaju da probaju novu hranu ili hranu koja može biti kašasta, sa tvrdom teksturom ili imati „komadiće“ u sebi, kao i jela sa „skrivenim“ sastojcima, kao što su lazanje i kaserole. Ne postoji konsenzus o tome šta tačno definiše izbirljivost u ishrani, ali najčešće prihvaćena definicija opisuje nespremnost da se jede poznata hrana ili proba nova, potom izbegavanje određene hrane što rezultira ograničenim repertoarom namirnica koje će dete jesti, i/ili ograničeni unos hrane što dovodi do nutritivnih ili energetskih deficita. Izraz izbirljivost u ishrani često se kolokvijalno koristi za označavanje selektivnog unosa hrane, ili jedenja neadekvatne vrste hrane. Razlozi zbog koje se javlja ova pojavnost odnose se na senzornu osetljivost (na osnovu teksture, ukusa ili boje hrane, na primer i to posebno u vlaknastoj hrani kao što su voće i povrće), ograničene preferencije prema hrani ili neofobiju (strah od pokušaja isprobavanja nove hrane). Istraživanja o ponašanju u ishrani kod dece s poremećajem iz spektra autizma (PSA) relativno su ograničena, a postojeća literatura se fokusirala na širok spektar poteškoća, uključujući probleme u hranjenju, ponašanje tokom obroka i izbirljivost u ishrani. Problemi sa hranjenjem ili ishranom kod ove dece obično se javljaju u ranoj fazi razvoja, često čak i pre nego što se identifikuju suspektnosti u vezi sa PSA. Bez sprovedenog tretmana, problemi hranjenja dece sa PSA imaju tendenciju da opstanu u kasnom detinjstvu. Jedna studija pokazala je da 53%–83% dece sa PSA, uzrasta od dve do šest godina, nerado pokušavaju isprobavanje nove hrane, izbirljivi su pri konzumaciji hrane, odbijaju gorak ukus (najčešće povrće) ili imaju ograničen repertoar koristljivih namirnica. U literaturi postoji ograničeno razumevanje u vezi sa tim da li takve probleme treba pripisati PSA, ili je dodatna dijagnoza opravdana. Rad je nastao kao rezultat istraživanja na projektu „Kreiranje Protokola za procenu edukativnih potencijala dece sa smetnjama u razvoju kao kriterijuma za izradu individualnih obrazovnih programa” (broj ugovora 451-03-68/2022-14) koji finansira Ministarstvo prosvete Republike Srbije

Razumevanje procesa rezilijentnosti iz ugla multisistemskog modela

Rezilijentnost se široko određuje kao kapacitet sistema da anticipira, adaptira i reorganizuje sebe u uslovima nedaća na načine koji promovišu i održavaju njegovo uspešno funkcionisanje. Danas nema spora da je ovaj kapacitet rezultat facilitativnih interakcija sa kopostojećim podređenim i nadređenim sistemima koji omogućavaju da sistem ili njegovi delovi dobro funkcionišu tokom i nakon napada, poremećaja ili stresa. Uvažavajući zahtev savremene nauke o rezilijentnosti da se u obzir uzmu multipli sistemi ili nivoi sistema (biološki, psihološki, socijalni, veštački i prirodni), sve veći broj naučnika, sudeći po novijim generacijama studija u humanim i prirodnim naukama, preusmerava interesovanje sa objašnjenja rezilijentnosti unutar jednog sistema na razvijanje multisistemskih modela koji uvažavaju recipročne interakcije između sistema tokom suočavanja sa spoljašnjim ili unutrašnjim pretnjama njihovoj stabilnosti. Pregledom literature iz različitih disciplina utvrđeno je da procesi koji promovišu rezilijentnost mogu biti veoma različiti u zavisnosti od konteksta u kome se pojavljuju, te da se u osnovi razlikuje najmanje pet procesa koji stoje u vezi sa rezilijentnošću, a to su: perzistencija, rezistencija, oporavak, adaptacija i transformacija. Prva dva procesa ne zahtevaju menjanje sistema i u tom smislu prethode aktiviranju rezilijentnosti, dok preostala tri doprinose promenama koje sisteme čine održivijim u kontekstima nedaća. U radu će biti predstavljeno na koji način sistemi, koji su u riziku da budi preplavljeni unutrašnjim i spoljašnjim stresorima, mogu, kroz procese perzistencije i rezistencije, nastaviti da funkcionišu bez promena i zadržati svoje uobičajeno ponašanje, te kako se, kroz procese oporavka, adaptacije i transformacije, sistemi pod stresom ili nakon napada mogu kretati ka novom režimu ponašanja, odnosno menjati na način da budu održiviji u kontekstima nedaća. Dodatno, u cilju razumevanja procesa rezilijentnosti iz ugla multisistemskog modela, biće ukazano na značaj uvažavanja praga stabilnosti, sprega povratnih informacija i kompromisa između sistema, te činjenice da procesi rezilijentnosti nisu agentični, tj. da sistemi ne biraju jednu strategiju suočavanja u odnosu na druge, već, umesto toga, optimizuju svoje funkcionisanje korišćenjem kopostojećih sistema za resurse koji različite strategije čine manje ili više izvodljivim

Quality of life and physical activity in people with rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common form of inflammatory rheumatism. The onset of synovitis in middle aged population, the irreversibility of damage and the progression of the disease reduce the possibilities and capacities of a person with RA to fulfill their needs and thus achieve the overall quality of life. Quality of life (Qol) is a multidimensional concept defined by the World Health Organization as a state of complete physical, mental, and social well-being. Early diagnosis, the therapeutic approach “treat to target” and the application of biological therapy are current recommendations that contribute to the Qol of people with RA. Regular physical activity (PA), or any physical movement that leads to energy expenditure, is a key component of a healthy life. Since existing research has shown a significant impact of PA on chronic diseases of the modern era, the question of the benefits of PA in RA arises. The objective of this paper is to review and analyze the available recent research in order to examine the effects and importance of the implementation of PA on the Qol of people with RA. This study is a review of the literature using PubMed/MEDLINE and Science Direct, not older than ten years. People with RA, in addition to designed programs of therapeutic exercises as part of physiotherapy, also practice different forms of PA in their free time or through organized activities. The results indicate that the implementation of regular PA, dosed according to time and intensity as well as according to the current picture of arthritis reduces the symptoms of arthritis, which improves the overall Qol of these people. Implementation of PA is beneficial for people with RA. In order to improve the Qol, it is necessary to design adapted programs of PA, respecting the specifics of each individual

Correlates and determinants of autonomy behavior in adolescents with mild intellectual disability

Osobe sa intelektualnom ometenošću imaju manje razvijene veštine autonomnog ponašanja i prilike da samostalno vrše izbore i donose odluke u svakodnevnom životu. Veća autonomija u ponašanju jača dostojanstvo i samopoštovanje osobe, omogućava joj kontrolu nad svojim životom i pozitivno utiče na njeno životno blagostanje. Cilj ovog istraživanja je bio utvrđivanje korelacija između autonomije, samopoštovanja i subjektivnog blagostanja, kao i odnosa između autonomije i demografskih karakteristika (pol i kalendarski uzrast) kod adolescenata sa lakom intelektualnom ometenošću. Uzorak je činilo 39 ispitanika sa lakom intelektualnom ometenošću, kalendarskog uzrasta od 16 do 21 godine (AS = 17.90, SD = 1.10), oba pola. U istraživanju su upotrebljene tri skale: Arkova skala samoodređenja (The Arc's Self-Determination Scale-Adult Version), Rozenbergova skala samopoštovanja (Rosenberg Self-Esteem Scale) i adaptirana verzija Indeksa ličnog blagostanja za osobe sa intelektualnom ometenošću (Personal Wellbeing Index – Intellectual Disability – PWI-ID). Dobijeni rezultati ukazuju na značajnu pozitivnu korelaciju između autonomnog ponašanja i subjektivnog blagostanja ispitanika. Utvrđen je i značajan pozitivan odnos između veštine nezavisnog ponašanja, pola i kalendarskog uzrasta ispitanika. Stariji ispitanici ovog uzorka, muškog pola, imaju statistički značajno viši nivo autonomnog ponašanja. Istraživanje ukazuje na značaj integrisanja intervencija za stimulisanje razvoja veština autonomnog ponašanja u tranzicione kurikulume adolescenata sa lakom intelektualnom ometenošću.People with intellectual disability have less developed skills of autonomous behavior and opportunity to make they own choices in everyday life. Higher level of autonomous behavior strengthens dignity and self-esteem and allows a person to have control over her life and provides positive influence on personal wellbeing. The aim of this research was to determine the correlations between autonomy, self-esteem and subjective wellbeing, as well as relationship between autonomy and demographic characteristics (gender and age) in adolescents with mild intellectual disability. The sample consisted of 39 participants with mild intellectual disability, aged 16 to 21 (AS = 17.90, SD = 1.10), both sexes. Three scales were used in the research: The Arc's Self-Determination Scale-Adult Version, Rosenberg Self-Esteem Scale – SES and Personal Wellbeing Index – Intellectual Disability – PWI-ID. The results indicate significantly positive correlation between autonomous behavior and subjective wellbeing of participants. Also, it’s been determined significant positive relationship between skill of independent behavior and gender and age of participants. Older male examinee in this research, have statistically significant higher level of autonomous behavior. The research indicates the importance of integrating interventions to stimulate the development of autonomous behavior skills into the transitional curriculum of adolescents with mild intellectual disability

Nastavnici i inkluzivna nastava usmerena na učenika

Educational inclusion is a complex process that includes many aspects related to systemic and organizational activities. In implementing inclusion, the complex and demanding role of teachers is cited as one of the most important factors. Primarily, teachers are expected to understand inclusive values and inclusive education, to have positive attitude towards diversity, to support all students and encourage their education; to collaborate with other professionals and be a reflective practitioners ready for continuous improvement. Without qualified, competent and motivated teachers, it is not possible to develop inclusive culture and inclusive education. When it comes to the inclusion of children with developmental disabilities, study results indicate that a significant number of teachers do not feel ready to implement inclusive education and that school communities are slow in developing inclusive educational ethos. The aim of the paper is to present the results of research related to the basic values of teachers' professional development and teaching aimed at students with developmental disabilities

Differences in Social Knowledge Between Persons with Intellectual Disability and Persons with Dual Diagnoses

Introduction Social knowledge is an important aspect of social cognition that pertains to broader knowledge of social concepts and norms. People with intellectual disabilities are more likely to experience mental health challenges, and it’s important to pay special attention to how comorbid conditions can affect their social cognition skills, potentially weakening these skills. Consequently, the present study seeks to compare social knowledge between two groups of adults in Bosnia and Herzegovina: those with intellectual disabilities and those diagnosed with a dual diagnosis encompassing intellectual disability and psychiatric conditions. An additional goal was to identify the factors contributing to social knowledge in these groups. Methods The study sample included 62 adults with mild intellectual disability, divided into two groups based on their comorbid psychiatric condition. We used a demographic questionnaire, Raven’s Progressive Matrices, Peabody Picture Vocabulary Test (PPVT), MINI PAS – ADD scale, and The Social Knowledge Test to assess social knowledge and intellectual functioning. We compared the social knowledge scores between the two groups and identified the predictors of social knowledge in each group. Results The results indicated that adult participants with dual diagnoses had lower social knowledge scores than those with intellectual disabilities only, even after controlling for intellectual functioning and verbal abilities. The predictors of social knowledge differed between the two groups, with age being the only statistically significant predictor in both groups. In individuals with intellectual disabilities, age and the presence of obsessive-compulsive disorder symptoms were important predictors of social knowledge, while in the group of participants with dual diagnoses, age and PPVT were significant predictors of social knowledge. Conclusion This study highlights the importance of social knowledge in individuals with intellectual disabilities and dual diagnoses. The findings suggest that individuals with dual diagnoses may have a specific deficit in social knowledge that is not fully explained by their intellectual functioning or verbal abilities. Clinicians and educators should focus on identifying and addressing social knowledge deficits in individuals with dual diagnoses to improve their overall social functioning

Relevance of parental monitoring strategies in explanation of externalising behaviour problems in adolescence: Mediation of parental knowledge

A process model of parental monitoring (PM) proposes that PM occurs in two distinct stages: before the adolescent goes out and when they return home. Parental and adolescent responses to monitoring interactions impact on future monitoring episodes. Research suggests that passive PM strategies (e.g. child disclosure) correlate with higher parental knowledge and less behavior problems. Self-reported measures were used on a sample of 507 Belgrade secondary school students (42.1% male) to examine the mediating effect (mediation analysis using JASP) of parental knowledge (the Scale of Parental Monitoring) on the relationship of PM strategies (Child Disclosure, Parental Solicitation and Parental Control) (the Scale of Parental Monitoring) with externalising problems (Aggressive and Rule-Breaking Behaviour) (ASEBA, YSR). The research results show that Parental Knowledge mediate the relation of Child Disclosure and RuleBreaking Behaviour (z = -6.544, p < .001) and Parental Control and Rule-Breaking Behaviour (z =-3.770, p< .001). No direct link between Parental Control and RuleBreaking Behavior, as well as Parental Solicitation and Rule-Breaking Behavior were established. Full mediation of the link between Child Disclosure and Aggressive Behavior by Parental Knowledge is found (total indirect effect z = -4.050, p < .001). The research results were discussed in the context of the relevance of the PM strategies for greater parental knowledge and prevention of externalising problems in adolescence

The role and the significance of fingerspelling alphabet With the deaf and the hard of hearing

Uvod: Razvoj jezika, proces usvajanja govora i artikulacije glasova kod gluvih i nagluvih, praćen je intenzivnom upotrebom prstne azbuke. U Srbiji postoje i paralelno se koriste jednoručna i dvoručna prstna azbuka, kao i ćirilična i latinična. One su drugačije i različite za svaki jezik. To znači da u svakom jeziku ima onoliko daktilema (daktilnih slova - znakova) koliko ima grafema (slova) u pismu tog jezika. Daktilologija je jednoručna prstna azbuka, dok se dvoručna naziva hirologija. Hirologiju znatno više koriste mala deca u procesu početnog savladavanja čitanja i pisana, dok odrasli gluvi više koriste daktilologiju. Daktilologija se znatno brže pokazuje, jedna ruka ostaje slobodna, što olakšava njenu primenu. Cilj: Cilj rada je da se utvrdi uloga i značaj primene daktilologije i hirologije kod gluvih i nagluvih. Metode: Primenjene su metode analize i evaluacije relevantne dostupne literature. Rezultati: Pregledom literature, uočava se značajna uloga i aktivna primena i daktilologije i hirologije. Naročito se izdvaja primena prstne azbuke u savladavanju procesa artikulacije, učenju početnog pisanja i čitanja, savladavanju novih reči i bogaćenju rečnika. Prstnom azbukom se iskazuju svi oni pojmovi (naročito opšti i apstraktni, ali i stručna terminologija mnogih nauka) koji ne postoje u znakovnom jeziku, koji je prvi, primarni jezik gluvih osoba. Brojna istraživanja ukazuju na značaj primene prstne azbuke tokom čitanja govora sa usana. Svi glasovi nisu jednako vidljivi na usnama, pa se pokazivanjem daktilnog znaka olakšava ovaj proces. Zaključak: Značaj upotrebe prstne azbuke, naročito na ranom uzrastu gluve i nagluve dece, je veliki. Početna komunikacija, otežana usled nerazvijenog govora se olakšava. Na starijim uzrastima, kao i kod odraslih gluvih i nagluvih, primena prstne azbuke takođe zauzima bitno mesto. Uporedo sa korišćenjem znakovnog jezika, prstna azbuka pomaže boljoj i uspešnijoj komunikaciji i smanjuje nesporazume, nastale usled specifičnosti svakog pojedinačnog znakovnog jezika.Introduction: The development of language, speech learning, and sound articulation process with the deaf and the hard of hearing is accompanied by the intensive use of the fingerspelling alphabet. In Serbia, there are one-handed and two-handed fingerspelling alphabets, as well as Cyrillic and Latin ones, which are used in parallel. They are different and various for each language. That means that each language has as many dactylemes (dactylic letters – signs) as there are graphemes (letters) in the alphabet of that language. Dactylology is the one-hand fingerspelling alphabet, whereas the two-handed fingerspelling alphabet is called chirology. Chirology is used considerably more by small children in the process of initial learning of reading and writing, while deaf adults rather use dactylology. Dactylology is presented much faster, as one hand remains free, which facilities its use. Aim: The study aims to establish the role and significance of the application of dactylology and chirology with the deaf and the hard of hearing. Methods: The methods of analysis and evaluation of the available relevant literature were applied. Results: The review of literature shows the significant role and the active application of both dactylology and chirology. What is distinguished in particular is the application of the fingerspelling alphabet in learning the articulation process, learning initial writing and reading, learning new words, and in the enrichment of vocabulary. The fingerspelling alphabet is used to express all those terms (especially the general and abstract ones, but the professional terminology of many sciences as well) which do not exist in sign language, which is the first and the primary language of deaf persons. Numerous research studies point to the significance of the application of the fingerspelling alphabet in lipreading. Not all sounds are equally visible on the lips, and thus the presentation of a dactylic sign facilitates this process. Conclusion: The significance of the use of the fingerspelling alphabet, especially at an early age of deaf and hard-of-hearing children, is huge. The initial communication, aggravated as the result of undeveloped speech, is made easier. At older ages, as well as with deaf and hard-of- hearing adults, the use of the fingerspelling alphabet is also important. The fingerspelling alphabet, in parallel with the use of sign language, contributes to better and more effective communication and reduces misunderstandings occurring as a result of the specific features of each individual sign language

Self-esteem and optimism in parents of children With visual impairment and their relation To the quality of life

Uvod: Oštećenje vida ima značajan uticaj na kvalitet života deteta, ali i na funkcionisanje porodice. Proučavanje korelata kvaliteta života porodica dece sa smetnjama u razvoju postalo je aktuelno zahvaljujući ekološkom pristupu roditeljstva i programima u specijalnoj edukaciji i rehabilitaciji usmerenim na roditelje. Kvalitet života porodice zavisi od velikog broja činilaca, međutim rezultati brojnih istraživanja konzistentno ukazuju da su negativne dimenzije ovog konstrukta povezane sa smetnjom u razvoju kod deteta, kao i sa nekim psihičkim karakteristikama roditelja. Ključne podatke o kvalitetu života osobe ili porodice moguće je dobiti na osnovu samoprocene ličnog doživljaja i vrednovanja njegovih strukturnih elemenata, kao što su zdravlje, dobrobit, emocionalno blagostanje i lične vrednosti i osećaj samopoštovanja. Cilj: Cilj istraživanja je utvrditi povezanost samopoštovanja i optimizma roditelja dece sa oštećenjem vida i kvaliteta života porodice. Metode: Za prikupljanje podataka korišćen je Pedijatrijski upitnik za procenu kvaliteta života dece sa oštećenjem vida i njihovih porodica (Pediatric Eye Questionnaire - PedsEyeQ). Za procenu samopoštovanja kod roditelja korišćena je Rozenbergova skala samopoštovanja (Rosenberg Self Esteem Scale), a za procenu optimizma Skala za merenje optimizma (Life Orientation Test). Uzorak je činilo 38 ispitanika, roditelja dece sa oštećenjem vida. Rezultati: Analizom rezultata utvrđena je pozitivna korelacija umerenog intenziteta između samopoštovanja roditelja dece sa oštećenjem vida i samoprocene kvaliteta života. Između samoprocene kvaliteta života i nivoa optimizma roditelja nije utvrđena povezanost.Zaključak: Za organizaciju aktivnosti u zajednici i donošenje odluka veoma je bitno kako roditelj deteta sa oštećenjem vida vrednuje sebe i vidi budućnost svoje porodice. Zato je neophodno da se, kroz programe intervencije usmerene na roditelje, stalno radi na oblikovanju njihovih realnih očekivanja (optimizma) i zdravog samopoštovanja.Introduction: Visual impairment significantly affects children’s quality of life and how families function. Research into the correlates of the quality of life of families with children with developmental disabilities has become possible due to the ecological approach to parenting and programs in special education and rehabilitation aimed at parents. A family’s quality of life depends on many factors. However, the results of numerous studies consistently indicate that the negative dimensions of this construct are associated with a child’s developmental disability and some psychological characteristics of parents. Essential information on the quality of life of a person or family can be obtained from self-assessment of personal experience and evaluation of its structural elements, such as health, well- being, emotional wellness, personal values, and self-esteem. Aim: This research aimed to determine the relationship between self- esteem and optimism in parents of children with visual impairment and the family’s quality of life. Methods: The Pediatric Eye Questionnaire – PedsEyeQ was used to collect information on the quality of life of children with visual impairment and their families. The Rosenberg Self Esteem Scale was used to assess self-esteem in parents, while Life Orientation Test was used for optimism. The sample included 38 parents of children with visual impairment. Results: The results showed a moderate positive correlation between self-esteem in parents of children with visual impairment and the self- assessed quality of life. No correlation was found between the parents’ self-assessed quality of life and the level of optimism. Conclusion: For organizing activities in the community and making decisions, it is very important how parents of children with visual impairment value themselves and see the future of their families. Thus, it is necessary to constantly work on shaping their realistic expectations (optimism) and healthy self-esteem through parent-oriented intervention programs

Voice quality in children with specific language Impairment

Uvod: Specifični jezički poremećaj (SJP) karakteriše kašnjenje ili atipičan obrazac u razvoju ekspresivnih i/ili receptivnih jezičkih sposobnosti uz odsustvo opšteg kognitivnog deficita, autizma, slušnih oštećenja, socijalnih i emocionalnih poremećaja i teške sredinske deprivacije. Cilj: Cilj ovog istraživanja je utvrđivanje karakteristika kvaliteta glasa i analiza učestalosti nepravilnosti u perceptivnim karakteristikama glasa kod dece sa specifičnim jezičkim poremećajem. Dodatni cilj podrazumevao je utvrđivanje polnih razlika u kvalitetu glasa kod ove dece. Metode: Uzorkom je obuhvaćeno 30 dece sa specifičnim jezičkim poremećajem, uzrasta od tri do devet godina (AS=6,40; SD=1,714), od kojih je 20 dečaka i 10 devojčica. Za procenu kvaliteta glasa korišćena je GRBAS skala. Rezultati: Dobijeni rezultati pokazuju da 36,7% ispitanika ima promuklost i šumnost u glasu, dok je napetost u glasu registrovana kod 46,7% ispitanika. Hrapavost glasa je najmanje zastupljena kod dece sa specifičnim jezičkim poremećajem (30%), dok je najčešća karakteristika kvaliteta glasa bila slabost u glasu (53,3%). Perceptivne promene glasa najčešće su okarakterisane kao promene blagog stepena, potom slede umerene, a najmanje su zastupljene izražene promene glasa. Postoje značajne razlike u stepenu promuklosti i hrapavosti glasa u odnosu na pol u korist dečaka. Zaključak: Iako su kod malog broja dece registrovane teškoće, one imaju značajne naučne i praktične implikacije. Njihova važnost ogleda se u značaju perceptivne procene glasa na ranom uzrastu od strane logopeda, koji poseduje stručne kompetencije za prepoznavanje mogućih smetnji u glasu. Na taj način ostvareni su svi uslovi za zdrav i kvalitetan glas kod dece.Introduction: Specific language impairment (SLI) is characterized by a delay or abnormality in the development of expressive and/or receptive language skills in the absence of general cognitive deficits, autism, hearing impairments, social and emotional disturbances, and severe environmental deprivation. Aim: The aim of this research was to determine the quality of voice and analysis of the frequency of irregularities in the perceptual characteristics of voice in children with specific language impairment. Also, the goal was to determine possible gender differences in the voice quality of these children. Methods: The sample included 30 children with specific language disorders, 3-9 years of age (M=6.40; SD=1.714), of which 20 were boys and 10 were girls. The GRBAS scale was used to assess voice quality. Results: The results showed that 36.7% of respondents had hoarseness in their voice, while tension in the voice was registered in 46.7% of respondents. Voice hoarseness was the least represented in children with specific language disorders (30%), while the most common voice pathology was voice weakness (53.3%). The most common perceptual voice changes were mild, followed by moderate, and the least pronounced voice changes. There were significant differences in the degree of hoarseness and roughness of voice in relation to gender, more pronounced in boys. Conclusion: Although difficulties were registered in a small number of children, they have significant scientific and practical implications. Their importance is reflected in the importance of perceptual assessment of voice in the early period by a vocal pathologist, who has a trained sensibility for expert recognition of possible voice disturbances. In this way, all possible conditions are met to preserve healthy and high-quality voice in children