Callous-unemotional (CU) traits in adolescent boys and response to teacher reward and discipline strategies

The aim of this study was to investigate the relationship between callous-unemotional (CU) traits and response to rewards and discipline in adolescent boys using a mixed methods approach. Participants comprised 39 boys aged between 12 and 13 years and eight teachers. Quantitative findings showed that CU traits were significantly related to punishment insensitivity, controlling for conduct problems, autism symptoms and hyperactivity. In contrast, there was no significant association between CU traits and reward sensitivity. Qualitative analysis indicated that teachers view children high in CU traits as responsive to fewer reward and discipline strategies, and strategies need to be implemented and monitored with care to avoid unintended, undesirable outcomes. However, time-out, praise, support from other staff and maintaining a positive teacher-child relationship were identified as effective strategies. Findings emphasise the need to carefully select, modify and implement existing evidence-based classroom behaviour management strategies with high CU children

Bad Boys and Mean Girls: Callous-Unemotional Traits, Management of Disruptive Behavior in School, the Teacher-Student Relationship and Academic Motivation

Callous-unemotional (CU) traits comprise a temperament dimension characterised by low empathy, interpersonal callousness, restricted affect and a lack of concern for performance. CU traits are the hallmark feature of psychopathy in youth and are associated with more varied, severe and stable antisocial behaviour. However, little is known about the presentation, impact and correlates of CU traits in schools. We conducted a mixed methods study investigating the relationships between CU traits, student disruptive behaviour, responses to classroom management strategies, teacher-student relationship quality and academic motivation. Participants comprised 437 children aged 11 to 14 years (M = 12.5 years, 51% female) and 12 teachers recruited from a state school in England. Teacher participants consisted of 8 women and 4 men aged 23 to 51 (M = 35.27 years, SD = 10.43). Children completed the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004). Teachers then completed an interview and questionnaires for a randomly selected subsample of students who i) scored in the top 25% on student report of CU traits (n = 24), and ii) scored below the median (n = 23). Thematic analysis of teacher interviews revealed that high CU children display more frequent, severe antisocial behaviour in school. Teachers reported that high CU students were resistant to teacher discipline strategies, often showing intense displays of anger in response to their attempts to set limits. High CU students appeared to be less responsive to social rewards (e.g., praise). Encouragingly, some teachers reported a good relationship with a child identified as high in CU traits, despite recognizing that this student’s behaviour made it difficult for other teachers to maintain a harmonious classroom environment. Teachers attributed the poor academic performance of children high in CU traits to a lack of motivation, reporting the need for intense monitoring and feedback to ensure that these students completed schoolwork. Findings suggest that risk pathways for poor school outcomes may differ for antisocial children high and low in CU traits, and emphasize the need to modify existing school-based interventions to promote academic engagement and prosocial behaviour in this high-risk subgroup of antisocial children

Women’s views on contact with a health visitor during pregnancy: an interview study

Aim: To explore recent mothers’ views of the health visiting antenatal contact in England. Background: English health visitors are mandated to be in contact with all women in the third trimester of pregnancy. The aim of this antenatal contact is to assess the needs of the family before the birth and support preparation for parenthood. Recent data show that this contact is provided fragmentarily and not always face-to-face. More information on how women view this contact could inform service provision. Methods: Twenty-nine mothers with a baby less than 1 year old were recruited via social media and word of mouth. Having had antenatal contact with a health visitor was not a requirement to participate in the study. Women took part in face-to-face or phone interviews and all recordings were transcribed verbatim. Data were analysed using systematic thematic analysis. Findings: Eleven women had contact with a health visitor during pregnancy: nine through a home visit, one via a letter and one via a phone call. The remaining 18 women were asked about what they would have wanted from an antenatal contact. Three themes were identified: relationship building, information provision, and mode and time of contact. Some participants who had experienced a home visit reported building rapport with their health visitor before the postnatal period, but not everyone had this experience. Women reported requesting and receiving information about the health visiting service and the role of the health visitor. Finally, women suggested different modes of contact, suggesting a letter or that the information about health visiting could be provided by a midwife. A few women preferred a home visit. These study findings show women were unclear regarding the aim of the health visitor antenatal contact. As such, the contact is unlikely to reach its full potential in supporting parents-to-be

Bad Boys and Mean Girls: Callous-Unemotional Traits, Management of Disruptive Behavior in School, the Teacher-Student Relationship and Academic Motivation

Callous-unemotional (CU) traits comprise a temperament dimension characterized by low empathy, interpersonal callousness, restricted affect and a lack of concern for performance. CU traits are the hallmark feature of psychopathy in youth and are associated with more varied, severe and stable antisocial behavior. However, little is known about the presentation, impact and correlates of CU traits in schools. We conducted a mixed methods study investigating the relationships between CU traits, student disruptive behavior, responses to classroom management strategies, teacher-student relationship quality and academic motivation. Participants comprised 437 children aged 11–14 years (M = 12.5 years, 51% female) and 12 teachers recruited from a state school in England. Teacher participants consisted of 8 women and 4 men aged 23–51 (M = 35.27 years, SD = 10.43). Children completed the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004). Teachers then completed an interview and questionnaires for a randomly selected subsample of students who (i) scored in the top 25% on student report of CU traits (n = 24), and (ii) scored below the median (n = 23). Thematic analysis of teacher interviews revealed that high CU children display more frequent, severe antisocial behavior in school. Teachers reported that high CU students were resistant to teacher discipline strategies, often showing intense displays of anger in response to their attempts to set limits. High CU students appeared to be less responsive to social rewards (e.g., praise). Encouragingly, some teachers reported a good relationship with a child identified as high in CU traits, despite recognizing that this student's behavior made it difficult for other teachers to maintain a harmonious classroom environment. Teachers attributed the poor academic performance of children high in CU traits to a lack of motivation, reporting the need for intense monitoring and feedback to ensure that these students completed schoolwork. Findings suggest that risk pathways for poor school outcomes may differ for antisocial children high and low in CU traits, and emphasize the need to modify existing school-based interventions to promote academic engagement and prosocial behavior in this high-risk subgroup of antisocial children

Parent-Dependent Stressors and the Onset of Anxiety Disorders in Children: Links with Parental Psychopathology

Exposure to stressors is associated with an increased risk for child anxiety. Investigating the family origins of stressors may provide promising avenues for identifying and intervening with children at risk for the onset of anxiety disorders and their families. The aim of this study was to compare the frequency of parent-dependent negative life events and chronic adversities experienced by children with an anxiety disorder (n = 34) in the 12 months prior to the onset of the child’s most recent episode, compared to healthy controls (n = 34). Life events and chronic adversities were assessed using maternal report during an investigator-based interview, which provided independent panel ratings of the extent that reported experiences were related to parent behaviour. There were no group differences in the number of parent-dependent negative life events for anxious children compared to controls. However, significantly more parent-dependent chronic adversities were present for anxious children compared to controls. Findings suggest that parents contribute to an increased frequency of chronic adversities but not negative life events prior to their child’s most recent onset of anxiety. Furthermore, increased child exposure to parent-dependent chronic adversities was related to parental history of mental disorder

Clinicians' and womens' experiences of two consent pathways in a trial of timing of clamping at very preterm birth:a qualitative study

Background Recruitment to trials when birth is imminent requires offering consent at a difficult and stressful time, often with limited time. The Cord Pilot Trial assessed timing of cord clamping at very preterm birth. To ensure high risk women were not excluded we developed a two stage oral assent pathway, for use when birth was imminent. A third of women were recruited using this pathway. The aim of this study was to explore clinicians’ and women’s’ experiences of the two consent pathways. Methods A qualitative interview design with semi-structured interviews. Clinicians and women were recruited from the 8 trial sites. Results were analysed using systematic thematic analysis. Results 17 clinicians were interviewed, 11 had experience of both pathways and 6 of one stage written consent only. [DL1]Themes identified: consent as a continual process; consent as a record versus consent as a legal document; team approach; different consent pathways for different trials; balance between time and information. 23 women were interviewed, 5 had been offered oral assent and 18 one stage written consent. Themes identified: importance of staff; time and information; reasons for agreeing to consent; trial secondary in women’s minds; understanding randomisation. Conclusion Overall, clinicians thought that one stage written consent was optimal for offering consent but were positive about the use of oral assent when there is limited time for offering participation. Women were positive about their experiences, particularly about the staff who approached them. Nevertheless, there were gaps in understanding of the trial in some women’s accounts

Women's views and experiences of two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study

BACKGROUND: The Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. In addition to standard written consent, an oral assent pathway was developed for use when birth was imminent. The aim of this study was to explore women's views and experiences of two alternative consent pathways to participate in the Cord Pilot Trial. METHODS: We conducted a qualitative study using semi-structured interviews. A total of 179 participants in the Cord Pilot Trial were sent a postal invitation to take part in interviews. Women who agreed were interviewed in person or by telephone to explore their experiences of two consent pathways for a preterm intrapartum trial. Data were analysed using inductive systematic thematic analysis. RESULTS: Twenty-three women who gave either written consent (n = 18) or oral assent followed by written consent (n = 5) to participate in the trial were interviewed. Five themes were identified: (1) understanding of the implications of randomisation, (2) importance of staff offering participation, (3) information about the trial and time to consider participation, (4) trial secondary in women's minds and (5) reasons for agreeing to take part in the trial. Experiences were similar for the two consent pathways. Women recruited by the oral assent pathway reported being given less information about the trial but felt it was sufficient to make a decision regarding participation. There were gaps in women's understanding of the trial and intervention, regardless of the consent pathway. CONCLUSIONS: Overall, women were positive about their experiences of being invited to participate in the trial. The oral assent pathway seems an acceptable option for women if the intervention is low-risk and time is limited. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN21456601 . Registered on 28 February 2013

Clinicans' views and experiences of two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study

BackgroundThe Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. Preterm birth can be rapid and unexpected, allowing little time for the usual consent process. Therefore, in addition to the usual procedure for written consent, a two-stage pathway for consent for use when birth was imminent was developed. The aims of this study were to explore clinicians’ views and experiences of offering two consent pathways for recruitment to a randomised trial of timing of cord clamping at very preterm birth.MethodsThis was a qualitative study using semi-structured interviews. Clinicians from eight hospitals in the UK who had been involved in offering consent to the Cord Pilot Trial were invited to take part in an interview. Clinicians were interviewed in person or by telephone. Interviews were analysed using inductive systematic thematic analysis.ResultsSeventeen clinicians who had either offered usual written consent only (n = 6) or both the two-stage pathway (with oral assent before the birth and written consent after the birth) and usual written consent (n = 11) were interviewed. Six themes were identified: (1) team approach to offering participation; (2) consent form as a record; (3) consent and participation as a continual process; (4) different consent pathways for different trials; (5) balance between time, information, and understanding; and (6) validity of consent. Overall, clinicians were supportive of the two-stage consent pathway. Some clinicians felt that in time-critical situations oral assent presented an advantage over the usual written consent as they provided information on a “need to know” basis. However, there was some concern about how much information should be given for oral assent, and how this is understood by women when birth is imminent.ConclusionsThe two-stage pathway for consent developed for use in the Cord Pilot Trial when birth was imminent was acceptable to clinicians for comparable low-risk studies, although some concerns were raised about the practicalities of obtaining oral assent