Health related quality of life of immigrant children: towards a new pattern in Germany?

Background: To study Health related quality of life (HRQoL) of a sample of kindergarten children with migration background. Methods: Five kindergartens in Frankfurt/Main and Darmstadt (Germany) participated. HRQoL was measured with the Kiddy-KINDL (KK) in 3 to 5 year old children. We examined the associations of HRQoL with socio-demographic variables, positive development and resilience, socio-emotional and motor development. Linear regression models were applied to examine differences in HRQoL between migrant and native-born German children. Results: The response rate was 90.5% (N = 283). The children had predominantly migrant background (81.35%). Perceived health was slightly higher in migrants (69.85, SD 17.00) compared to native-born German children (68.33, SD 17.31, p > 0.05), even though migrant children were characterized by a lower socio-economic status (p < 0.01). Conclusions: Results suggest that HRQoL at early ages in our study exhibits a different pattern than reported previously in studies among older individuals. We attribute the discrepancy partly to a possible changing pattern of migration in Europe with more migrants capable to migrate with healthy profiles, and to the age of our population. Our findings underscore the need to study the life course trajectory of HRQoL among young immigrants and replication in representative samples

Pediatric Health-Related Quality of Life:A Structural Equation Modeling Approach

Objectives: One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children.Methods: The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3-5 years old) participating in a follow-up study that investigates pediatric health outcomes.Results: Model fit was chi(2) = 5.5; df = 6; p = 0.48; SRMR = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model.Conclusions: The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.</p

A European perspective on auditory processing disorder-current knowledge and future research focus

Current notions of \u201chearing impairment,\u201d as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as \u201cAuditory Processing Disorder\u201d (APD) or \u201cCentral Auditory Processing Disorder\u201d is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimumdiagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus

Expressive Vocabulary: a Comparison of two Psychological Tests for Kindergarden Children

Eine Zufallsstichprobe von 55 normalen Kindergartenkindern im Alter von 3;4 bis 4;11 Jahren wurde mit zwei aktiven Wortschatztests im Einzelverfahren untersucht. Ziel war, die Übereinstimmung zwischen dem neuen Subtest „Wortschatz" aus der K-ABC (1991) und dem älteren AWST 3-6 (1979) zu prüfen. Die Zahl der richtigen Benennungen pro Test wurde jeweils gemäß Testmanual in einen Normwert transformiert. Die Korrelation zwischen beiden Testverfahren beträgt r=0.69 (p = 0.0001). Der Mittelwert der Differenzen beider Testergebnisse pro Kind liegt zwar nur bei 0,1, doch muss in Einzelfällen mit erheblichen Ergebnisdifferenzen zwischen beiden Tests gerechnet werden. Bei einer Standardabweichung von s = 7,8 streuen die Differenzen in einer relativ breiten Spanne von - 15,5 bis + 15,7, wenn man den Bereich von +/- zwei Standardabweichungen zugrunde legt. Hieraus folgt, dass der K-ABC-Subtest „Wortschatz" in der Eingangsdiagnostik aus zeitökonomischen Gründen gegebenenfalls vorzuziehen ist; allerdings sollte bei grenzwertigem Ergebnis der detailliertere AWST 3-6 nachgetragen werden. (DIPF/ Orig.)Fifty-five subjects were drawn from a population of average kindergarden children. Their ages ranged between 3;4 and 4;11 years. Two vocabulary tests were administered individually in a quiet room to each subject. A new instrument for testing the active vocabulary (Subtest "vocabulary" of the K-ABC, 1991) was compared with an established one (AWST 3-6, 1979) to see whether they agree sufficiently for the new to replace the old. Raw scores were computed according to the test instructions for each correct response and transformed into normscores. These were compared, and both tests correlated with r = 0.69 (p = 0.0001). So, the K-ABC-Subtest "vocabulary" may be administered in the first diagnostic setting. The mean of the differences of both vocabulary tests is 0,1; yet, in some cases large differences between the results of both vocabulary tests are to be expected, because the differences vary in the broad range from - 15,5 to + 15,7 (= +/- 2 SD). Therefore the more detailed AWST 3-6 should be used to assess the amount of active vocabulary in children with a low norm score in the KABC-Subtest "vocabulary". (DIPF/ Orig.

Haptic perception and developmental language achievements in kindergarten and preschool children

An einer Stichprobe von 101 dreieinhalb-, vier- und fünfjährigen Kindern wurden aktiver Objektwortschatzumfang, morpho-syntaktische Fähigkeiten sowie haptische Wahrnehmungsfähigkeit (Objektstereognosie, Stereognosie von Objektqualitäten) testpsychologisch erhoben. Zwischen den Variablen der haptischen Wahrnehmung und den Sprachmaßen fanden sich zum Teil bedeutsame, substantielle korrelative Zusammenhänge. Die Altersdifferenzen im Wortschatz und in den morpho-syntaktischen Fähigkeiten erwiesen sich als unabhängig von den beiden Variablen der haptischen Wahrnehmung, während sich die Altersdifferenzen in der haptischen Wahrnehmung bei Auspartialisierung der Sprachmaße teilweise eliminieren ließen. Die Ergebnisse werden im Hinblick auf die Bedeutung der haptischen Wahrnehmungsfähigkeit für die Entwicklung einzelner Sprachkomponenten diskutiert.(DIPF/Orig.)In a study with 101 children aged 3 to 5 years expressive vocabulary, morpho-syntactical language skills, and tactile-kinesthetic/haptic perception (stereognosis of object properties, object stereognosis) were assessed. Substantial correlations were found between tactile-kinesthetic/ haptic perception and the selected language facets. Age differences in expressive language skills remained significant even when tactile-kinesthetic/haptic perception was partialized out. On the contrary, age differences in tactile-kinesthetic/haptic perception were partially eliminated when language skills were controlled for. The results are discussed with regard to the role of the tactile-kinesthetic/haptic senses in language development.(DIPF/Orig.

Diagnostics of developmental language disorders in a walk-in clinic: Demands and reality

In einem 3-Jahreszeitraum haben die Phoniater/Pädaudiologen der (inzwischen aufgelösten) Abteilung Phoniatrie/Pädaudiologie (Universitätsmedizin Göttingen) – der vor allem Kinder von niedergelassenen Kinder-, HNO-Ärzten oder Allgemeinmedizinern überwiesen werden – 29 Kinder mit Sprachentwicklungsstörungen zur psychologischen Diagnostik (Testung) abteilungsintern vorgestellt. Offensichtlich sahen sie wenig Notwendigkeit für eine psychologische Diagnostik/Differentialdiagnostik dieser Klientel – obgleich eine solche gemäß ICD-10 mit Ausschluss- und Diskrepanzkriterien vorgesehen ist. Allein 55 % dieser sinnesgesunden, sprachgestörten Kinder (16/29) wiesen komorbide Besonderheiten bzw. Begleitstörungen auf, deren Relevanz für die individuelle Entwicklung schwerlich von einer Berufsgruppe allein überblickt werden kann. Bei den psychologisch vorgestellten Kindern wurde phoniatrischerseits primär eine normorientierte entwicklungspsychologische Diagnostik nach vermeintlich wenig erfolgreicher Sprachtherapie erbeten, 19 Kinder wurden als Therapie-Non-Responder bzw. zur Klärung der Frage einer Fortsetzung der logopädischen Therapie, ggf. Abklärung eines anderen Förderbedarfs vorgestellt. Mögliche Gründe für die niedrige Überweisungsrate an Psychologen werden diskutiert mit dem Ziel, einer praktisch stärkeren Integration psychologischer Fachkompetenz in der Diagnostik von Sprachentwicklungsstörungen näher zu kommen.In a 3-year period, 29 children with language impairments – referred to the former Department of Phoniatrics and Pediatric Audiology (University Hospital Goettingen; in the meantime closed) by practicing paediatricians, otorhinolaryngologists or general practitioners – were presented for psychological examination (testing) by the phoniatric doctors. Of these language impaired-children, 55% (16 of 29) had comorbid dysfunctions or associated disorders. Their relevance for the individual development of a language-impaired child can hardly be observed respectively diagnosed by only one professional group. However, the phoniatric doctors within the Department saw little need for professional psychological diagnostics/differential diagnostics in this clientele, although such is obligatory according to ICD-10 having regard to exclusion and discrepancy criteria. In the majority of cases, the selective psychological referral to norm-referenced developmental diagnostics came after supposed unsuccessful language treatment. Nineteen children were introduced to the psychologist as therapy-non-responders respectively to clarify the question whether the language therapy should be continued or to investigate special educational needs. To achieve the aim of a stronger integration of psychological professional competence in the diagnostics of developmental language disorders reasons for the low rate of referrals to clinical psychologists are discussed together with possible implications

Diagnostics of developmental language disorders in a walk-in clinic: Demands and reality

In a 3-year period, 29 children with language impairments - referred to the former Department of Phoniatrics and Pediatric Audiology (University Hospital Goettingen; in the meantime closed) by practicing paediatricians, otorhinolaryngologists or general practitioners - were presented for psychological examination (testing) by the phoniatric doctors. Of these language impaired-children, 55% (16 of 29) had comorbid dysfunctions or associated disorders. Their relevance for the individual development of a language-impaired child can hardly be observed respectively diagnosed by only one professional group. However, the phoniatric doctors within the Department saw little need for professional psychological diagnostics/differential diagnostics in this clientele, although such is obligatory according to ICD-10 having regard to exclusion and discrepancy criteria. In the majority of cases, the selective psychological referral to norm-referenced developmental diagnostics came after supposed unsuccessful language treatment. Nineteen children were introduced to the psychologist as therapy-non-responders respectively to clarify the question whether the language therapy should be continued or to investigate special educational needs. To achieve the aim of a stronger integration of psychological professional competence in the diagnostics of developmental language disorders reasons for the low rate of referrals to clinical psychologists are discussed together with possible implications

Common Misconceptions Regarding Pediatric Auditory Processing Disorder

Pediatric hearing evaluation based on pure tone audiometry does not always reflect how a child hears in everyday life. This practice is inappropriate when evaluating the difficulties children experiencing auditory processing disorder (APD) in school or on the playground. Despite the marked increase in research on pediatric APD, there remains limited access to proper evaluation worldwide. This perspective article presents five common misconceptions of APD that contribute to inappropriate or limited management in children experiencing these deficits. The misconceptions discussed are (1) the disorder cannot be diagnosed due to the lack of a gold standard diagnostic test; (2) making generalizations based on profiles of children suspected of APD and not diagnosed with the disorder; (3) it is best to discard an APD diagnosis when another disorder is present; (4) arguing that the known link between auditory perception and higher cognition function precludes the validity of APD as a clinical entity; and (5) APD is not a clinical entity. These five misconceptions are described and rebutted using published data as well as critical thinking on current available knowledge on APD