Comparing Service Delivery Models for Children with Developmental Delays in Canada: Adaptive and Maladaptive Behaviours, Parental Perceptions of Stress and of Care

This study compares two service delivery models (community-based and centre-based), examining them in light of children’s adaptive and maladaptive behaviours, and parental perceptions of stress and of care. More specifically, parents of 96 children with developmental delays assessed their children’s adaptive and maladaptive behaviours and rated their own perceived levels of stress as well as their perceptions of care from service providers. Findings indicated that children from the community-based sites were perceived as having less severe social skill deficits than those from centre-based sites. Regarding parental stress, mothers from community-based settings reported more challenges with their child’s father than did the mothers from centre-based settings; and fathers from the community-based settings reported more challenges related to their health than did the fathers from the centre-based settings. Regarding care, parents from the centre-based settings had more positive perceptions of care than did parents from the community-based settings. Therefore, in general, parents receiving services within community-based settings reported fewer positive perceptions of care and more challenges than those from centre-based settings. Overall, the results of this investigation can inform future programming for community- and centre-based service delivery systems. More specifically, the findings highlight the important role that family-centred care can play in supporting the needs of children with developmental delays and their families; particularly for families using community-based services

Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems. METHODS: After initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7–11 years (mean age 8.61 years, SD 1.27 years) participated in the present study. RESULTS: In both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident. CONCLUSIONS: Sleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ

Transition to school for children with autism spectrum disorders: Review of the literature, policy implications, and intervention efficacy

The transition to school is often an exciting, yet challenging, experience for children and their families (e.g., Rimm-Kaufman, Pianta, & Cox, 2000). The experience is often increasingly difficult for children with disabilities, such as autism spectrum disorder (ASD; Rous, Teeters, Myers, & Stricklin, 2007). Children with ASDs’ social and communication deficits and restrictive, repetitive, patterns of behaviour (American Psychiatric Association, 2013) make the adjustment to school particularly challenging (e.g., Forest, Horner, Lewis-Palmer, & Todd, 2004). These challenges adjusting to school may be closely related to a lack of collaboration between home and school, a lack of perceived family support, or teachers with insufficient intervention training (Janus, Lefort, Cameron, & Kopechanski, 2007). In recent years, the short-term and long-term implications of successful early school transitions have been highlighted at an international level. Short-term benefits of successful transitions to school include increased academic achievement and social-emotional adjustment (Ahtola et al., 2011; Schulting, Malone, & Dodge, 2005), while long-term implications of high quality early school experiences include societal cost-benefits from increased taxable income (Schweinhart et al., 2005). Given the recent increase in prevalence in ASD (Centers for Disease Control and Prevention, 2014) and the global attention transition to school has recently been given, this research program will explore issues related to transition to school for children with ASDs and their families. To understand the transition to school, two theoretical models frame this program of study. Guralnick’s (2005) developmental systems model for early intervention proposes a developmental systems approach to early intervention. The comprehensive model describes salient elements in an early intervention system, which culminates with transition planning. Rimm-Kaufman and Pianta’s (2000) ecological and dynamic model of transition emphasizes a child’s individual skills, their environments, and the linkages between environments. Based on Guralnick and Rimm-Kaufman and Pianta’s models, this research program will investigate various aspects or components (i.e., review of the literature, transition policy, transition intervention) of the transition to school for children with autism spectrum disorders and their families. Study 1 reviewed and synthesized the current literature on transition to school and ASDs. Study 2 investigated and described transition to school policy for children with ASDs and their families in Canada via a transition to school survey completed by preschool service providers. Finally, Study 3 involved the implementation and evaluation of a transition to school intervention for children with ASDs preparing to make the transition to kindergarten. This research program is expected to increase our understanding of issues related to the transition to school for children with ASDs and their families and inform future policy on supporting successful school transitions for these children and their families.La transition vers l’école constitue souvent une expérience excitante, mais difficile pour les enfants et leurs familles (Rimm-Kaufman, Pianta & Cox, 2000). L'expérience est souvent de plus en plus difficile pour les enfants handicapés, tels que ceux ayant un trouble du spectre de l’autisme (TSA; Rous, Teeters, Myers et Stricklin, 2007). L’ajustement à l’école est particulièrement difficile pour ces enfants (Forest, Horner, Lewis-Palmer et Todd, 2004) en raison de leurs déficits persistants au niveau de la communication et de l’interaction sociale, et de leurs comportements, intérêts ou activités restreints ou répétitifs (American Psychiatric Association, 2013). Ces difficultés d'adaptation à l'école peuvent être étroitement liées à un manque de collaboration entre la maison et l'école, à une perception de manque de soutien de la part de la famille ou à une formation insuffisante des enseignants (Janus, Lefort, Cameron et Kopechanski, 2007). Au cours des dernières années, les conséquences à court et à long terme de la réussite des transitions précoces ont été soulignées au niveau international. Les avantages à court terme d'une transition à l'école réussie comprennent une réussite scolaire accrue et un ajustement socio-affectif (Ahtola et al., 2011; Schulting, Malone & Dodge, 2005), tandis que les retombées à long terme d’expériences scolaires précoces de bonne qualité incluent des coûts-avantages sociétaux dus à l'augmentation du revenu imposable (Schweinhart et al., 2005). Compte tenu de la récente augmentation de la prévalence des TSA (Centres de contrôle et de prévention des maladies, 2014) et de l'attention portée récemment sur la transition à l'école, ce programme de recherche explorera les problèmes liés au passage à l'école des enfants atteints de TSA et de leurs familles. Pour comprendre le passage à l'école, deux modèles théoriques encadrent ce programme d'études. Le modèle de systèmes de développement pour une intervention précoce de Guralnick (2005) propose une approche développementale et systémique pour l’intervention précoce. Le modèle complet décrit les éléments essentiels d'un système d'intervention précoce, aboutissant à la planification de la transition. Le modèle de transition écologique et dynamique de Rimm-Kaufman et Pianta (2000) met l’accent sur les compétences individuelles des enfants, leurs environnements et les liens qui les unissent. Basé sur les modèles de Guralnick et Rimm-Kaufman et de Pianta, ce programme de recherche étudiera divers aspects ou composantes (revue de la littérature, politique de transition, intervention de transition) de la transition à l’école des enfants atteints de TSA et de leurs familles. La première étude a examiné et synthétisé la littérature actuelle sur la transition à l'école et les TSA. La deuxième étude a examiné et décrit la politique de transition à l'école pour les enfants atteints de TSA et leur famille au Canada au moyen d'une enquête sur la transition à l'école réalisée par des fournisseurs de services préscolaires. Enfin, la troisième étude a impliqué la mise en œuvre et l’évaluation d’une intervention de transition vers l’école pour les enfants atteints de TSA. Ce programme de recherche devrait nous permettre de mieux comprendre les problèmes liés à la transition vers l’école des enfants atteints de TSA et de leurs familles et d’informer les futures politiques sur la transition réussie de ces enfants et de leurs familles

Short sleep duration is associated with teacher-reported inattention and cognitive problems in healthy school-aged children

PURPOSE: Pediatric, clinical, and research data suggest that insufficient sleep causes tiredness and daytime difficulties in terms of attention-focusing, learning, and impulse modulation in children with attention deficit hyperactivity disorder (ADHD) or in those with ADHD and primary sleep disorders. The aim of the present study was to examine whether sleep duration was associated with ADHD-like symptoms in healthy, well-developing school-aged children. PATIENTS AND METHODS: Thirty-five healthy children (20 boys, 15 girls), aged 7–11 years participated in the present study. Each child wore an actigraphic device on their nondominant wrist for two nights prior to use of polysomnography to assess their typical sleep periods. On the third night, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Teachers were asked to report symptoms of inattention and hyperactivity/impulsivity on the revised Conners Teacher Rating Scale. RESULTS: Shorter sleep duration was associated with higher levels of teacher-reported ADHD-like symptoms in the domains of cognitive problems and inattention. No significant association between sleep duration and hyperactivity symptoms was evident. CONCLUSION: Short sleep duration was found to be related to teacher-derived reports of ADHD-like symptoms of inattention and cognitive functioning in healthy children

Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD

Abstract Background Children with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems. Methods After initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7–11 years (mean age 8.61 years, SD 1.27 years) participated in the present study. Results In both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident. Conclusions Sleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ.</p

Cost-effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops.

Abstract Background: In the Los Angeles Barbershop Blood Pressure Study (LABBPS), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and healthcare costs of one year of the LABBPS intervention versus control are projected. Methods: A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and non-fatal cardiovascular disease events, and non-cardiovascular disease death in LABBPS participants. Program costs, total direct healthcare costs (2019 USD), and quality-adjusted life years (QALYs) were estimated for the LABBPS intervention and control arms from a healthcare sector perspective over a 10-year horizon. Future costs and QALYs were discounted 3% annually. High and intermediate cost-effectiveness thresholds were defined as \u3c$50,000 and \u3c$150,000 per QALY gained, respectively. Results: At 10 years, the intervention was projected to cost an average of $2,356 (95$264-$4,611) more per participant than the control arm and gain 0.06 (95$42,717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17,162 per QALY gained. The LABBPS intervention would be only intermediately cost effective if pharmacists were less likely to intensify antihypertensive medications when systolic blood pressure was ≥150 mmHg or if pharmacist weekly time driving to barbershops increased. Conclusions: Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve blood pressure control in Black men