Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

addresses: Royal Children's Hospital, Murdoch Childrens Research Institute and University of Melbourne, Parkville, Vic 3052, Australia. [email protected]: PMCID: PMC2737607types: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov'tCopyright © 2009 by the BMJ Publishing Group Ltd. This articles was first published in: BMJ, 2009, Vol. 339, pp. b3308 -To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children

Do emotional difficulties and peer problems hew together from childhood to adolescence? The case of children with a history of developmental language disorder (DLD)

Children and adolescents with developmental language disorder (DLD) are, overall, vulnerable to difficulties in emotional adjustment and in peer relations. However, previous research has shown that different subgroups follow different trajectories in respect of quality of peer relations. Less is known of the trajectories of emotional development. We consider here the possibility that development in these two domains is interrelated: that is, the trajectories of emotional and peer problems will proceed in parallel. We conducted longitudinal joint trajectories analyses of emotional and peer relations in a sample of young people identified as having DLD at age 7 years and seen at intervals up to 16 years. Potential influences on joint trajectory group membership were examined. Findings revealed five distinct joint trajectories. Emotional and peer difficulties do hew together from childhood to adolescence for just over half of the sample, but not all. The variables most clearly associated with group membership were pragmatic language ability, prosociality and parental mental health. This is the first study to examine joint longitudinal trajectories of emotional and peer difficulties in individuals with DLD. We demonstrate that development in individuals with DLD is heterogeneous and identify three key variables associated with personal and social adjustment from childhood to adolescence. Theoretical and clinical implications of these findings are discussed

Protocol for the Adaptation of a Direct Observational Measure of Parent-Child Interaction for Use With 7–8-Year-Old Children

ObjectiveParenting sensitivity and mutual parent-child attunement are key features of environments that support children&rsquo;s learning and development. To-date, observational measures of these constructs have focused on children aged 2&ndash;6 years and are less relevant to the more sophisticated developmental skills of children aged 7&ndash;8 years, despite parenting being equally important at these ages. We undertook a rigorous process to adapt an existing observational measure for 7&ndash;8-year-old children and their parents. This paper aimed to: (i) describe a protocol for adapting an existing framework for rating parent-child interactions, (ii) determine variations in parents&rsquo; sensitive responding and parent-child mutual attunement (&lsquo;positive mutuality&rsquo;) by family demographics, and (iii) evaluate the psychometric properties of the newly developed measure (i.e., inter-rater reliability, construct validity).MethodParent-child dyads completed one home visit, including a free-play observation and parent questionnaire. Dyads were provided with three toy sets: LEGO&reg; Classic Box, Classic Jenga&reg;, and animal cards. The Coding of Attachment-Related Parenting (CARP) was adapted for use with 7&ndash;8-year-old children, and rating procedures were streamlined for reliable use by non-clinician/student raters, producing the SCARP:7&ndash;8 Years. Trained staff rated video-recorded observations on 11 behaviors across two domains (five for parents&rsquo; sensitive responding, six for parent-child positive mutuality).ResultsData were available for 596 dyads. Consistently strong inter-rater agreement on the 11 observed behaviors was achieved across the 10-week rating period (average: 87.6%, range: 71.7% to 96.7%). Average ICCs were 0.77 for sensitive responding and 0.84 for positive mutuality. These domains were found to be related but distinct constructs (r = 0.49, p &amp;lt; 0.001). For both domains, average ratings were strongly associated with the main toy used during the observation (p &amp;lt; 0.001, highest: cards, lowest: LEGO&reg;). Adjusted multivariate linear regression models (accounting for toy choice) revealed that less sensitive responding was associated with younger parent (p = 0.04), male parent (p = 0.03), non-English speaking background (p = 0.04), and greater neighborhood disadvantage (p = 0.02). Construct validity was demonstrated using six parent-reported psychosocial and parenting measures.ConclusionThe SCARP: 7&ndash;8 Years shows promise as a reliable and valid measure of parent-child interaction in the early school years. Toy selection for direct observation should be considered carefully in research and practice settings.</jats:sec

Expectations and experiences of parents taking part in parent-child interaction programmes to promote child language: a qualitative interview study

BACKGROUND: Parent-child interaction therapies are commonly used by speech and language therapists (SLTs) when providing services to young children with language learning difficulties. However, the way parents react to the demands of such interventions is clearly important, especially for those from socially disadvantaged backgrounds. Parents play a central role in the therapy process so to ensure parent engagement, and to maximize intervention effectiveness, parents' views must be considered. AIMS: To explore the expectations and experiences of parents from socially disadvantaged backgrounds who had taken part in a parent-child interaction programme aimed at promoting language development in 2-3 year olds with language difficulties. METHODS & PROCEDURES: The sample included parents who had a child aged 2-3 years and had attended a parent-child interaction programme to promote their child's language development. Parents were eligible to take part if they were living in the 30% most deprived areas in a city in the North of England that constituted the study site. Ten parents participated in a qualitative semi-structured face-to-face interview in the home. Framework analysis was used to analyse the interview transcripts. OUTCOMES & RESULTS: Parents' expectations before taking part in parent-child interaction interventions contribute to how they may engage throughout the intervention process. Barriers include parents' uncertainty about the nature of the intervention and differing attitudes regarding intervention approaches and strategies. Facilitators during the intervention process include gaining support from other parents, reassurance from the SLT regarding their child's language development, and their own ability to support their child's language learning, as well as increased confidence in how they support their child's development. CONCLUSIONS & IMPLICATIONS: Parents respond very differently to parent-child interaction intervention for children with language difficulties, depending on their expectations and attitudes towards intervention. Thus, it is critical that these different perspectives are understood by practitioners before intervention commences to ensure successful engagement. What this paper adds What is already known on this subject Parent-child interaction interventions are widely used to promote child language development. Parents play a central role in the therapy process of such interventions, so to maximize effectiveness, parents must be appropriately 'engaged' in that intervention. This involves attending, fully participating and having appropriate attitudinal and/or emotional involvement. The reciprocal nature of engagement means that parents are more likely to become engaged in intervention over time when they are supported by their SLT. What this paper adds to existing knowledge Parental expectations about the intervention process vary considerably and often need to be negotiated before the start of intervention. Reassurance and supporting positive attitudes to co-working with their SLT may be particularly important for families living with social disadvantage. Supporting parent engagement in parent-child interaction programmes can contribute to the parents' capability to continue implementing language-promoting strategies outside the intervention context and beyond the end of therapy. What are the potential or actual clinical implications of this work? Parents have different expectations regarding programme involvement. Therefore, having a two-way, open dialogue between parents and SLTs from the beginning is clearly important, not only as a way of sharing information but also to build on parents' understanding of what the intervention will involve and trust that the SLT will be able to deliver the intervention in collaboration with the parent. SLTs can enhance parent engagement by supporting parents to feel confident and providing reassurance in terms of their child's development and how they can support their child's language learning