Pregnancy outcome following prenatal diagnosis of chromosomal anomaly: a record linkage study of 26,261 pregnancies

Previous studies have demonstrated the influence of changes in the age at which women give birth, and of developments in prenatal screening and diagnosis on the number of pregnancies diagnosed and terminated with chromosomal anomalies. However, we are unaware of any population studies examining pregnancy terminations after diagnosis of chromosomal anomalies that has included all aneuploidies and the influence of maternal factors. The aims of this study were to examine the association between results of prenatal tests and pregnancy termination, and the proportion of foetuses with and without chromosomal anomalies referred for invasive diagnostic tests over time. Diagnostic information of 26,261 prenatal invasive tests from all genetic service laboratories in Scotland from 2000 to 2011 was linked to Scottish Morbidity Records to obtain details on pregnancy outcome. Binary logistic regression was carried out to test the associations of year and type of diagnosis with pregnancy termination, while controlling for maternal age, neighbourhood deprivation and parity. There were 24,155 (92.0%) with no chromosomal anomalies, 1,483 (5.6%) aneuploidy diagnoses, and 623 (2.4%) diagnoses of anomaly that was not aneuploidy (including translocations and single chromosome deletions). In comparison with negative test results, pregnancies diagnosed with trisomy were most likely to be terminated (adjusted OR 437.40, 95% CI 348.19–549.46) followed by other aneuploid anomalies (adjusted OR 95.94, 95% CI 69.21–133.01). During the study period, fewer pregnancies that were diagnosed with aneuploidy were terminated, including trisomy diagnoses (adjusted OR 0.44, 95% CI 0.26–0.73). Older women were less likely to terminate (OR 0.35, 95% CI 0.28, 0.42), and parity was also an independent predictor of termination. In keeping with previous findings, while the number of invasive diagnostic tests declined, the proportion of abnormal results increased from 6.09% to 10.88%. Systematic advances in prenatal screening have improved detection rates for aneuploidy. This has been accompanied by a reduction in the rate of termination for aneuploidy. This may reflect societal changes with acceptance of greater diversity, but this is speculation, and further research would be needed to test this

The effects of early years' childcare on child emotional and behavioural difficulties in lone and co-parent family situations

With targeted childcare initiatives and welfare-to-work programmes policy-makers have sought to address employment activation of lone mothers and negative outcomes for children in lone parent households. The present study examines non-parental childcare use and maternal employment among children living in lone and co-parent family situations at ages three and four and emotional and behavioural difficulties at ages four and five. The results demonstrate that negative outcomes associated with lone motherhood are explained largely by mother's age, education, material circumstances and area deprivation; and that maternal employment does not relieve lone mothers’ disadvantages in a way that alleviates the risks of difficulties to their children. However, in any family constellation, mainly group-based formal pre-school childcare does have a positive impact on child difficulties compared to drawing on informal childcare arrangements as main provider. In addition, and specifically for the difficulties of children in lone mother family situations, any non-parental childcare – formal or informal − for at least twenty-five hours per week is beneficial. Study findings support policy agendas which tackle families’ material hardship beyond promoting mothers’ employment, and through investment in formal childcare provision, and also through arrangements allowing lone mothers to divide their weekly load of childcare with another main provider

Mental health services for children and adolescents with learning disabilities: a review of research on experiences of service users and providers

Background: Children and young people with learning disabilities experience high rates of mental health problems. Methods: The present study reviewed the literature on mental health services for children with learning disabilities, to identify known models of service provision and what has been experienced as effective or challenging in providing good services. Results: Children with learning disabilities and their parents experience barriers accessing mental health services that are related to a lack of information and perceptions of services as being inadequate. Service providers identified a lack of resources as a barrier to meeting needs. Although positive experiences are also observed, many parents have found services to be inappropriate or overwhelming. Conclusion: Research linking population need to available resources, and service models to services users’ outcomes would be valuable to make clear recommendations on how mental health services can address the needs of this group more effectively

Patients with mild traumatic brain injury and acute neck pain at the emergency department are a distinct category within the mTBI spectrum:a prospective multicentre cohort study

Background: Acute neck pain (ANP) has recently been demonstrated to be a predictor of persistent posttraumatic complaints after mild traumatic brain injury (mTBI). The aim of this study was to determine specific characteristics of patients with ANP following mTBI, their posttraumatic complaints and relationship with functional outcome. Methods: Data from a prospective follow-up study of 922 mTBI patients admitted to the emergency department (ED) in three level-one trauma centres were analysed. Patients were divided into two groups: 156 ANP patients and 766 no acute neck pain (nANP) patients. Posttraumatic complaints were evaluated 2 weeks and 6 months post-injury using standardized questionnaires and functional outcome was evaluated at 6 months with the Glasgow Outcome Scale Extended (GOSE). Results: ANP patients were more often female (p < 0.01), younger (38 vs. 47 years, p < 0.01) with more associated acute symptoms at the ED (p < 0.05) compared to nANP patients. More motor vehicle accidents (12% vs. 6%, p = 0.01) and less head wounds (58% vs. 73%, p < 0.01) in ANP patients indicated 'high-energy low-impact' trauma mechanisms. ANP patients showed more posttraumatic complaints 2 weeks and 6 months post-injury (p < 0.05) and more often incomplete recovery (GOSE < 8) was present after 6 months (56% vs. 40%, p = 0.01). Conclusions: MTBI patients with acute neck pain at the ED constitute a distinct group within the mTBI spectrum with specific injury and demographic characteristics. Early identification of this at risk group already at the ED might allow specific and timely treatment to avoid development of incomplete recovery

Parental attributions of control for child behaviour and their relation to discipline practices in parents of children with and without developmental delays

Children with developmental delays (DD) are at risk for developing behavior problems. Research suggests that parents’ causal attributions for child behavior are related to parenting. This study investigated this association in parents of children with DD compared to parents of typically developing (TD) children. It specifically focused on attributions of child control by separating these from attributions of responsibility, blame and intent, and from attributions of parent control and responsibility. Fifty-one parents of children with DD and 69 parents of TD children completed two questionnaires. The Written Analogue Questionnaire measured causal attributions. The Parenting Scale measured dysfunctional discipline practices. Parents of children with DD viewed the child’s role in problematic behavior more positively while also viewing misbehavior as more fixed than parents of TD children. Parents of TD children who viewed their child as more in control over misbehavior used less dysfunctional discipline, but this association was not found for parents of children with DD. The results advance understanding of how parents perceive behavior problems in children with DD and the important role these perceptions play in parental behavior management strategies. More importantly, these perceptions relate to discipline practices differently for parents of children with DD compared to parents of TD children, highlighting that parent interventions should be adapted to the specific needs of parents of children with DD

Parenting children with a learning disability, the relationship between parental causal attributions, parenting strategies and child behaviour problems

This thesis used an attributional framework to examine parental cognitions of behaviour of children with a learning disability (LD), in particular how they predict parent and child behaviour and how these views compare to prevailing societal views of disability. Four studies were carried out. The first study assessed views prevailing among parents of typically developing (TD) children of children with an LD and compared these to views held by parents of children with an LD. Parents of children with an LD overall complied to these prevailing views of LD. A small group of parents holding more affirmative views was identified and these parents made corresponding affirmative choices for their child. The second study was qualitative and investigated the views of parents of children with an LD more in-depth by evaluating views on causes of misbehaviour. Both causes relating to the LD and more typical causes were identified and seemed to affect parenting strategies in different ways. The third study then examined these relationships quantitatively in parents of children with an LD in comparison to parents of TD children. Result showed that parents' attributions predicted strategies differently for each group. An attribution of high child control and low parent responsibility was unsupportive of effective parenting in parents of children with an LD while this was not the case for parents of TD children. The final study subsequently aimed to examine in more detail the underlying structure of parent and child responsibility and control over behaviour in parents of children with an LD and uncovered two different interpretations of responsibility in parents. Implications for theory and measurement of attributions are discussed and suggestions for child behaviour interventions are given.This thesis used an attributional framework to examine parental cognitions of behaviour of children with a learning disability (LD), in particular how they predict parent and child behaviour and how these views compare to prevailing societal views of disability. Four studies were carried out. The first study assessed views prevailing among parents of typically developing (TD) children of children with an LD and compared these to views held by parents of children with an LD. Parents of children with an LD overall complied to these prevailing views of LD. A small group of parents holding more affirmative views was identified and these parents made corresponding affirmative choices for their child. The second study was qualitative and investigated the views of parents of children with an LD more in-depth by evaluating views on causes of misbehaviour. Both causes relating to the LD and more typical causes were identified and seemed to affect parenting strategies in different ways. The third study then examined these relationships quantitatively in parents of children with an LD in comparison to parents of TD children. Result showed that parents' attributions predicted strategies differently for each group. An attribution of high child control and low parent responsibility was unsupportive of effective parenting in parents of children with an LD while this was not the case for parents of TD children. The final study subsequently aimed to examine in more detail the underlying structure of parent and child responsibility and control over behaviour in parents of children with an LD and uncovered two different interpretations of responsibility in parents. Implications for theory and measurement of attributions are discussed and suggestions for child behaviour interventions are given

Causal attributions for misbehaviour in children with LD : unpacking parent perceptions of child control

Background: Children with learning disabilities (LD) are at risk for developing behaviour problems. Research suggests that parents’ causal attributions for child behaviour are an important factor related to parenting strategies and child behaviour problems. The present study investigated relationships between these three factors in parents of children with LD in comparison to parents of typically developing (TD) children. Additionally, prior research on parent perceptions of child controllability over misbehaviour suggests that both high and low levels of control have disadvantageous effects on parenting. Therefore, the study specifically focused on examining controllability further by separating attributions of control from responsibility, blame and intent. Method: Eighty parents of children with LD and eighty parents of TD children aged six to twelve completed questionnaires. The Written Analogue Questionnaire measured parents’ attributions, the Child Behaviour Checklist assessed behaviour problems and the Parenting Scale measured parents’ use of ineffective strategies. Results: Parents of children with LD reported more behaviour problems in their child and saw these as more stable than parents of TD children. Additionally, parents of children with LD attributed less control, responsibility, blame and intent towards their child for misbehaviour than parents of TD children. While blame was positively related to overreactive parenting, responsibility was negatively related to lax parenting. Conclusions: Perceptions of child controllability need to be further unpacked as they differentially impact on parenting strategies. Overall, results will advance understanding of how parents perceive behaviour problems in their child with LD and how families can be supported to reduce these problems

Relationships between causal attributions, parenting strategies and child behaviour problems in parents of children with ID : the outcomes and methods of two studies

Background: Research suggests that parents’ causal attributions for child behaviour are an important aspect related to parenting strategies and child behaviour problems. Using different instruments, two studies were undertaken to investigate relationships between these factors in parents of children with intellectual disability (ID). Methods: Fifty-one parents of children with ID participated in Study 1 and 35 in Study 2. In Study 1, the Written Analogue Questionnaire (WAQ) measured attributions through direct questions and vignettes while in Study 2 the Parent Cognition Scale (PCS) measured attributions through aggregated scales and asking parents to think back to their child’s behaviour. To assess child behaviour, the Child Behaviour Checklist (CBCL) was used in Study 1 and the Nisonger Child Behavior Rating Form (NCBRF, developed for ID groups), was used in Study 2. The Parenting Scale (PS) measured ineffective strategies in both studies. Results: Study 1 found that attributions predicted strategies. However, strategies did not predict child behaviour. The results of Study 2 are expected to corroborate relationships between attributions and strategies and to provide insight into the underlying structure of attributions in parents of children with ID. Relationships between the PS and NCBRF would suggest the CBCL is inappropriate for ID groups, while absence of associations could suggest that PS strategies have a different meaning in TD and ID groups. Conclusions: The studies identify parents’ attributions as important predictors for strategies and stress that methods developed for TD groups cannot always be applied to ID groups as behaviour and strategies must be seen in a different contex