PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique

OBJECTIVE: There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings. DESIGN: Two-round modified Delphi consensus method. SETTING: Irish and UK general practice. PARTICIPANTS: A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel. RESULTS: 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2). CONCLUSIONS: The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases

Emotion and cognition processes in preschool children

The core processes of emotion understanding, emotion control, cognitive understanding, andcognitive control and their association with early indicators of social and academic success wereexamined in a sample of 141 3-year-old children. Confirmatory factor analysis supported thehypothesized four-factor model of emotion and cognition in early childhood. A subsequentstructural model indicated that emotion understanding processes were significantly positivelyassociated with early indicators of academic success, while emotion control processes wereinversely related to socioemotional problems. These results point to the utility of an integratedmodel of emotion and cognition in early development and offer support for the differentiation ofunderstanding and control processes within these developmental arenas as a framework forfuture study

Cognitive and emotional processes as predictors of a successful transition into school

Research Findings: The aim of this research was to delineate developmental processes that contribute to early school success. To achieve this aim, we examined emotion regulation, executive functioning, emotion knowledge, and metacognition at ages 3 and 4 as distal and proximal predictors of age 5 achievement and school adjustment in a sample of 263 children (42% non-White). We also explored mediational pathways among these 4 processes in the prediction of the age 5 outcomes. Results revealed that all 4 processes affected achievement and school adjustment, but in different ways, with executive functioning emerging as a key predictor. Practice or Policy: Executive functioning was found to be a key factor in predicting achievement and school performance in the kindergarten year. This finding provides support for the development of executive functioning training programs that can be applied in the preschool classroom, particularly for promoting reading development. However, additional emphasis should be placed on both cognitive and emotional processes in the preschool years to promote optimal development

Preschool-aged children's understanding of gratitude: Relations with emotion and mental state knowledge

Developmental precursors to children's early understanding of gratitude were examined. A diverse group of 263 children was tested for emotion and mental state knowledge at ages 3 and 4, and their understanding of gratitude was measured at age 5. Children varied widely in their understanding of gratitude, but most understood some aspects of gratitude-eliciting situations. A model-building path analysis approach was used to examine longitudinal relations among early emotion and mental state knowledge and later understanding of gratitude. Children with a better early understanding of emotions and mental states understand more about gratitude. Mental state knowledge at age 4 mediated the relation between emotion knowledge at age 3 and gratitude understanding at age 5. The current study contributes to the scant literature on the early emergence of children's understanding of gratitude

Do hours spent watching television at age 3 and 4 predict vocabulary and executive functioning at age 5?

We examined the impact of television viewing at ages 3 and 4 on vocabulary and at age 5 on executive functioning in the context of home learning environment and parental scaffolding. Children (N = 263) were seen in the lab when they were 3 years old and then again at ages 4 and 5. Parents completed measures assessing child television viewing and the home environment at ages 3 and 4, and mother-child interaction was observed during a problem-solving task. At age 5, children completed measures of vocabulary and executive functioning. Results indicated that although the amount of television viewing was negatively related to vocabulary and executive functioning, this association was no longer significant once background variables, home learning environment, and parental scaffolding were taken into consideration. Parental scaffolding emerged as a primary predictor of vocabulary above demographic covariates. Implications of the research are discussed in terms of recommendations for parents regarding television viewing by preschool children

Maternal Expressive Style and Children's Emotional Development

Maternal expressive styles, based on a combination of positive and negative expressive patterns, were identified at two points in time and related to multiple aspects of preschool children's emotional development. Mother–child pairs from 260 families participated when the children were 3?years old, and 240 participated again at aged 4?years. Expressive styles were identified at age 3 using cluster analysis, replicated at age 4 and examined in relation to children's emotional understanding, expressiveness and regulation. Three expressive styles were identified: high positive/low negative, very low positive/average negative and average positive/very high negative. Cluster membership was stable in 63% of families from age 3 to 4?years; no systematic patterns of change were evident in the remaining families. Expressive style was related to aspects of children's emotional expression at 3?years and to emotion expression and regulation at 4?years. Children's expressiveness and regulation at age 3 were also related to changes in mothers' expressive styles over 1?year. Identifying mothers' expressive styles provides a unique way to understand the potential role of the emotional climates in which preschool-aged children learn to express and regulate their own emotion

Links between Family Social Status and Preschoolers' Persistence: The Role of Maternal Values and Quality of Parenting

Children who develop persistence in the preschool years are likely to function more effectively during the transition into school. In this study of 231 3-year-old children and their mothers, we examined the relations among family social status, maternal values of self-direction, quality of parenting, and children's persistence in challenging tasks. Results of structural equation modelling path analysis indicated that family social status was related to maternal values of self-direction, which in turn were associated with the quality of maternal cognitive stimulation and emotional support and child persistence at preschool age. Family social status and maternal values were indirectly related to child persistence through emotional support. Focusing on parental values of self-direction and provision of support during challenging tasks may help to reduce the gap in school success between children from lower and higher social status families

Developmental Dynamics of Emotion and Cognition Processes in Preschoolers

Dynamic relations during the preschool years across processes of control and understanding in the domains of emotion and cognition were examined. Participants were 263 children (42% non-White) and their mothers who were seen first when the children were 3 years old and again when they were 4. Results indicated dynamic dependence among the processes studied. Specifically, change in cognitive processes of control and understanding were dependent upon initial levels of the other processes. Changes in emotion control and understanding were not predicted by earlier performance in the other processes. Findings are discussed with regard to the constructs of control and understanding and the developmental interrelations among emotion and cognitive processes

Moderate Vagal Withdrawal in 3.5-Year-Old Children is Associated with Optimal Performance on Executive Function Tasks

Vagal tone (measured via respiratory sinus arrhythmia, RSA) and vagal withdrawal (measured by decreases in RSA) have been identified as physiological measures of self-regulation, but little is known how they may relate to the regulation of cognitive activity as measured through executive function (EF) tasks. We expected that baseline measures of vagal tone, thought to be an indicator of attention, would correlate with EF performance. We also predicted that vagal withdrawal would allow for the reorientation of attention that is needed to succeed on EF tasks, but too much withdrawal would be detrimental. RSA measured at baseline was indeed related to EF performance in 220 3.5-year-old children, and those who exhibited a moderate decrease in RSA during the EF tasks outperformed children whose RSA decreased by too little or too much. These findings implicate vagal tone withdrawal as a psychophysiological measure of higher cognitive processes, most likely substantiated through increases in the levels of focused attention