Factors Affecting Young Mothers’ Access to Child Healthcare Services: A Behavioural Analysis to Guide the Development of Interventions

Young mothers are more likely to access healthcare for their children in emergent care settings and less likely to use preventive care. This study examines the healthcare-seeking behaviours of young mothers to inform the design of tailored interventions. Semi-structured interviews with nine young mothers (aged ≤ 25 years) who were attending a supported playgroup in Brisbane, Australia were conducted and explored using the Capability, Opportunity and Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Five behavioural themes were identified (navigating the system, complex referral pathways, delays and long wait times, understanding child development, and connecting to services) and the role of the supported playgroup in shaping young mothers’ understanding of child development and connecting them to services was highlighted. Recommended strategies to address these factors include opportunities for young mothers to learn about child developmental milestones, improving young mothers’ health literacy, increasing young mothers’ skills and/or the availability of support to help them navigate health services, and providing more accessible entry points for child assessments, referrals, or early intervention programs

Natural History of Stuttering to 4 Years of Age: A Prospective Community-Based Study

These findings from a community-ascertained cohort refute long-held views suggesting that developmental stuttering is associated with a range of poorer outcomes. If anything, the reverse was true, with stuttering predicting subsequently better language,nonverbal skills, and psychosocial health-related quality of life at 4 years of age.Future research with this cohort will support a more complete longitudinal understanding of when and in whom recovery occurs. Current best practice recommends waiting for 12 monthsbefore commencing treatment, unlessthe child is distressed, there is parental concern, or the child becomes reluctant to communicate. It may be that for many children treatment could be deferred even longer. Treatment is efficacious15 but is both intensive (median of 15.4o ne-hour clinical sessions followedby 10 one-hour clinical maintenance sessions) and expensive; this "watchful waiting" recommendation would therefore help target allocation of scarce resources to the small number of children who do not resolve and experience adverse outcomes, secure in the knowledge that delaying treatment by a year or more has been shown not to compromise treatment efficac

DETERIORO DEL LENGUAJE, DEL HABLA Y TRASTORNOS DE LA FLUIDEZ, MANEJO DE LOS TRASTORNOS DEL LENGUAJE Y EL HABLA EN LA INFANCIA. - SPEECH IMPAIRMENT, SPEECH AND FLUENCY DISORDERS, MANAGING LANGUAGE DISORDERS AND SPEECH IN CHILDHOOD.

Una guía para identificar los problemas más comunes, entender su evolución clínica, decidir cuándo y para qué se consultan los servicios, y entender qué mejoras se pueden esperar.Aprender a hablar es uno de los logros más importantes de la vida. El lenguaje, por lo general adquirido con tan poco esfuerzo, sustenta el aprendizaje y la capacidad de interactuar con los demás y establece las relaciones de cada niño. La mala comunicación tiene profundas implicancias para el empleo, la salud, la alfabetización, la crianza de la siguiente generación, y las desigualdades sociales. Por lo tanto es de gran preocupación social que el lenguaje, el habla, y los desórdenes de la fluidez sean algunos de los trastornos más comunes del desarrollo.El objetivo de esta revisión clínica es resumir la información actual sobre los deterioros del lenguaje y del habla para ayudar a los médicos generales, servicios universales de salud del niño y pediatras a identificar los problemas más comunes, entender su evolución clínica, decidir cuándo y para qué se consultan los servicios, y entender qué mejoras se pueden esperar

A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions

Purpose: To compare two experimental Westmead Program treatments with a control Lidcombe Program treatment for early stuttering. Method: The design was a three-arm randomized controlled trial with blinded outcome assessments 9 months post-randomization. Participants were 91 pre-school children. Results: There was no evidence of difference in percentage syllables stuttered at 9 months among groups. Dropout rates were substantive and may have been connected with novel aspects of the trial design: the use of community clinicians, no exclusion criteria, and randomization of children younger than 3 years of age. Conclusion: The substantive dropout rate for all three arms in this trial means that any conclusions about the 9-month stuttering outcomes must be regarded as tentative. However, continued development of the Westmead Program is warranted, and we are currently constructing an internet version

Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial

Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services

Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial

BackgroundEarly language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system. Methods/DesignA large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or &lsquo;usual care&rsquo; control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a &lsquo;step up-step down&rsquo; therapeutic approach depending on the child&rsquo;s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills. DiscussionA key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.<br /

The agreement between parent-reported and directly measured child language and parenting behaviors

Parenting behaviors are commonly targeted in early interventions to improve children\u27s language development. Accurate measurement of both parenting behaviors and children\u27s language outcomes is thus crucial for sensitive assessment of intervention outcomes. To date, only a small number of studies have compared parent-reported and directly measured behaviors, and these have been hampered by small sample sizes and inaccurate statistical techniques, such as correlations. The Bland-Altman Method and Reduced Major Axis regression represent more reliable alternatives because they allow us to quantify fixed and proportional bias between measures. In this study, we draw on data from two Australian early childhood cohorts (N = 201 parents and slow-to-talk toddlers aged 24 months; and N = 218 parents and children aged 6-36 months experiencing social adversity) to (1) examine agreement and quantify bias between parent-reported and direct measures, and (2) to determine socio-demographic predictors of the differences between parent-reported and direct measures. Measures of child language and parenting behaviors were collected from parents and their children. Our findings support the utility of the Bland-Altman Method and Reduced Major Axis regression in comparing measurement methods. Results indicated stronger agreement between parent-reported and directly measured child language, and poorer agreement between measures of parenting behaviors. Child age was associated with difference scores for child language; however, the direction varied for each cohort. Parents who rated their child\u27s temperament as more difficult tended to report lower language scores on the parent questionnaire, compared to the directly measured scores. Older parents tended to report lower parenting responsiveness on the parent questionnaire, compared to directly measured scores. Finally, speaking a language other than English was associated with less responsive parenting behaviors on the videotaped observation compared to the parent questionnaire. Variation in patterns of agreement across the distribution of scores highlighted the importance of assessing agreement comprehensively, providing strong evidence that simple correlations are grossly insufficient for method comparisons. We discuss implications for researchers and clinicians, including guidance for measurement selection, and the potential to reduce financial and time-related expenses and improve data quality. Further research is required to determine whether findings described here are reflected in more representative populations

Acquisition of Maternal Education and its Relation to Single Word Reading in Middle Childhood: An Analysis of the Millennium Cohort Study

Maternal education captured at a single time point is commonly employed as a predictor of a child's cognitive development. In this paper we ask what bearing the acquisition of additional qualifications has upon reading performance in middle childhood. This was a secondary analysis of the UK's Millennium Cohort Study, a birth cohort of 18,000 children born in 2000. Our outcome variable was Single Word Reading from the British Abilities Scales at 7 years. Predictors included maternal age and education, relative poverty and parity. Increasing maternal education over time was associated with improved child outcomes with a 2 month developmental advantage for children whose mothers had increased education over those whose mothers had not. Parity was important but conditional on this, there was no evidence of child attainment reducing for the children of older mothers. A time-varying education level model is consistent with an input quality mechanism for language development.casl63pub4328pub

EHLS at school: school-age follow-up of the early home learning study cluster randomized controlled trial

BACKGROUND: Targeted interventions during early childhood can assist families in providing strong foundations that promote children\u27s health and wellbeing across the life course. There is growing recognition that longer follow-up times are necessary to assess intervention outcomes, as effects may change as children develop. The Early Home Learning Study, or \u27EHLS\u27, comprised two cluster randomized controlled superiority trials of a brief parenting intervention, smalltalk, aimed at supporting parents to strengthen the early childhood home learning environment of infants (6-12&nbsp;months) or toddlers (12-36&nbsp;months). Results showed sustained improvements in parent-child interactions and the home environment at the 32&nbsp;week follow-up for the toddler but not the infant trial. The current study will therefore follow up the EHLS toddler cohort to primary school age, with the aim of addressing a gap in literature concerning long-term effects of early childhood interventions focused on improving school readiness and later developmental outcomes. METHODS: \u27EHLS at School\u27 is a school-aged follow-up study of the toddler cluster randomized controlled trial (n&thinsp;=&thinsp;1226). Data will be collected by parent-, child- and teacher-report questionnaires, recorded observations of parent-child interactions, and direct child assessment when children are aged 7.5&nbsp;years old. Data linkage will provide additional data on child health and academic functioning at ages 5, 8 and 10&nbsp;years. Child outcomes will be compared for families allocated to standard/usual care (control) versus those allocated to the smalltalk program (group program only or group program with additional home coaching). DISCUSSION: Findings from The Early Home Learning Study provided evidence of the benefits of the smalltalk intervention delivered via facilitated playgroups for parents of toddlers. The EHLS at School Study aims to examine the long-term outcomes of this initiative to determine whether improvements in the quality of the parent-child relationship persist over time and translate into benefits for children\u27s social, academic and behavioral skills that last into the school years

Hypothesis-driven genome-wide association studies provide novel insights into genetics of reading disabilities

Peer reviewe