Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Social problem-solving skills in children with traumatic brain injury: long-term outcomes and prediction of social competence.

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Academic achievement of low birthweight children at age 11: the role of cognitive abilities at school entry

We examine the extent to which deficits in academic achievement in low birthweight (LBW) children at age 11 are explained by deficits in cognitive abilities at school entry. Data come from a longitudinal study of a stratified sample of LBW and normal birthweight (NBW) children from an innercity and middle class suburbs in the Detroit area. Woodcock-Johnson Psychoeducational Battery-Revised was used to measure reading and math at age 11. WISC-R and specific neuropsychologic tests were administered at age 6. On reading, the LBW-NBW difference was -3.6 points (SE = 1.2). The difference was explained almost entirely by IQ at age 6. On math, the LBW-NBW difference was -6.1 points (SE = 1.1). The difference on math was trivial and not significant, when IQ and neuropsychological tests at age 6 were controlled. Level of LBW was unrelated to reading, but it had a gradient relationship with math, with birthweight < or = 1,500 g associated with a greater deficit than heavier LBW. The results imply that most of the LBW-NBW gap in academic achievement at age 11 could be eliminated by eliminating differences in cognitive abilities at age 6. Interventions to improve academic performance of LBW children should focus on the preschool years.     

Social Problem-Solving Skills in Children with Traumatic Brain Injury: Long-Term Outcomes and Prediction of Social Competence

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Attention deficit hyperactivity disorder and the frontal lobe syndrome.

The usefulness of frontal lobe (FL) dysfunction as a conceptual model for Attention Deficit Hyperactivity Disorder (ADHD) was investigated. Twenty-four ADHD and 24 normal control (NC) children were tested using two batteries of tasks. The first was sensitive to FL deficits in motor control and problem solving skills. The second consisted of memory tasks sensitive to temporal lobe dysfunction. ADHD children differed significantly from NCs on measures of FL function, but not on tests of temporal lobe functions. Where norms were available for normal children on the same FL tests, ADHDs performed like 6- to 7-year-olds, despite their mean age of 10 years and minimum age of 8 years. The differential performance of ADHDs on tasks sensitive to FL and temporal lobe dysfunction supports the hypothesis that ADHD deficits are analogous to FL dysfunction and demonstrates that the children's deficits do not reflect generalized cognitive impairment.     

Age at injury and long-term behavior problems after traumatic brain injury in young children

Objective: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). Method: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. Results: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. Conclusions: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

A critical appraisal of the role of neuropsychological deficits in preschool ADHD

The present study aimed at improving our understanding of the role of neuropsychological deficits in preschool Attention Deficit Hyperactivity Disorder (ADHD). The study included 52 children in the ADHD group and 72 controls (age 4–6 years). Both laboratory measures and teacher reports of executive deficits (i.e., working memory, inhibition, and shifting), delay-related behaviors (i.e., the preference for minimizing delay), and emotional functions (i.e., emotion recognition and regulation) were included. Variable-oriented analyses were complemented with person-oriented analyses (i.e., identifying the proportion of patients considered impaired). Results showed that the ADHD group differed from controls with regard to all measures of executive functioning and most measures of delay-related behaviors, but few differences were found for emotional functioning. A substantial subgroup (23%) of children with ADHD did not have a neuropsychological deficit in any domain. There were subgroups with executive or delay-related deficits only, but no pure emotional subgroup. The overlap between different neuropsychological deficits was much larger when teacher reports were used as opposed to laboratory measures. Regarding functional impairments, large mean differences were found between the ADHD group and controls. However, neuropsychological deficits were not able to explain individual variations in daily life functioning among children with ADHD. In conclusion, the present study identified some important methodological and theoretical issues regarding the role of neuropsychological functioning in preschool ADHD.     

Health-related quality of life of preterm children and their caregivers

As advances in medical science have extended the limit of viability downward to 23 or 24 weeks gestation, interest has turned from long-term health outcomes to quality of life for survivors. During the last decade, the first studies of the health-related quality of life (HRQOL) of children and young adults who were born extremely preterm were published. Taken from the fields of anthropology, economics, sociology, and psychology, the foundation of HRQOL is formed by theories of functionalism, positive well-being, and utility. HRQOL can be defined as the physical, psychological, and social domains of health, which can be influenced by an individual's experiences and perception. HRQOL instruments are generally composed of multiple domains and measure physical functioning, mental health, and social role functioning in some form. Utilities, or preferences for health outcomes under conditions of uncertainty, are also used. Studies of HRQOL to-date indicate that preterm children have, on average, poorer health than their normal birthweight peers, but the majority do not perceive their quality of life as significantly different than others of their own age. Measures of HRQOL should not replace the traditional measures of morbidity, but should become part of the standard battery of tools used to assess a preterm child's health and well-being. Ultimately, studies of the HRQOL of preterm children should identify aspects of life, physical, psychological, or social, that could be improved with intervention.     

Limitations in verbal fluency following heavy burdens of early childhood diarrhea in Brazilian shantytown children.

The effects of heavy burdens of diarrhea in the first 2 years of life on specific executive control function like verbal fluency are not well understood. In previous studies, we have shown associations of early childhood diarrhea (ECD) with nonverbal intelligence and school functioning. Therefore, we postulated that ECD might affect early neuropsychological development leading to long-term deficits in normal cognitive development. Based on our extensive 14-year prospective cohort studies of early childhood diarrheal illnesses in a Brazilian shantytown community, we examined ECD correlations between specific impairments of higher mental function and executive skills in shantytown children 5-10 years later (now at 6-12) years of age. Specifically we examined whether heavy diarrheal illnesses correlate with reduced performance on selected tests of executive function. Our study, for the first time, suggests a disproportional impairment in semantic but not phonetic fluency in a subset of children with heavy burdens of diarrhea in their first 2 years of life even when controlling for maternal education, breastfeeding, and child schooling. Similar semantic decrements have been associated with impaired recovery from brain injury. These exploratory studies suggest the importance of verbal fluency tests to assess executive functioning in children challenged by poor nutrition and diarrhea in early life. In addition, our unique findings show the potential influences of early childhood diarrhea on language development that is so critical to productive adulthood and potentially set a foundation for new neuropsychological approaches, which assess early burdens of enteric illnesses on childhood development.     

Use of the everyday memory questionnaire with children.

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N = 101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.     

Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury.

Examined posttraumatic stress (PTS) symptoms in children following pediatric traumatic brain injury (TBI). Children (ages 6-12) with TBI (n = 81) and orthopedic injury (OI; n = 59) were assessed 6 and 12 months postinjury. Parents of children with severe TBI reported higher levels of child PTS symptoms than did parents of children with moderate TBI or OI at the 6- and 12-month follow-ups. Group differences in child-reported PTS symptoms emerged at the 12-month follow-up with higher symptom levels reported by children with severe TBI than by those with moderate TBI or OI. At both follow-ups, rates of clinically significant symptom levels were higher in the severe TBI group than in the moderate TBI or OI groups. The group differences in parent and child reports were significant even after taking ethnicity, social disadvantage, and age at injury into account. Parent and child reports of child PTS symptoms were related to family socioeconomic status. Implications for clinical intervention with children and families following pediatric TBI are discussed.     

Spatial grouping activity in young children with congenital right or left hemisphere brain injury

Spatial grouping abilities were examined in 20 preschool-aged children with right or left hemisphere congenital focal brain injury, and a group of age-matched normal control children. Children were presented with a series of spontaneous grouping tasks in which they were given small sets of blocks and asked to play with them. Although the children with focal brain injury played as actively with the blocks as normal children, the constructions they produced differed systematically. Across eight measures of spatial grouping both children with right and left hemisphere injury were delayed compared to normal children. In addition, the behavioral profiles for the two groups of children with focal brain injury were qualitatively different. Data for the children with RH injury suggested difficulty organizing objects into coherent spatial groupings, while data from the children with LH injury suggested difficulty with local relations within the spatial arrays. These findings are consistent with data reported for adults on spatial construction tasks. Developmental trajectories in the 3- to 4-year age period suggest, further, that the spatial integrative deficits observed in the children with RH injury are persistent. When the children began to produce spatial constructions using complex grouping procedures, those constructions were heaps or disordered clusters. In contrast, when children with LH injury began to use complex procedures, they generated the types of constructions usually associated with those procedures in normal children, e.g., arches, enclosures, and symmetries. These data were found within a cross-sectional study of 20 children and confirmed in a series of six longitudinal case study reports of three children with RH and three with LH injury. The data confirm our previous reports of spatial integrative deficit associated with early RH injury and present the first indication of spatial encoding deficits in children with LH injury.     

When the alternative would have been better: Counterfactual reasoning and the emergence of regret

Counterfactual reasoning about how events could have turned out better is associated with the feeling of regret. However, developmental studies show a discrepancy between the onset of counterfactual reasoning (at 3 years) and the feeling of regret (at 6 years). In four experiments we explored possible reasons. Experiment 1 (3- to 6-year-old children) and Experiment 2 (adult control) show that even when regret is assessed more directly than in previous studies (e.g., Amsel & Smalley, 2000) only adults but not children regret their decision. Experiment 3 (3- to 14-year-old children) suggests that double-questioning—asking children how happy they are with what they got before and after they had seen what they could have got—creates false positive indications of regret in the youngest children and that—when controlling for false positives—regret is not evident before 9 years. However, children before this age make a difference between attractive (three candies) and less attractive (one candy) items (Experiment 4; 6- to 8-year-old children). Taken together, this suggests that before 9 years of age children base their judgements solely on what they got without taking into account what they could have got.     

Use of the Everyday Memory Questionnaire With Children

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N=101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.     

The development of spatial and class relations in four young children with right-cerebral-hemisphere damage: Evidence for an early spatial constructive deficit

This study followed the development of four children with right-hemisphere injury on a series of manipulative classification tasks to determine whether and how early brain injury affects the development of spatial and class relations. The children were first tested at about 2 years of age. Their data were compared with previously collected data from 18- to 42-month-old normal children, and with data from four young children with left-hemisphere injury. The results showed the children with right-hemisphere injury do not generate a particular spatial relation (next to) in their spatial groupings with the same frequency as normal or left-hemisphere damaged children, although they do generate in and on relations with normal frequency. An apparent deficit in the development of class relations is shown to be secondary to the spatial deficit, in that it is evident only in tasks that require spatial grouping.     

When the alternative would have been better: counterfactual reasoning and the emergence of regret

Counterfactual reasoning about how events could have turned out better is associated with the feeling of regret. However, developmental studies show a discrepancy between the onset of counterfactual reasoning (at 3 years) and the feeling of regret (at 6 years). In four experiments we explored possible reasons. Experiment 1 (3- to 6-year-old children) and Experiment 2 (adult control) show that even when regret is assessed more directly than in previous studies (e.g., Amsel & Smalley, 2000) only adults but not children regret their decision. Experiment 3 (3- to 14-year-old children) suggests that double-questioning--asking children how happy they are with what they got before and after they had seen what they could have got--creates false positive indications of regret in the youngest children and that--when controlling for false positives--regret is not evident before 9 years. However, children before this age make a difference between attractive (three candies) and less attractive (one candy) items (Experiment 4; 6- to 8-year-old children). Taken together, this suggests that before 9 years of age children base their judgements solely on what they got without taking into account what they could have got.     

Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Mild traumatic brain injury (mTBI) is a leading cause of injury among children, with approximately 15% of children experiencing a TBI prior to 15 years of age. Acutely, mTBI has been associated with a range of cognitive, physical, emotional and behavioural impairments. However, few studies have examined outcomes beyond five years post injury, long before the developmental process is complete and the full extent of any deficits may manifest. Our group had the unique opportunity to use data from a longitudinal birth cohort of 1265 children (Christchurch Health and Development Study) to examine the long term outcomes of early injury (0–5 years). Information about these children, including mTBI events, had been collected at birth, 4 months and at yearly intervals until age 16, and again at ages 18, 21 and 25 years. We found that even after statistical control for a wide range of child and family confounds, children who had been hospitalized for an mTBI had increased inattention/hyperactivity and conduct as rated by mothers and teachers over ages 7–13 years. Increased rates of psychiatric disorders were over 14–16 years for those injured in the preschool, including symptoms consistent with Attention Deficit/Hyperactivity Disorder (ADHD), Odds Ratio = 4.6, Conduct Disorder (CD), Odds Ratio = 5.6 and Substance Abuse (Odds Ratio = 9.1). Over ages 21–25 ongoing behaviour problems were assessed using self‐reported arrests, violent offenses and property offenses. Compared to non‐injured individuals, mTBI groups were more likely to be arrested, involved in property, and violent offences. We controlled for a wide range of factors and there was still clear evidence of ongoing problems for individuals who had experienced a mTBI compared to their non injured counterparts. These findings provide compelling evidence of long term psychosocial and psychiatric outcomes following mTBI.     

Paralinguistic processing in children with callosal agenesis: emergence of neurolinguistic deficits

Recent research revealed impaired processing of both nonliteral meaning and affective prosody in adults with agenesis of the corpus callosum (ACC) and normal intelligence. Since normal children have incomplete myelination of the corpus callosum, it was hypothesized that paralanguage deficits in children with ACC would be less apparent relative to their peers. The Familiar and Novel Language Comprehension Test (FANL-C) and Prosody Test were given to 18 children with ACC and normal intelligence and 17 controls matched for age (7-13 years), education, and IQ (83-122). When controlling for age, children with ACC were significantly poorer in comprehension of the precise meaning of both literal and nonliteral items on the FANL-C. Adults with ACC had previously been shown to have difficulty only on nonliteral items. The effect size for nonliteral comprehension in children with ACC was smaller than that seen in adults. There was only a trend for the child ACC group to perform worse on the recognition of affective prosody. Thus, while deficits in paralinguistic processing were apparent, children with ACC were not as clearly different from age peers as adults, and were equally deficient at comprehending literal and nonliteral expressions. The differences in results between adults and children with ACC are thought to reflect incomplete callosal development in normal children, and the importance of the corpus callosum in the early stages of the development of the ability to process literal language.     

From egocentric to exocentric spatial orientation: development of posture control in bimanual and trunk inclination tasks

The authors investigated the emergence of independent control of body segments in bimanual tasks involving either voluntary or involuntary trunk motion by tracking the transition from an ego- to an exocentric mode of postural control during childhood (i.e., from body-referenced orientation to externally referenced action). A paradigm combining a seated manual task and various trunk manipulations described the coordination strategies used by 24 children at different ages (2 to 9 years) and by adults. The following questions were asked: (a) When do children begin to dissociate upper limb movements from those of the trunk? (b) What segmental strategies are exhibited by each age group (2-3, 4-6, and 7-9 years, and adults)? Kinematic analyses revealed that younger children (2-6 years) used either the trunk or the support surface as reference to orient the limbs. Older children (7-9 years) began to use a gravitational reference frame similar to that of adults; they uncoupled upper limb motion from the trunk in either voluntary or imposed conditions. Young children patterned the forearm trajectory after the initiating segment (support surface or the trunk), thus reducing the degrees of freedom during the dual task. Echoing previous reports, 7-9 years of age appears to be a critical period in which children master postural control and develop an internal representation of body scheme.     

From Egocentric to Exocentric Spatial Orientation: Development of Posture Control in Bimanual and Trunk Inclination Tasks

The authors investigated the emergence of independent control of body segments in bimanual tasks involving either voluntary or involuntary trunk motion by tracking the transition from an ego- to an exocentric mode of postural control during childhood (i.e., from body-referenced orientation to externally referenced action). A paradigm combining a seated manual task and various trunk manipulations described the coordination strategies used by 24 children at different ages (2 to 9 years) and by adults. The following questions were asked: (a) When do children begin to dissociate upper limb movements from those of the trunk? (b) What segmental strategies are exhibited by each age group (2-3, 4-6, and 7-9 years, and adults)? Kinematic analyses revealed that younger children (2-6 years) used either the trunk or the support surface as reference to orient the limbs. Older children (7-9 years) began to use a gravitational reference frame similar to that of adults; they uncoupled upper limb motion from the trunk in either voluntary or imposed conditions. Young children patterned the forearm trajectory after the initiating segment (support surface or the trunk), thus reducing the degrees of freedom during the dual task. Echoing previous reports, 7-9 years of age appears to be a critical period in which children master postural control and develop an internal representation of body scheme.