Postoperative Rehabilitation of Multidirectional Instability Surgery: A Systematic Review.

Multidirectional instability (MDI) of the shoulder is managed with surgery when conservative rehabilitation fails. The optimal postsurgical management of MDI is not well understood. The purpose of this study is to create a systematic review evaluating postsurgical rehabilitation protocols treating MDI. Articles were included if a postsurgical rehabilitation protocol was described following surgical treatment for MDI. Identified articles underwent 2 phases of screening by blinded team members. Remaining articles had their level of evidence determined by a predefined grading system, ranging from levels I to V. Articles with evidence levels I to IV were included in analysis. Of the 163 articles identified in the literature, 9 were included in this study. Surgical techniques examined in these articles include capsular plication, rotator interval closure, and capsular shift. Rehabilitation protocols were evaluated for duration of treatment and physical therapy modalities. Article results were evaluated for subjective and objective measures of protocol success. Overall, there is a lack of evidence to indicate the optimal rehabilitation protocol post-MDI surgery. Further research is needed to compare rehabilitation protocols following specific surgical procedures to determine their effect on postsurgical patient outcomes.

Associations between child physical abuse potential, observed maternal parenting, and young children's emotion regulation: Is participation in Early Head Start protective?

Clinicians working with Early Head Start (EHS) families consider family well-being and positive parent-child relationships as foundational to school readiness. Understanding the links between risk factors and these dimensions of family engagement can inform clinical decision-making, as risk assessments are used to tailoring program services. The current study examined the associations between high risk, or potential, for child physical abuse and both parenting quality and children's emotion regulation (ER) during toddlerhood; EHS participation was examined as a buffer. The sample included EHS-eligible mothers of infants (N = 80) drawn from one site of the EHS Research and Evaluation Project. Associations were tested between mothers' potential for child physical abuse, measured during infancy, and observed maternal sensitivity, positive regard, harshness, and children's ER skills at child ages 1 and 2 years. Results indicated that high potential for child physical abuse was associated with lower positive regard at age 1 and lower ER skills at age 2. EHS participation operated as a buffer on each of these associations. Implications for screening for child physical abuse potential and the constructs it represents in clinical settings as well as how EHS can promote family engagement are discussed.

Los clínicos que trabajan con familias del Programa de Comienzo Temprano (Early Head Start - EHS) consideran el bienestar familiar y las positivas relaciones entre progenitor y niño como aspectos fundamentales para estar listo para la escuela (US DHHS, 2011). El poder comprender las conexiones entre los factores de riesgo y estas dimensiones de la participación familiar puede servir de base para la toma de decisiones clínicas, ya que las evaluaciones de riesgo se usan para amoldar los servicios del programa. El presente estudio examinó las asociaciones entre el alto riesgo, o riesgo potencial, del abuso físico del niño y tanto la calidad de la crianza como la regulación de la emoción por parte del niño durante la primera etapa de la niñez; se examinó la participación en EHS como mediadora. El grupo muestra incluía madres de infantes elegibles para EHS (N = 80) quienes formaban parte de un mismo Proyecto de Investigación y Evaluación del Programa de Comienzo Temprano. Se pusieron a prueba las asociaciones entre el potencial de las madres de abuso físico del niño, medidas durante la infancia, y las observaciones de sensibilidad materna, consideraciones positivas, dureza, y las habilidades de regulación de la emoción del niño a la edad de 1 y 2 años del niño. Los resultados indicaron que el alto potencial de abuso físico del niño estaba asociado con más bajas consideraciones positivas a la edad de 1 año, así como con las más bajas habilidades de regulación de la emoción a la edad de 2 años. La participación en EHS funcionó como mediadora en cada una de estas asociaciones. Se discuten las implicaciones para detectar el potencial de abuso físico del niño y la estructura que representa en escenarios clínicos, y también cómo EHS puede promover la participación familiar.

Les cliniciens travaillant avec des familles du programme américain de Early Head Start (EHS) familles considèrent le bien-être familial et des relations parent-enfants positives comme étant les fondations de la préparation au cadre scolaire (US DHHS, 2011). Le fait de comprendre les liens entre les facteurs de risque et ces dimensions de l'engagement familial peut informer la prise de décision clinique, comme les évaluations de risque sont utilisées pour adapter les services de programmes. Cette étude s'est penchée sur les liens entre le risque élevé, ou potentiel, de maltraitance physique de l'enfant et à la fois la qualité du parentage et la régulation d'émotion des enfants durant la petite enfance; la participation à l'EHS étant examinée comme tampon. L'échantillon a inclus des mères de nourrissons étant admissible à l'EHS (N = 80), tiré d'un site du Projet de Recherche et d'Evaluation du EHS. Les associations ont été testées entre le potentiel de maltraitance physique de l'enfant par les mères, mesuré durant la très petite enfance, et la sensibilité maternelle observée, l'égard positif, la dureté, et les compétences de régulation de l'émotion des enfants aux âges de 1 et 2 ans. Les résultats indiquent qu'un fort potentiel de maltraitance de l'enfant était lié à un égard positif plus bas à l'âge de 1 ans, et à des compétences de régulation de l'émotion moins élevées à l'âge de 2 ans. La participation à l'EHS a servi de tampon dans chacune de ces associations. Les implications pour le dépistage de potentiel de maltraitance physique de l'enfant et pour les constructions qu'il représente dans les contextes cliniques, ainsi que la manière dont l'EHS peut promouvoir un engagement familial sont discutées.

BUILDING EVALUATION PARTNERSHIPS WITH TRIBAL COMMUNITIES FOR HOME VISITING.

The goal of this current descriptive study was to examine the roles and relationships of evaluators with the tribal communities in which they work. First, we describe a participatory community research model with a strong capacity-building component as the standard for assessing successful working partnerships between evaluators, programs, tribes, and tribal organizations. This model serves as a yardstick against which we examine the success and challenges of program-evaluation partnerships. Second, we report on a survey of tribal Maternal, Infant, and Early Childhood Home Visiting program leaders and outline their impressions of successes and challenges related to program-evaluation partnerships. Survey participants discussed the importance of working with evaluators who have deep investment in and understanding of the tribal community; respect for cultural relevance and honor for cultural ways; collaboration that includes transparency, trust, and translation of research for community leaders and members; a focus on strength-based design without losing the need to consider challenges; and relationships of mutual trust that can weather addressing stressors when issues of conflict, limited resources, and/or mixed expectations arise.

Maltreated Children Use More Grammatical Negations.

Many studies reveal a strong impact of childhood maltreatment on language development, mainly resulting in shorter utterances, less rich vocabulary, or a delay in grammatical complexity. However, different theories suggest the possibility for resilience-a positive adaptation to an otherwise adverse environment-in children who experienced childhood maltreatment. Here, we investigated different measures for language development in spontaneous speech, examining whether childhood maltreatment leads to a language deficit only or whether it can also result in differences in language use due to a possible adaptation to a toxic environment. We compared spontaneous speech during therapeutic peer-play sessions of 32 maltreated and 32 non-maltreated children from the same preschool and equivalent in gender, age (2 to 5 years), home neighborhood, ethnicity, and family income. Maltreatment status was reported by formal child protection reports, and corroborated by independent social service reports. We investigated general language sophistication (i.e., vocabulary, talkativeness, mean length of utterance), as well as grammatical development (i.e., use of plurals, tense, grammatical negations). We found that maltreated and non-maltreated children showed similar sophistication across all linguistic measures, except for the use of grammatical negations. Maltreated children used twice as many grammatical negations as non-maltreated children. The use of this highly complex grammatical structure shows an advanced linguistic skill, which shows that childhood maltreatment does not necessarily lead to a language deficit. The result might indicate the development of a negativity bias in the structure of spontaneous language due to an adaptation to their experiences.

Parenting Supports for Early Vocabulary Development: Specific Effects of Sensitivity and Stimulation through Infancy.

Growing recognition of disparities in early childhood language environments prompt examination of parent-child interactions which support vocabulary. Research links parental sensitivity and cognitive stimulation to child language, but has not explicitly contrasted their effects, nor examined how effects may change over time. We examined maternal sensitivity and stimulation throughout infancy using two observational methods - ratings of parents' interaction qualities, and coding of discrete parenting behaviors - to assess the relative importance of these qualities to child vocabulary over time, and determine whether mothers make related changes in response to children's development. Participants were 146 infants and mothers, assessed when infants were 14, 24, and 36 months. At 14 months, sensitivity had a stronger effect on vocabulary than did stimulation, but the effect of stimulation grew throughout toddlerhood. Mothers' cognitive stimulation grew over time, whereas sensitivity remained stable. While discrete parenting behaviors changed with child age, there was no evidence of trade-offs between sensitive and stimulating behaviors, and no evidence that sensitivity moderated the effect of stimulation on child vocabulary. Findings demonstrate specificity of timing in the link between parenting qualities and child vocabulary which could inform early parent interventions, and supports a reconceptualization of the nature and measurement of parental sensitivity.

It's not as simple as it sounds: Problems and solutions in accessing and using administrative child welfare data for evaluating the impact of early childhood interventions.

In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children's involvement with the child welfare system from birth through age eleven. We provide "lessons learned" for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research.

The effect of Early Head Start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes.

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse.

Use Your Words: The Role of Language in the Development of Toddlers' Self-Regulation.

Self-regulation emerges throughout early childhood, and predicts later success in socially and cognitively challenging situations. Vygotsky proposed that symbols, particularly words, serve as mental tools to be used in service of self-regulation. Cross-sectional research indicates a positive but inconsistent association between language and self-regulation skills throughout toddlerhood, but research has not accounted for general cognitive development, nor gender differences in these domains. We used growth modeling of longitudinal data for 120 toddlers collected when children were 14, 24, and 36 months to test the impact of two expressive language skills - spoken vocabulary and talkativeness - on the growth of toddlers' self-regulation, and to determine whether associations between these domains exist when controlling for cognitive development. Results reveal gender differences in self-regulation trajectories, and in the impact of language on self-regulation. Vocabulary is a better predictor of self-regulation than talkativeness, and both concurrent and prior vocabulary positively predicted children's levels of self-regulation. When cognitive development was controlled, 24-month vocabulary still predicted the trajectory of self-regulation. Results reveal that, even in early development, words are tools that can be applied to the task of self-regulation, and may be a more necessary tool for boys than for girls at this age.

Developmental pathways to integrated social skills: the roles of parenting and early intervention.

Dynamic skill theory was utilized to explain the multiple mechanisms and mediating processes influencing development of self-regulatory and language skills in children at 14, 24, and 36 months of age. Relations were found between family risks, parenting-related stresses, and parent-child interactions that contribute either independently or through mediation to the child's acquisition of self-regulatory skills even when accounting for the influence of language development. Variation in impacts between control and Early Head Start (EHS) intervention samples was compared to explore the sequence of developmental mechanisms over time. Findings indicate that EHS protects parenting, child language, and self-regulatory development from the effects of demographic risks and parenting stress, and thus supports parents to raise healthy children.

Family Connections: an approach for strengthening early care systems in facing depression and adversity.

Over a 4-year period, the authors worked in partnership with a large early care provider and a Head Start center to design and implement a systems-wide preventive program with the aim of increasing staff's capacity to deal with depression and related adversities in their encounters with families and children. The intervention consisted primarily of training sessions and mental health consultation. Staff interviews, focus groups, reports by consultants, observations by assessors, and documentation of staff use of sick time were used to assess program impact. Reports by staff showed that the intervention proved feasible to deliver and resulted in sustained parent, classroom, and teacher activities. Teachers were better able to deal with the challenges presented by parents and children. Results suggest that center-wide staff-focused training and consultation approaches deserve consideration.

Symbols Build Communication and Thought: The Role of Gestures and Words in the Development of Engagement Skills and Social-Emotional Concepts during Toddlerhood.

Social skills and symbol skills are positively associated in middle childhood, but the relation between these domains is less clear in newly verbal toddlers. Vygotsky (1934/1986) proposed that symbols are both tools for interaction and mental tools for thought. Do symbols help even very young children build skills for interacting with and conceptualizing the social world? Longitudinal data from 108 children and mothers were collected when children were 14, 24, and 36 months. Children's gestures and words during mother-child interactions were used as symbol skill indicators to predict children's abilities to engage others and the number of social-emotional concepts children portray during play. In a series of growth models, words had a stronger effect on engagement skills while early gesture use predicted later development of social-emotional concepts. Therefore, even in early development, symbols serve as both communication tools and mental tools to construct understanding of the social-emotional world.

Correlates and consequences of spanking and verbal punishment for low-income white, african american, and mexican american toddlers.

This study examined the prevalence, predictors, and outcomes of spanking and verbal punishment in 2,573 low-income White, African American, and Mexican American toddlers at ages 1, 2, and 3. Both spanking and verbal punishment varied by maternal race/ethnicity. Child fussiness at age 1 predicted spanking and verbal punishment at all 3 ages. Cross-lagged path analyses indicated that spanking (but not verbal punishment) at age 1 predicted child aggressive behavior problems at age 2 and lower Bayley mental development scores at age 3. Neither child aggressive behavior problems nor Bayley scores predicted later spanking or verbal punishment. In some instances, maternal race/ethnicity and/or emotional responsiveness moderated the effects of spanking and verbal punishment on child outcomes.

It takes time: Impacts of Early Head Start that lead to reductions in maternal depression two years later.

The Early Head Start Research and Evaluation Project, a random-assignment evaluation, found a broad pattern of positive impacts for children and families. However, there were no program impacts on depression or use of mental health services by the time children reached age 3, at the end of the Early Head Start (EHS) program. This paper presents recent findings from the follow-up study in the spring prior to the children entering kindergarten, when a positive program impact emerged for reducing maternal depression. Results show that earlier program impacts on children and parents (when children were 2 and 3 years of age) mediated, or led to, the delayed impact on maternal depression. The combination of the most promising child factors accounted for over 57% of the later impact on depression, while the most promising parent factors accounted for over 35% of the later impact on depression. Implications for EHS programs are discussed.

Cognitive and emotional differences in young maltreated children: a translational application of dynamic skill theory.

Through a translational approach, dynamic skill theory enhances the understanding of the variation in the behavioral and cognitive presentations of a high-risk population-maltreated children. Two studies illustrate the application of normative developmental constructs from a dynamic skills perspective to samples of young maltreated and nonmaltreated children. Each study examines the emotional and cognitive development of maltreated children with attention to their developing world view or negativity bias and cognitive skills. Across both studies, maltreated children demonstrate negativity bias when compared to their nonmaltreated counterparts. Cognitive complexity demonstrated by the maltreated children is dependent upon a positive or negative context. Positive problem solving is more difficult for maltreated children when compared to their nonmaltreated counterparts. Differences by maltreatment type, severity, timing of the abuse, and identity of the perpetrator are also delineated, and variation in the resulting developmental trajectories in each case is explored. This translation of dynamic skill theory, as applied to maltreated children, enhances our basic understanding of their functioning, clarifies the nature of their developmental differences, and underscores the need for early intervention.

Analyzing development of working models for disrupted attachments: the case of hidden family violence.

This article offers a developmental model of attachment theory rooted in dynamic skill theory. Dynamic skill theory is based on the assumption that people do not have integrated, fundamentally logical minds, but instead develop along naturally fractionated strands of a web. Contrary to traditional interpretations of attachment theory, dynamic skill theory proposes that individuals continue to modify their working models of attachments throughout the lifespan. In particular, working models of close relationships develop systematically through a series of skill levels such that the skills vary across strands in the web and will not automatically form a unified whole. The continual modification of working models is particularly pertinent for the consequences of hidden family violence for individuals' development. Dynamic skill theory shows how trauma can produce not developmental delay or fixation, as has been proposed previously, but instead the construction of advanced, complex working models.

Considering suffocatory abuse and Munchausen by proxy in the evaluation of children experiencing apparent life-threatening events and sudden infant death syndrome.

This study describes 138 young children admitted to the hospital over a 23 year period for recurrent apparent life threatening events (ALTEs), unexplained deaths, or with Sudden Infant Death Syndrome (SIDS)-related diagnoses. In examining the potential for suffocatory abuse in living children, we utilized characteristics in the literature that distinguish SIDS or ALTEs due to natural disease states from abuse. Findings demonstrate a co-occurrence of risk factors that raise suspicions of suffocatory abuse or Munchausen by Proxy. Of the 35 children who died, SIDS was the presumed clinical diagnosis at the time of death in 71 % of the cases. Comprehensive chart review and autopsy findings revealed a non-SIDS diagnosis in 54% and confirmed or suspicious child abuse in 37% of these deaths. Reports to Child Protective Services were made in 6% of cases. Recommendations for assessment of children including attention to risk indicators, involvement of child protection teams, mandatory autopsies, and eath scene investigations are offered.

Munchausen by proxy: presentations in special education.

Munchausen by proxy is a disorder in which a child is victimized through a form of child abuse called pediatric condition falsification (PCF). PCF has been documented for psychological and psychiatric conditions including one such form presented here in which educational disabilities are the focus of falsification. Parents meet their own self-serving needs through "impostering" as good mothers. This maternal mental disorder is called factitious disorder by proxy. This article presents a series of cases in which children have PCF that primarily consists of educational disabilities. Characteristics of the children, their mothers, and their families are outlined and outcomes for the 9 children in the sample are discussed. Guidelines for identification of children with PCF in educational settings are provided, and special guidance is offered in differential diagnosis.