Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury.

BACKGROUND: Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. PRIMARY OBJECTIVE: To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. REVIEW OF INFORMATION: Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. OUTCOMES: This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.

Employing a serious game intervention to promote adolescent school children's perceptions of nursing and midwifery professions.

AIM: To test a serious game intervention about nursing and midwifery perceptions among adolescent school children. BACKGROUND: Nursing and midwifery professions face challenges in recruitment, with persistent gender stereotypes and a lack of clarity regarding the roles contributing to this issue. This study addresses the need for innovative approaches to reshape perceptions and encourage career exploration in adolescent school children. DESIGN: Employing a pre/post-test design, this study involved 137 post-primary students aged sixteen or seventeen in the United Kingdom. METHODS: Data collection occurred between November 2022 to April 2023, involving three post-primary schools. Participants engaged with a digital serious game designed to address misconceptions and promote a more accurate understanding of nursing and midwifery. Participants completed pre- and post-intervention questionnaires, including an adapted version of the Nursing as a Career Choice Questionnaire. Statistical analyses included descriptive statistics, paired t-tests, and independent groups t-tests. RESULTS: The serious game intervention resulted in statistically significant improvements in students' perceptions across multiple domains. Overall, participants showed higher mean post-test scores (M = 139.57, SD = 15.10) compared to their mean pre-test score (M = 131.06, SD = 14.73) on the questionnaire. The domains of self-efficacy (p < .001), job prospects (p < .001) and social influences (p < .001) exhibited the most substantial positive changes. Female participants showed higher perceptions than males in pre- and post-tests and students from all-girls schools consistently scored higher than those from all-boys and mixed-gender schools. CONCLUSIONS: A serious game about the nursing and midwifery professions appears to be capable of changing perceptions of self-efficacy and job prospects related to nursing and midwifery professions. The study suggests that a serious game intervention may have the potential to change adolescent perceptions of nursing and midwifery professions which may lead to their considering of these when making future career choices.

Recruiting males to the nursing profession: acceptability testing of the 'Make a Difference with Nursing' intervention for post-primary school students.

BACKGROUND: The nursing profession is facing a worldwide recruitment shortage which could be partially addressed by recruiting more males. However, in many developed countries numbers of male nurses have traditionally been low. To address this issue we developed and tested a post-primary school-based intervention to recruit more males into the nursing profession. METHODS: Participants included thirty-four  female students drawn from an all-girls post-primary school, fifty-one males from an all-boys post-primary school and seven males and fifteen females drawn from a mixed gender post-primary school, all located in Northern Ireland. Participants were all sixteen years of age and were in receipt of careers education. The intervention titled 'Make a Difference with Nursing' was co-designed with careers teachers, nurses and post-primary school students. This video based intervention was created to fit within existing career lessons and featured nursing staff and students describing their experiences of the profession. Participants completed the six domains of Nursing as a Career Choice Questionnaire prior to viewing the intervention and again after viewing. RESULTS: Positive and statistically significant increases in perceptions of the nursing profession were found between pre and post test scores across all six domains. No statistically significant differences in perceptions were found between males and females after watching the intervention. Comparison by school type showed statistically significant differences on the domains of prior healthcare exposure (p = 0.046; 95% CI -0.19 to 3.79) and job prospects (p = 0.005; 95% CI 1.04 to 7.01). Students from the all-girls school rated these more positively than those from the all-boys and mixed-gender schools. CONCLUSIONS: A short video presentation to post-primary school students is capable of changing how they perceive the nursing profession. Students expressed surprise over the variety of professional nursing roles suggesting that many were not well informed about the realities of nursing. Providing tailored resources for use in careers lessons can better educate students and teachers about nursing and provide positive portrayals of male role models in the profession.

Challenges of Conducting Research With Young Offenders With Traumatic Brain Injury.

The purpose of this commentary is to highlight the challenges encountered when conducting research with young offenders. This is drawn from the first-hand experience of 3 researchers working on separate projects within this environment. Young offenders present as a complex clinical population with high levels of illiteracy, substance abuse, and mental health issues. Significant planning is therefore required before working with this group. Consideration must be given to the heterogeneity of prison populations alongside the potential limitations of datacollection methods, in particular, reliance on self-report. The capacity of young offenders to comprehend and effectively engage with research is also of concern, posing issues of both a practical and ethical nature. The absence of a consistent "research culture" within prison environments poses further practical challenges, potentially also placing significant burden on both researchers and prison resources. The challenges discussed in this article may help inform future studies in the area and emphasize the need for greater critical reflection among researchers conducting work of this type.

Traumatic brain injury and abuse among female offenders compared to non-incarcerated controls.

OBJECTIVE: To examine the prevalence of traumatic brain injury (TBI) and past abuse experienced by adult female offenders. METHODS: Twenty-nine female offenders from a UK women's prison and twenty-nine age and gender matched university controls were recruited. In addition to demographic data, the Brain Injury Screening Index was utilized alongside the Childhood Trauma Questionnaire and the Abusive Behaviour Inventory. RESULTS: Approximately 79% (n = 21) of female offenders reported a history of TBI, with 38% (n = 8) reporting six or more injuries. However, only 28.5% of female offenders reporting injury (n = 6) believed they had sustained a brain injury. Prevalence of both childhood (n = 15, 51.7%), and partner (n = 19, 65.5%) abuse was also high among offenders. TBI Index scores correlated with past childhood and past partner physical abuse. Past mental illness, partner physical abuse, and number of convictions were predictive of greater TBI severity. CONCLUSION: This is the first European study to examine combined TBI and abuse among an exclusively female offender population. It suggests that TBI is as prevalent among incarcerated females as it is among males. The unique presentation of female offenders must be acknowledged if effective rehabilitation programs are to be implemented.

Traumatic brain injury and co-occurring problems in prison populations: A systematic review.

BACKGROUND: A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population. METHODS: Six electronic databases were systematically searched for articles published between 1980-2014. Studies were screened for inclusion based on pre-determined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool. RESULTS: Twenty-six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good), with an overall average of 60%. Twenty-four papers included TBI prevalence rates, which ranged from 5.69-88%. Seventeen studies explored co-occurring factors including rates of aggression (n = 7), substance abuse (n = 9), anxiety and depression (n = 5), neurocognitive deficits (n = 4) and psychiatric conditions (n = 3). CONCLUSIONS: The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured, with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI and qualitative outcomes were found.

Experiences of children and young people with attention deficit hyperactivity disorder (ADHD) during COVID-19 pandemic and lockdown restrictions.

PURPOSE: To explore the experiences of children and young people (CYP) with attention deficit hyperactivity disorder during the COVID-19 pandemic and lock down restrictions. METHODS: Semi-structured, online interviews were conducted with 17 children and young people from the UK, Northern Ireland, aged 10-14 years with ADHD. Over half the participants had a co-existing diagnosis, such as autism spectrum disorder. Interviews were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS: Four themes were identified; the emotional impact of the pandemic, adjustments to daily living, impact of remote learning and the effect on relationships. Many CYP citied feelings of sadness, loneliness and anxiety, others found the reduction in social demands favourable. CONCLUSIONS: As one of few studies to capture the experiences of children and young people with ADHD during the COVID-19 pandemic, this research highlights the potential negative long-term impact on emotional welfare, schooling and relationships.Implications for rehabilitationHealth care professionals should be aware of the overall impact on health and well-being for children and young people with ADHD following the COVID-19 pandemic and lockdown restrictions to ensure that the effect of these are minimised and managed in the future.Educators and clinicians should be cognisant of the long term consequences of poor mental health during the COVID-19 pandemic and should put in place pro-active strategies to support children and young people with ADHD.Children and young people with ADHD may suffer greatly from reduced access to sports and leisure facilities. Policy makers should be conscious of the potential negative consequences of placing limitations on access to such facilities.

Randomised controlled feasibility study protocol of the Carers-ID online intervention to support the mental health of family carers of people with intellectual disabilities.

BACKGROUND: Family carers play a crucial role in supporting the health and well-being of people with intellectual disabilities. Given their role and responsibilities, many family carers experience significant and ongoing stress and mental health difficulties. Programmes and interventions which provide training and support to family carers have been shown to have a positive impact on levels of stress and quality of life. However, these are often face to face which can create barriers to full participation. Online interventions have been shown to offer flexibility in delivery compared with traditional face-to-face approaches. The primary objective of this study is to determine the feasibility of delivering the Carers-ID online intervention, while the secondary outcome is improved mental health in family carers of people with intellectual disabilities. METHODS: Family carers (n = 120) will be randomised to receive the intervention (n = 60) or assigned to a wait-list control (n = 60) group. The intervention ( www.Carers-ID.com ) consists of 14 modules which cover topics including the following: promoting resilience, providing peer support, reducing anxiety, managing stress, accessing local supports and managing family conflict and information for siblings who are carers. The intervention has been co-produced with voluntary sector organisations and family carers and tested for acceptability. Primary outcomes for this study include acceptability and feasibility of the outcome measures, recruitment, participation and retention rates and effect sizes. Secondary outcomes will be completed at three time points (baseline, following intervention completion and 3 months after completion). These include the following: the Depression, Anxiety and Stress Scale, the Warwick-Edinburgh Mental Well-being Scale, the Resilience Scale and the Social Connectedness Scale Revised. Participants (n = 12) who have taken part in the intervention arm of the research will be invited to participate in semi-structured interviews as part of the process evaluation. DISCUSSION: The Carers-ID intervention provides an online resource for family carers to support their mental health and well-being and promote their resilience. It represents an affordable and accessible means of delivering such support. Testing the feasibility of the intervention and related trial procedures is required to determine whether a full-scale randomised controlled trial to evaluate the intervention's effectiveness is warranted. TRIAL REGISTRATION: ClinicalTrials.gov : NCT05737823.

'It's like a problem that doesn't exist': the emotional well-being of mothers caring for a child with brain injury.

BACKGROUND: Although research has shown that significant burden and adverse psychological impact are associated with caring for a child with brain injury, limited knowledge exists concerning the qualitative experience and impact of this burden. OBJECTIVE: To provide an account of the experiences of mothers who care for a childhood survivor of brain injury. RESEARCH DESIGN: Postal survey. METHODS AND PROCEDURES: A self-report questionnaire was sent to a consecutive sample of mothers (n = 86) of children (aged 2-28) with acquired brain injury, registered with a UK children's brain injury charity. Five essay style questions enabled mothers to reflect on and describe at length their caring experiences, with particular emphasis placed on the perceived impact on emotional well-being. MAIN OUTCOMES AND RESULTS: Thematic analysis identified five key themes: Perpetually Anxious, The Guilty Carer, The Labour of Caring, A Self-Conscious Apologist and Perpetually Grieving. Collectively, these themes highlight two core processes shaping mothers' caring experiences and concomitant mental well-being. First, the collective and enduring nature of caregiver burden over time. Second, the crucial role played by socio-cultural values in perpetuating caregiver burden. CONCLUSIONS: Societal norms, particularly those relating to the nature and outcome of brain injury and motherhood, serve to marginalize mothers and increase feelings of isolation. Findings suggest the value of peer support programmes as an effective means of providing appropriate social support.

Educational professionals' understanding of childhood traumatic brain injury.

PRIMARY OBJECTIVES: To determine the understanding of educational professionals around the topic of childhood brain injury and explore the factor structure of the Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI). RESEARCH DESIGN: Cross-sectional postal survey. METHODS AND PROCEDURES: The CM-TBI was posted to all educational establishments in one region of the UK. One representative from each school was asked to complete and return the questionnaire (n = 388). MAIN OUTCOMES AND RESULTS: Differences were demonstrated between those participants who knew someone with a brain injury and those who did not, with a similar pattern being shown for those educators who had taught a child with brain injury. Participants who had taught a child with brain injury demonstrated greater knowledge in areas such as seatbelts/prevention, brain damage, brain injury sequelae, amnesia, recovery and rehabilitation. Principal components analysis suggested the existence of four factors and the discarding of half the original items of the questionnaire. CONCLUSIONS: In the first European study to explore this issue, it is highlighted that teachers are ill-prepared to cope with children who have sustained a brain injury. Given the importance of a supportive school environment in return to life following hospitalization, the lack of understanding demonstrated by teachers in this research may significantly impact on a successful return to school.

Social workers and acquired brain injury: A systematic review of the current evidence-base.

Social work plays an important role in the assessment and treatment of people with acquired brain injury. Acquired brain injury is a complex and highly prevalent condition which can impact on cognitive, emotional and social domains. As acquired brain injury is a hidden disability it can be misdiagnosed or classified as another condition entirely. We sought to systematically explore the evidence base to examine how social workers have been prepared to work with their clients with brain injury. Employing six electronic databases (Social Policy & Practice, Web of Science, Scopus, PubMed, PsycINFO, CINAHL Plus) we reviewed 1071 papers. After applying eligibility criteria 17 papers were included in this review. We utilised standardised data extraction and quality appraisal tools to assess all included papers. Following appraisal, 9 papers were judged as possessing high methodological quality whilst 8 were judged as medium. Employing narrative synthesis, we identified four themes which captured the key findings of these papers. Themes were named as (i) advocacy and social work (ii) training and multidisciplinary team working (iii) inclusion of social networks and (iv) societal barriers. In order to meet their statutory responsibilities to practice safely, social workers must receive training in how to identify ABI and develop understanding of its consequences and subsequent need for provision. Social workers are also in a unique position to advocate for their clients and should make every effort to ensure their needs are met.

The causal attributions of nursing students toward adolescent survivors of brain injury.

BACKGROUND: The hidden nature of brain injury means that it is often difficult for people to understand the sometimes challenging behaviors that individuals exhibit. The misattribution of these behaviors may lead to a lack of consideration and public censure if the individual is seen as simply misbehaving. OBJECTIVE: The aim of this study was to explore the impact of visual cues indicating the presence or absence of brain injury on prejudice, desire for social interaction, and causal attributions of nursing and computing science students. METHOD: An independent-groups design was employed in this research, which recruited 190 first-year nursing students and 194 first-year computing science students from a major university in Belfast, UK. A short passage describing an adolescent's behavior after a brain injury, together with one of three images portraying a young adolescent with a scar, a head dressing, or neither of these, was given to participants. They were then asked to answer questions relating to prejudice, social interaction, locus of control, and causal attributions. The attributional statements suggested that the character's behavior could be the result of brain injury or adolescence. RESULTS: Analysis of variance demonstrated a statistically significant difference between the student groups, where nursing students (M = 45.17, SD = 4.69) desired more social interaction with the fictional adolescent than their computer science peers (M = 38.64, SD = 7.69). Further, analysis of variance showed a main effect of image on the attributional statement that described adolescence as a suitable explanation for the character's lack of self-confidence. DISCUSSION: Attributions of brain injury were influenced by the presence of a visible but potentially specious indicator of injury. This suggests that survivors of brain injury who do not display any outward indicator may receive less care and face expectations to behave in a manner consistent with the norms of society. If their injury does not allow them to meet with these expectations, they may face public censure and discrimination.

Traumatic brain injury and social competence among young male offenders.

Purpose: To investigate the prevalence of traumatic brain injury (TBI) among young incarcerated males and determine the extent of deficits in behavioural regulation, aggression, hopelessness, and perceived social support, compared to a control group of non-incarcerated males.Methods: Sixty-two young offenders and 58 university-based, gender-matched controls agreed to take part. We collected information on criminal history, risk taking behaviour, drug and alcohol abuse, and mental illness. In addition, we employed measures of brain injury, hopelessness, behavioural regulation, aggression, and perceived social support.Results: Just over 87% (n = 54) of offenders exhibited some level of TBI with over 31% (n = 17) reporting six or more injuries. Offenders with TBI exhibited poorer behavioural control (p < 0.001; M = 66.01 vs. M = 51.33; 95% CI -19.08 to -11.76), higher levels of aggression (p < 0.001; M = 101.19 vs. M = 69.39; 95% CI -38.31 to -27.17), and higher levels of hopelessness (p < 0.001; M = 5.65 vs. M = 2.55) when compared to controls with TBI. Severity of TBI correlated positively with behavioural regulation, aggression, and hopelessness.Conclusions: Greater recognition of the presence and consequences of TBI within the custodial estate is necessary if the needs of young offenders are to be adequately met. Young offenders with TBI experience heightened vulnerability and need rehabilitative input to support their time in prison and on their return to society.Implications for rehabilitationThe presence of TBI is under reported within offending populations, with many young offenders lacking awareness of their injury or its implications on their health and behaviour.Healthcare staff within the custodial estate should be trained to screen and assess cognitive, behavioural and emotional deficits which have arisen following TBI.Greater recognition of TBI within the custodial estate could improve the targeting of deficits and lead to rehabilitation programmes which address behavioural regulation difficulties.Rehabilitation of TBI deficits within, and on release from prison, has the potential to help reduce recidivism, leading to reduced costs for the criminal justice system and improved quality of life for young men.

Muscle-specific variations in use-dependent crossed-facilitation of corticospinal pathways mediated by transcranial direct current (DC) stimulation.

The tendency for contractions of muscles in the upper limb to give rise to increases in the excitability of corticospinal projections to the homologous muscles of the opposite limb is well known. Although the suppression of this tendency is integral to tasks of daily living, its exploitation may prove to be critical in the rehabilitation of acquired hemiplegias. Transcranial direct current (DC) stimulation induces changes in cortical excitability that outlast the period of application. We present evidence that changes in the reactivity of the corticospinal pathway induced by DC stimulation of the motor cortex interact systematically with those brought about by contraction of the muscles of the ipsilateral limb. During the application of flexion torques (up to 50% of maximum) applied at the left wrist, motor evoked potentials (MEPs) were evoked in the quiescent muscles of the right arm by magnetic stimulation of the left motor cortex (M1). The MEPs were obtained prior to and following 10 min of anodal, cathodal or sham DC stimulation of left M1. Cathodal stimulation counteracted increases in the crossed-facilitation of projections to the (right) wrist flexors that otherwise occurred as a result of repeated flexion contractions at the left wrist. In addition, cathodal stimulation markedly decreased the excitability of corticospinal projections to the wrist extensors of the right limb. Thus changes in corticospinal excitability induced by DC stimulation can be shaped (i.e. differentiated by muscle group) by focal contractions of muscles in the limb ipsilateral to the site of stimulation.

Misconceptions about traumatic brain injury among probation services.

PURPOSE: The prevalence of traumatic brain injury (TBI) among offender populations is significantly higher than among the general population. Despite this, no study has yet assessed the knowledge of members of the probation service surrounding TBI. METHOD: Knowledge was assessed among members of the Probation Board for Northern Ireland (PBNI) using a cross-sectional online version of the Common Misconceptions about TBI (CM-TBI) questionnaire. Mean total misconception scores, along with scores on four subdomains (recovery, sequelae, insight, and hidden injury) were calculated. Analysis of variance was used to explore differences in misconceptions based on the collected demographic information. RESULTS: The overall mean percentage of misconceptions for the group was 22.37%. The subdomain with the highest rate of misconceptions (38.21%) was insight into injury which covered misconceptions around offenders' self-awareness of injuries. Those who knew someone with a brain injury scored significantly higher in the CM-TBI total score, F(1,63) = 6.639, p = 0.012, the recovery subdomain, F(1,63) = 10.080, p = 0.002, and the insight subdomain, F(1,63) = 5.834, p = 0.019. Additionally, significant training deficits around TBI were observed among the probation service. CONCLUSIONS: This study is the first of its kind to examine the level of understanding around TBI within probation services. The findings reflect potential barriers to identification and rehabilitation of TBI for offenders coming into contact with the criminal justice system. A lack of identification coupled with misconceptions about TBI could lead to inaccurate court reporting with a subsequent impact on sentencing. Implications for Rehabilitation Despite being one of the first points of contact for offenders entering the criminal justice system, members of the probation service reported having no formal training on traumatic brain injury (TBI). The subdomain with the highest rate of misconceptions (insight into injury) revealed an over-reliance on survivors of brain injury to identify, understand, and communicate the extent and severity of their injuries. Probation service personnel require training on TBI to improve awareness of the potential outcomes of the condition, ensuring injuries are identified and referred to the appropriate care pathways.

A systematic review and meta-analysis of educational interventions for children and adolescents with acquired brain injury.

BACKGROUND: Children with brain injuries face significant challenges in their recovery. One of the greatest is transitioning from hospital/home to school where they face issues such as reintegration, lack of understanding and catching up with missed work. Many children struggle with their altered circumstances and require additional supports to meet the academic demands of systems which are ill equipped to teach them. OBJECTIVE: To summarise the best available evidence for the use of educational interventions to improve academic attainment in childhood survivors of acquired brain injury (ABI). METHODS: Six electronic databases (Cinahl, Embase, Medline, PsycINFO, Pubmed, & Web of Science) were systematically searched for randomised controlled trials published between 1980 and 2017. Two authors independently reviewed these studies and extracted data on type of intervention, characteristics of participants, outcome measures, findings and recommendations. The Cochrane Collaboration's Risk of Bias tool was used to assess systematic error in the included studies. RESULTS: Four studies met the inclusion criteria (n = 296 children and adolescents). Three studies (n = 287) were included in meta-analysis for the primary outcome which showed no statistically significant difference between the intervention and control conditions on academic attainment (SMD 1.31, 95% CI -0.06 to 2.68, p = 0.06). No statistically significant differences were found which favoured the intervention for the secondary outcomes of attention, internalising or externalising behavior. All effect sizes were considered as small. CONCLUSIONS: This review suggests that no currently effective educational interventions exist for children with ABI. Greater efforts are required to produce effective and rigorously tested interventions to improve outcomes for these children.

An international perspective on educators' perceptions of children with Traumatic Brain Injury.

BACKGROUND: Educators lack understanding of traumatic brain injury (TBI), which can lead to a lack of appropriate assessment and intervention methods for these students. OBJECTIVE(S): This qualitative study explored what experienced teachers perceive, believe, and know about pediatric TBI. METHODS: Following development of a standardized interview protocol, 46 teachers from Australia, New Zealand, Northern Ireland, and the United States took part in semi-structured interviews. Topics included understanding of the effects of TBI on school performance, supporting a child with TBI in the classroom, and challenges and teaching efficacy in working with students with TBI. RESULTS: The themes we identified were: personal experience with TBI, lack of content knowledge, non-TBI-specific adaptations, collaboration with experts, need for specific training, confidence in working with students with TBI, and knowledge of students' rights to service provision. Our findings show that although teachers had little knowledge of TBI, many felt they would be able to adequately support a child with appropriate input from specialists. CONCLUSION: Teachers fill their knowledge gaps about TBI with their own personal experiences and prior information about working with students with disabilities. These findings support important implications for changes in how we educate and support teachers.

Reduced community integration in persons following traumatic brain injury, as measured on the Community Integration Measure: an exploratory analysis.

PURPOSE: To explore the community integration of individuals who had suffered a Traumatic Brain Injury (TBI) and compare this to members of the general public. METHOD: An independent groups design explored differences in three groups' levels of community integration. These groups consisted of ten survivors of TBI, ten male and ten female controls and were measured using The Community Integration Measure (CIM). All participants were resident in Northern Ireland (NI). The brain injured participants were drawn from a Belfast-based social skills programme. RESULTS: Mann-Whitney U tests showed a statistically significant difference between female controls and brain-injured individuals (U = 26.50, N(1) = 10, N(2) = 10, p = 0.037, one-tailed). CONCLUSION: Females were more integrated into their communities than males, who were, in turn, more integrated than brain injured individuals. It would appear that brain injury survivors are doubly disadvantaged. Their gender (mainly male), and the injury itself, conspire to reduce their integration within the wider community.

Stress in parents of children born very preterm is predicted by child externalising behaviour and parent coping at age 7†years.

OBJECTIVE: To examine factors which predict parenting stress in a longitudinal cohort of children born very preterm, and seen at age 7 years. METHODS: We recruited 100 very preterm (≤32 weeks gestational age) child-parent dyads and a control group of 50 term-born dyads born between 2001 and 2004 with follow-up at 7 years. Parents completed the Parenting Stress Index, Ways of Coping Questionnaire, Child Behavior Check List, Beck Depression Inventory and the State Trait Anxiety Inventory questionnaires. Child IQ was assessed using the Wechsler Intelligence Scale-IV. RESULTS: After controlling for maternal education, parents of preterm children (95% CI 111.1 to 121.4) scored higher (p=0.027) on the Parenting Stress Index than term-born controls (95% CI 97.8 to 113.2). Regression analyses showed that child externalising behaviour, sex and parent escape/avoidance coping style, predicted higher parenting stress in the preterm group. Parents of preterm girls expressed higher levels of stress than those of boys. CONCLUSIONS: Maladaptive coping strategies contribute to greater stress in parents of very preterm children. Our findings suggest that these parents need support for many years after birth of a very preterm infant.

Executive functioning deficits in young adult survivors of bronchopulmonary dysplasia.

PURPOSE: To assess long-term impairments of executive functioning in adult survivors of bronchopulmonary dysplasia (BPD). METHOD: Participants were assessed on measures of executive functioning, health-related quality of life (HRQoL) and social functioning. Survivors of BPD (n = 63; 34 males; mean age 24.2 years) were compared with groups comprising preterm (without BPD) (<1500 g; n = 45) and full-term controls (n = 63). Analysis of variance was used to explore differences among groups for outcome measures. Multiple regression analyzes were performed to identify factors predictive of long-term outcomes. RESULTS: Significantly more BPD adults, compared with preterm and term controls, showed deficits in executive functioning relating to problem solving (OR: 5.1, CI: 1.4-19.3), awareness of behavior (OR: 12.7, CI: 1.5-106.4) and organization of their environment (OR: 13.0, CI: 1.6-107.1). Birth weight, HRQoL and social functioning were predictive of deficits in executive functioning. CONCLUSIONS: This study represents the largest sample of survivors into adulthood of BPD and is the first to show that deficits in executive functioning persist. Children with BPD should be assessed to identify cognitive impairments and allow early intervention aimed at ameliorating their effects. Implications for Rehabilitation Adults born preterm with very-low birth weight, and particularly those who develop BPD, are at increased risk of exhibiting defects in executive functioning. Clinicians and educators should be made aware of the impact that BPD can have on the long-term development of executive functions. Children and young adults identified as having BPD should be periodically monitored to identify the need for possible intervention.