"You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects.

Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.

Children's Narrative Coherence in "Achieving Best Evidence" Forensic Interviews and Courtroom Testimony.

In the United Kingdom, Section 27 of the Youth Justice and Criminal Evidence Act permits "Achieving Best Evidence" (ABE) forensic interviews to replace the evidence-in-chief in cases involving children. It is therefore imperative that forensic interviewers elicit complete, reliable, and coherent narratives from children. The goal of the current research study was to assess the coherence of forensic interviews and whether the interviewers' emotional or cognitive support was associated with increases in the coherence of these interviews. Children's narrative coherence was examined in 80 transcripts of ABE investigative interviews with 7- to-15-year-olds who disclosed sexual abuse. Narrative coherence was assessed using the Narrative Coherence Coding Scheme, including three dimensions of narrative coherence: chronology, consistency, and theme (Reese et al., 2011). Findings revealed that first elicited events were more likely to be more coherent compared to subsequently elicited events, and child engagement was positively associated with all dimensions of narrative coherence. Interviewer support was positively associated with chronology, script accounts of abuse were associated with decreased consistency and chronology (but not theme), and cognitive support was not associated with any dimension of narrative coherence.

The dynamics of two-session interviews with suspected victims of abuse who are reluctant to make allegations.

Supportive forensic interviews conducted in accordance with the National Institute of Child Health and Human Development Revised Protocol (RP) help many alleged victims describe abusive experiences. When children remain reluctant to make allegations, the RP guides interviewers to (a) focus on rapport building and nonsuggestive support in a first interview, and (b) plan a second interview to allow continued rapport building before exploring for possible abuse. We explored the dynamics of such two-session RP interviews. Of 204 children who remained reluctant in an initial interview, we focused on 104 who made allegations when re-interviewed a few days later. A structural equation model revealed that interviewer support during the first session predicted children's cooperation during the rapport-building phase of the second session, which, in turn, predicted more spontaneous allegations, which were associated with the interviewers' enhanced use of open-ended questions. Together, these factors mediated the effects of support on children's free recall of forensically important information. This highlighted the importance of emphasizing rapport with reluctant children, confirming that some children may need more time to build rapport even with supportive interviewers.

Is interviewer support associated with the reduced reluctance and enhanced informativeness of alleged child abuse victims?

Child maltreatment victims are often reluctant to report abuse when formally interviewed. Evidence-based guidelines like the National Institute of Child Health and Human Development Standard Investigative Interview Protocol do not adequately address such reluctance because they are focused on cognitive rather than socioemotional strategies. The present study was designed to determine whether the Revised National Institute of Child Health and Human Development Protocol, which emphasizes supportive interviewing more than the standard protocol does, might predict increases in the overall informativeness and reductions in the reluctance of alleged victims. A total of 254 interviews, 166 using the revised protocol and 88 using the standard protocol, were conducted with 4.06- to 13.98-year-old children (M = 9.20, SD = 2.49) who disclosed multiple incidents of physical abuse by their parents and were thus expected to be more reluctant than victims of extrafamilial abuse. We coded indices of interviewer support and question types, children's reluctance, and informativeness in each utterance during the substantive phases of the interviews. The Revised Protocol was associated with better interviewer support and questioning as well as reduced reluctance and increased informativeness on the part of the children. These findings document the value of training interviewers to attend to the socioemotional needs of suspected abuse victims during investigative interviews. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Child maltreatment identification rates in a child development center: suggestions for improved detection.

Under-identification of child maltreatment (CM) remains a significant problem. The study aim was to examine rates of CM identification in a child development center (CDC) vs. a community clinic (CC). This was a cross-sectional study, involving study (CDC) and comparison groups (CC) and using administrative data for the period 2011-2015. The study group consisted of children 0-18 years belonging to the Meuhedet Health Maintenance Organization (HMO)-Northern Region, who attended the CDC, including satellite clinics, for assessment/treatment. The CDC employed a multi-disciplinary approach to improve CM identification. The comparison group consisted of children with a disability belonging to the HMO, who attended a CC, but were not known to the CDC. Rates of CM identification, socio-demographic characteristics, and disability severity were compared. CM identification during the study period was 2.1% for the CDC vs. 0.8% for the CC. Children visiting the CDC had five times higher odds to be identified with suspected CM than children in the CC, after adjusting for age, gender, socioeconomic status, ethnicity, and disability severity. CONCLUSION: CM identification rates in children with disability were higher in a CDC vs. CC. The approach used in the CDC may significantly improve CM identification in children with disability. What is Known: • There is significant under-identification of CM. What is New: • By examining child maltreatment identification rates in a child development center vs. the community, the study found that a multi-disciplinary staff approach can significantly improve CM Identification.

Understanding autism and its treatment: The child's perspective.

INTRODUCTION: While parents' and professionals' perceptions regarding children with autism spectrum disorder (ASD) have been studied extensively, limited data regarding the perspectives of children with ASD on their needs and the challenges they face are available. The study aimed to examine how children with ASD understand their condition and the aims of the interventions they undergo. METHODS: Nineteen children and adolescents (ages 5.7-14.2 years) formally diagnosed with ASD, with borderline to high intelligence (range 70-140), and able to converse verbally were interviewed in person at a child development clinic. A qualitative approach was used to capture children's perceptions of their strengths and challenges and their understanding of a novel ASD treatment. The interview included direct and projective open-ended questions on each topic. Interpretive content analysis was used to evaluate the children's answers. Medical data were extracted from medical records. The children's parents completed questionnaires on their children's disability levels, awareness of ASD diagnosis, and sociodemographic details. FINDINGS: Children spoke of their embodied sensations and feelings and discussed "normality" vs. "disability." They varied in their awareness of their diagnosis/symptoms, and only one boy named his diagnosis and described its consequences in detail. Most children lacked an understanding of the educational and therapeutic aspects of the goals set for them. DISCUSSION AND CONCLUSIONS: Children with ASD are aware of their unique emotional and behavioral challenges. Nevertheless, they are frequently excluded from the process of patient information provision and lack an understanding of the goals of interventions. Findings suggest the need to explore developmentally and emotionally adaptive ways to involve children with ASD in discussions of their condition and possible interventions.

Nonverbal Emotions While Disclosing Child Abuse: The Role of Interviewer Support.

Statements by alleged victims are important when child abuse is prosecuted; triers-of-fact often attend to nonverbal emotional expressions when evaluating those statements. This study examined the associations among interviewer supportiveness, children's nonverbal emotions, and informativeness during 100 forensic interviews with alleged victims of child abuse. Raters coded the silent videotapes for children's nonverbal emotional expressions while other raters coded the transcripts for interviewer support, children's verbal emotions, and informativeness. Results showed that children's nonverbal signals were more common than and preceded the verbal signs. Interviewer support was associated with children's expressivity. When children expressed more nonverbal emotions, they were more responsive during the pre-substantive phases and more informative about the abuse. Nonverbal emotions partially mediated the association between support and informativeness. The findings underline the value of nonverbal emotional expression during forensic interviews and demonstrate how the interviewers' supportive demeanor can facilitate children's emotional displays and increase informativeness.

Family Quality of Life in Children with Severe or Profound Disability: Home Versus Residential Care.

BACKGROUND: Most children with severe and profound intellectual disability (SPID) are cared for in their homes, according to current recommendations. Yet, their families face marked emotional, health, and economic challenges. AIMS: The aim of this study was to examine family quality of life (FQOL) along with psychological and health factors among families who raise children with SPID at home versus those residing in residential care. METHODS: Sixty caregivers of children aged 2 to 18 years (M = 8.81, SD = 4.62) with SPID (developmental quotient/intellectual quotient <35), living at home (38 caregivers-"home group") or in residential care (22 caregivers-"residential group"), completed the FQOL Survey, Beck Depression Inventory, Parental Stress Index, Shame and Guilt Scale, and Health and Demographic questionnaires. RESULTS: FQOL for most domains and dimensions was rated better among families whose child resides in residential care compared with families who raise their child at home. Similarly, parental stress relating to the child was worse among families who raise their children at home. No significant differences between the 2 groups were noted on other psychological or health measures. CONCLUSION: Family and individual needs for those raising a child with SPID at home should be addressed when planning policy and interventions.

Emotional valence and the types of information provided by children in forensic interviews.

BACKGROUND: Emotions can powerfully affect memory retrieval although this effect has seldom been studied in everyday contexts. OBJECTIVE: This study aimed to explore the association between children's verbal emotional expressions and the type of information reported during forensic interviews. PARTICIPANTS AND SETTING: The sample included 198 interviews with 4- to 14-year-old (M = 9.36, SD = 2.37) alleged victims of repeated physical abuse perpetrated by family members conducted using the Revised NICHD Protocol which emphasizes a supportive interviewing style. METHODS: Interview videos were transcribed and each conversational turn was coded to reflect the amount and type of children's verbal emotional expressions, forensic information provided, interviewers' demeanor, and type of question asked. RESULTS: The verbal expression of negative emotions was positively associated with the production of more central details (ß = 0.29, SE = 0.05, p < 0.001) and peripheral details (ß = 0.66, SE = 0.07, p < 0.001), while the verbal expression of positive emotions was correlated with peripheral details (ß = 0.29, SE = 0.15, p = 0.047). The verbal expression of negative emotions was associated with the production of more specific details (ß = 0.73, SE = 0.06, p < 0.001]) and less generic information (ß = -0.39, SE = 0.18, p = 0.029) whereas positive emotions were associated only with increased specific information (ß = 0.28, SE = 0.12, p = 0.025). CONCLUSIONS: These findings highlight how emotional expression, especially of negative emotions, enhances the quantity and quality of children's reports in forensic contexts.

Transcranial Direct Current Stimulation (tDCS) in children with ADHD: A randomized, sham-controlled pilot study.

BACKGROUND: ADHD is a common neurodevelopmental disorder with a pediatric prevalence of 5.2%.While medication treatment for ADHD is effective, it does not address all symptoms and a small but notable subgroup does not respond to medications. Adverse effects limit its use and some parents and participants resist use of medication. Thus, limitations of medication treatment for ADHD motivate searching for other therapeutic options. Transcranial Direct Current Stimulation (tDCS) has been suggested as a treatment for children with ADHD, with mixed results to date. Protocol variables employed, including combined use of cognitive training (CT) and scheduling of sessions, may explain diverse findings to date. The aim of this study was to examine safety, feasibility and efficacy of tDCS combined with CT provided three-times-per week for one-month to treat children with ADHD. METHODS: In a double blind, randomized, sham-controlled pilot study, 25 children with ADHD were randomized to receive 12 sessions of either anodal tDCS or sham-tDCS for 20 min combined with CT three-times-per-week for four weeks. The tDCS anode was over left dorsolateral prefrontal cortex (DLPFC) and cathode over vertex. Assessments were obtained prior to, after 6 sessions, 12 sessions and one-month after intervention. RESULTS: No significant post-intervention differences were found between those receiving tDCS or sham-tDCS. Both groups demonstrated significant improvement on questionnaire measures of ADHD and executive function with mixed results seen on computerized performance measures. Overall, adverse effects were mild with no significant difference between groups. However, three children, all from the tDCS group, experienced headaches with two requiring temporary cessation and one requiring removal from the study. CONCLUSIONS: Anodal tDCS to the DLPFC using the above protocol in children with ADHD did not demonstrate additional treatment benefits beyond that of CT.

Increased risk for child maltreatment in those with developmental disability: A primary health care perspective from Israel.

BACKGROUND: Child Maltreatment (CM) is a worldwide phenomenon. Literature suggests that children with disabilities are at increased risk for CM. However, limited information exists regarding if such increased risk is noted in community primary care clinics. AIM: To report on the incidence of CM in children with and without disabilities attending community primary care clinics. METHOD: This was a cohort study of children belonging to a Health Maintenance Organization (HMO) in Israel. The study group consisted of children with disabilities and the control group consisted of children without disabilities. Formal reports to child protection services, medical and sociodemographic data were extracted from designated documentation and medical records. RESULTS: The odds to be identified as suspected CM, after adjusting for sociodemographic variables, was 6.2 times higher among children with disabilities compared to children without disabilities and 5.0 times higher among children with severe vs. mild disability. CONCLUSIONS: Developmental disability is a risk factor for CM, and is noted even more seriously in community primary care clinics. CM positively correlated with the severity of disability. The presented data marks higher figures than previously reported, enhancing understanding of the scope of the problem and its relation to the type of organization being examined.

Facilitating the Expression of Emotions by Alleged Victims of Child Abuse During Investigative Interviews Using the Revised NICHD Protocol.

Children's testimony is often critical to the initiation of legal proceedings in abuse cases. In forensic interviews, the expression of emotions can powerfully enhance both the quality of children's statements and perceptions that their statements are coherent and credible. However, children rarely express their emotions when reporting abusive events. The Revised The National Institute of Child Health and Human Development (NICHD) Protocol (RP) was designed to emphasize socioemotional communication during forensic interviews and thus should be associated with more extensive and diverse expressions of emotions by alleged victims of abuse. The present study focused on forensic interviews (178 using the Revised and 100 using the Standard NICHD Protocol) with victims of physical child abuse whose allegations were corroborated using independent evidence. Detailed content coding showed that the RP was associated with the expression of more different emotions, more expression of abuse-related emotions, and more expression of emotions related to the interview context. Emotional expressiveness was associated with increased informativeness, and the association between the type of protocol and informativeness was fully mediated by emotional expressiveness. These results suggest that the Revised Protocol facilitates the expression of emotions by alleged victims of abuse in a way that enhances the value of children's testimony in multiple ways.

Family quality of life among families with a child who has a severe neurodevelopmental disability: Impact of family and child socio-demographic factors.

We aimed to examine family quality of life (FQOL) of Northern Israeli families having a child with a severe neurodevelopmental disability and its relation to socio-demographics. The cohort included caregivers of 70 children ages (mean ± standard deviation) 5.36 ± 3.53 years. Families were two-parent (85.7%), lived in the periphery (67.1%) and included Jews (60%), Muslims (18.6%), Druze (14.3%) and Christians (7.1%). Religiosity included: secular (38.6%), traditional (31.4%), religious (30%). Children's diagnosis included autistic spectrum disorder (41.4%), intellectual disability (21.4%), cerebral palsy (17.1%), genetic syndromes (17.1%) and sensorineural hearing loss (2.9%). Degree of support (1-minimal,5-greatest) required by the child was 3.67 ± 1.28 for physical and 3.49 ± 1.36 for communication. Primary caregivers completed the FQOL Survey. Domain scores were highest for family relations and lowest for financial well-being. Dimension scores were highest for importance and lowest for opportunities. Overall FQOL approximated average. Jewish families and residents of a major urban area reported higher and more religious families reported lower overall FQOL. Regression analysis found ethnicity contributing to overall FQOL and domain scores with residence contributing to support from services. Ethnicity and child dependence contributed to dimension scores. Northern Israeli families having a child with a severe neurodevelopmental disability report average FQOL scores. However, family and child dependence characteristics affect FQOL scores. Professionals working with these families should consider FQOL information when making recommendations.