Sleep clinics with health visitors: a 2-year evaluation.

This study was undertaken to evaluate a service for sleep clinics over a time span of 2 years. The service was operated jointly by health visitors and clinical psychologists and based on a previous model run by the same team of psychologists and child development advisors. The outcome was not supportive of this type of service in terms of referral rates over a period of time, improvement rate, continued existence or cost-effectiveness of such a service. The reasons for the difficulties of such clinics are discussed.

Perinatal information on infant crying.

Research and postnatal service developments have begun to draw attention to the frequency with which mothers encounter difficulties in the management of infant crying. Such difficulties may have unfavourable long-term consequences for the mother-infant relationship. This study investigated the effect of providing first-time mothers with information and advice specific to cry management, during the in-stay period. A sample of 70 mothers was recruited antenatally and subjects allocated to an intervention or non-intervention group. All mothers were asked to complete a range of measures at 2 days postpartum and again 1 month after birth. A post-intervention comparison of groups indicated interesting evidence of a selective intervention effect. Results indicated that certain mothers in the non-intervention group were significantly more likely than intervention group mothers to experience higher levels of negative emotional arousal in response to crying. They were also more likely to adopt a passive response strategy to infant crying and to report generally higher levels of present state anxiety. The significance of the findings is discussed.

The effects of multivitamins and minerals on children with Down syndrome.

The effects of high-dosage multivitamin and mineral supplements on 15 children with Down syndrome aged between 7.5 and 63 months were studied in a placebo-controlled crossover trial. Active treatment was associated with decreased developmental progress, and various side-effects were reported by the parents. The only suggestions of benefit were parents' observations of improvement in general appearance and skin freshness. However, the parents were willing to continue using the treatment and to recommend it to other parents, despite the side-effects.

Profiles of skill gain in delayed infants and young children.

Thirty-eight developmentally delayed preschool children were entered into a study to assess their developmental progress on skills checklists during a 3-month period. All children were receiving the South Glamorgan Home Advisory Service. Weekly tasks were set in a balanced manner. Children were assessed on twelve developmental checklists both prior to and following the study period. Results showed that in general children made greater progress in inspection/tracking and perceptual problem-solving skills than in motor, self-help and visuomotor areas. Separate analyses for Down's children and for children of different developmental levels indicated slightly altered developmental profiles. Results are discussed in terms of implications for early intervention programmes.

Evaluation of teaching methods in a home-based training scheme for developmentally delayed pre-school children.

Thirty-eight pre-school developmentally delayed children receiving the South Glamorgan Home Advisory Service were included in the study. The children were grouped according to developmental ability and manifesting problems. The effectiveness of three methods of teaching (activity charts, target setting, suggestion) were assessed under a balanced design. Weekly skill gain and increments on checklists were measured at the start and at the end of the study period. Parents' opinions on the different methods of teaching were requested and time samples of duration of home visiting were taken. On weekly skill gain, suggestion proved less effective than activity charts or target setting. Severely delayed children made least progress on weekly skill gains. Progress on checklists was independent of teaching method. However, group differences were observed in that severely delayed children (DQ range 22-61) and older (greater than 17 months) Down's syndrome children made least gains on the checklists. Activity charts were preferred by parents although they were also rated as being the most time consuming. Duration of home visits tended to be greater when activity charts were used. Implications of the findings are discussed with reference to ways of improving advice given to parents and alternative ways of evaluating pre-school educational programmes for particular groups of children.

Health visiting and pre-school children with behavioural problems in the County of South Glamorgan: an exploratory study.

This study surveys firstly, using a modified semantic differential technique, how a sample of health visitors in the County of South Glamorgan perceived different behavioural problems in pre-school children. A selection of visiting records, covering a 1-year period, is also studied. Results from the semantic-differential indicate that health visitors perceive eating and sleeping as the most common problem areas. Hyperactivity and sleeping problems are seen as being the most difficult to deal with and the most disruptive to family life. Although health visitors generally feel it is necessary to follow up children with behaviour problems, they find these difficult to resolve. About one third of children are referred to other agencies. Visiting records reveal that children with hyperactivity and sleeping problems receive the highest number of visits from health visitors and that there is little improvement in these children over a period of 1 year. An extension of the health visitor's role and training to include behavioural treatments for pre-school children is discussed.

Parents' report of family life with a developmentally delayed child.

This study was undertaken to investigate how parents who have a child with some degree of handicap perceive the effect of the child on family life. Also, a measure of parental health was taken. The parents' response was compared with that of parents of age-matched children without any known developmental difficulties. The parents and children were grouped according to the manifested handicap of the child [Down's syndrome, developmental quotient (DQ) greater than 65, DQ less than 65 with/without limb dysfunction and normal controls]. The children's ages ranged from 4 to 126 months and they all had received the South Galmorgan Home Advisory Service (HAS) at some time. Sixty-one families completed a questionnaire concerning family life and activities and Rutter's Malaise Inventory (Rutter et al. 1971). Thirty-one control families also completed the questionnaire and Malaise Inventory. The findings showed very little difference between the control group and handicapped groups and suggested that the presence of a delayed child in the family unit does not appear to change the family routine to any large extent. Parents of handicapped children were not found to suffer from significantly greater ill health when compared with the parents of normal children. The implication of the results is that provision should be made available for both fathers and mothers to play an equal part in the support facilities and guidance offered.

Brief intervention therapy for behaviourally disturbed pre-school children.

A group of children with behavioural difficulties were treated using behavioural techniques and were compared with a group of control children. The treated children had various behavioural difficulties including poor concentration, sleep problems adn non-cooperation with parents. They were treated in the home for periods up to 7 weeks, after a 2-week baseline observation period. Of nine families that started the treatment, two did not cooperate and one improved spontaneously. Videotape recordings of the child at play were made lasting 15 minutes and immediately prior to the psychologist's visits. The matched control children were investigated similarly. The videotapes were analysed to assess attention span, mother-child verbal interaction and cooperation. There was consideration improvement in attention span as the treated children's behavior became similar to the control children in four to five visits. The improvements lasted over the 3- and 6-month follow-up period. It is concluded that brief intervention behavioural treatment has considerable potential and is reasonably economical in terms of staff time.

Parental responses to their developmentally delayed children and the South Glamorgan Home Advisory Service.

This study was undertaken to investigate how parents who have a child with some degree of handicap describe their child's behaviour and their own feelings and adjustment to having such a child. Their response was compared with that of parents of age-matched children without any known development difficulties. The parents and children were grouped according to the manifested handicap of the child (Down's syndrome, developmental quotient (DQ) greater than 65, DQ less tha 65 with/without limb dysfunction and normal controls). The children's ages ranged from 4 to 126 months and they all had received the South Glamorgan Home Advisory Service (HAS) at some time. Sixty-one families completed attitude and behaviour rating scales and parents were asked to express their preferences for prescribed services. The attitude and rating scales were also completed by twenty-five control families with normal children. A consistent trend was revealed towards increasingly favourable attitudes and feelings from past to future, and the DQ less than 65, with/without limb dysfunction, group was found to require further investigation in terms of provision of appropriate services. A distinct preference was shown for the South Glamorgan Home Advisory Service.

The progress of developmentally delayed pre-school children in a home-training scheme.

The present study compared the rates of development of a group of 35 pre-school children in a home-training scheme. The children entered the service at different ages and suffered from different disabilities. The families received weekly visiting from a home advisor, who was specially trained to develop skills in the parents to help their children. Those who developed most rapidly were the group of environmentally deprived children. The non-specific developmentally delayed and Down's syndrome children progressed well during the study period. The children who suffered from cerebral palsy and those with visual handicaps developed at a very slow rate, despite the training that they were receiving. This finding may reflect the severity of their handicaps but also it suggests that the needs of these particular groups should be further examined. The age of entry to the scheme did not seem to be an important variable. The individual variability within each specified group was wide.

Griffiths Scales of Mental Development and different users.

In a study of the inter-rater reliability of the Griffiths Mental Development Scales, the Eye-Hand Coordination and the Performance and Practical Reasoning Scales were found to show greater consistency between raters than the Locomotor, Personal-Social scale and the Hearing-Speech Scale. The latter scales were more sensitive to interpretation by different assessors, even when all viewed the same videotaped performance. No significant discrepancies were found between raters with different backgrounds and experience.

A home advisory service for pre-school children with developmental delays.

This paper describes the development of a home advisory service for families of children with developmental difficulties. It demonstrates the transition from a research phase to routine service provision, and indicates that the expansion in numbers of families receiving the service has been achieved whilst maintaining or improving the actual quality of the service. Information is provided on the placement of children who have left the service, and on the plans for future research within the service.

Behavioural treatment of hyperactive children.

This study reports the value of behavioural treatment of hyperactive children. Twelve children with multiple behavioural problems, including concentration difficulties, were identified and treated during a 3-month period. Six of the children began treatment immediately; the other 6 children received similar treatment but after a delay of between 4 and 6 weeks. Children were seen at the clinic or in the home, depending upon the individual difficulties and geographical distances. Initially the families were seen weekly, but the frequency later was determined by the severity of the problems and the response to treatment. There was a significant improvement in the children's behaviour as reported by the parents, the home visitor, and videotaped recordings. During the initial period of beteen 4 and 6 weeks the treated children improved significantly, whereas the others, as yet untreated, showed no change. As soon as the treatment was introduced to the second group these children's behaviour also improved and to about same extent in 6 weeks as the treated children had in up to 12 weeks' treatment. This interesting observation suggests that a short period of treatment, only 6 weeks, may be sufficient for most children with hyperactivity. This is more feasible with the present-day resources of many departments.

Benefits to Down's syndrome children through training their mothers.

This study investigated the hypothesis that training of mothers with Down's syndrome children would be beneficial both to the child and parents. The mothers were taught behaviour modification techniques based on learning theory and were given group discussions on dealing with their family or personal problems. The subjects were 16 mothers with a Down's syndrome child, divided into two groups on the basis of their child's sex and chronological and mental ages. The Griffiths Scale was used for assessment. The mothers in the treatment group received 12 sessions of training and group counseling over a 6-month period, whereas the control mothers received no additional attention except the usual routine from the general practitioner and health visitor. The result show clear gains to both the child and mother in the treatment group. The child improved, especially in language development as well as in the other areas, and the mother-gained more confidence and competence in her daily management of the child.