Exploratory structural equation modeling: a streamlined step by step approach using the R Project software.

Confirmatory Factor Analysis (CFA) has been a popular yet limited approach to assessing latent factor structures. Despite items rarely loading exclusively on one latent factor in multifactorial scales, CFA assumes all indicators/items should load uniquely on their allocated latent dimensions. To address this weakness, Exploratory Structural Equation Modeling (ESEM) combines exploratory factor analyses (EFA) and CFA procedures, allowing cross-loadings to occur when assessing hypothesized models. Although such advantages have enhanced ESEM popularity, its adoption is often limited by software rigidity and complex coding difficulties. To address these obstacles, the current tutorial presents a streamlined, step-by-step approach using the open-source software R while providing both R and Mplus ESEM syntax. The tutorial demonstrates the sequence of the ESEM stages by examining the frequently debated Strengths and Difficulties Questionnaire (SDQ) factor structure, using openly accessible data from the Longitudinal Study of Australian Children (LSAC). As ESEM may allow a better understanding of the complex associations in multidimensional scales, this tutorial may optimize the epidemiological and clinical assessment of common yet multifaceted psychiatric presentations.

Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions.

Background: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. Methods: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. Results: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. Conclusions: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.

Anxiety, concerns and emotion regulation in individuals with Williams syndrome and Down syndrome during the COVID-19 outbreak: a global study.

Individuals with neurodevelopmental conditions (NDCs) have been reported to experience increased levels of anxiety during the COVID-19 pandemic. In our study, we document how individuals with Down Syndrome (DS; N = 557; Mage = 16.52; 233 female) and Williams syndrome (WS, N = 247; Mage = 18.43; 113 female) experienced the first wave (April 2020-May 2020) of the COVID-19 pandemic across the world. Using multilevel linear mixed regressions, we studied (a) parental reported anxiety of individuals with DS and WS, (b) these individuals' specific concerns, and (c) their use and efficacy of emotion regulation (ER) strategies during the first wave of COVID-19. Predictors of anxiety, such as the age of the individual with NDC, type of condition, and time, were investigated. Individuals with WS experienced higher levels of anxiety compared to those with DS and the older the individuals with NDC were the more anxiety they experienced. In terms of concerns, group effects indicated that individuals with WS scored higher for most of the concerns. There were no gender differences in concerns, yet most of the concerns increased with age except for concerns about loss of routine, boredom, loss of institutional support and family conflict. Finally, significant group effects were found and indicated a more frequent use of a variety of adaptive and maladaptive ER strategies in individuals with WS. We did not identify group differences in the efficacy of ER strategies. Our results indicate that individuals with WS are likely to exhibit higher levels of anxiety, but also higher levels of concerns depending on their age. Similarly, individuals with WS use a variety of ER strategies more frequently but these strategies are not necessarily more efficient for them. We discuss the impact of these findings in relation to anxiety identification and support across individuals with NDCs.

All views my own? Portraying the voices of children with complex neurodevelopmental disorders in statutory documents.

Portraying the voices of children with complex genetic neurodevelopmental disorders about their health, care and education needs in their statutory documents is a challenging task. This study examined the ways by which the perspectives of children diagnosed with Down Syndrome (DS) and Williams Syndrome (WS) are portrayed in their statutory documents, namely the Education Health and Care plans, in England. Using the International Classification of Functioning Disability and Health for Children and Youth, we analysed the content of Section A of the Education Health and Care plans of 52 children and young people with WS and DS, between 5 and 26 years of age. A minority of statutory documents (7.7 %) explicitly reported the children's voices, and many failed to document how the children's voices were accessed. Only a few specific or evidence-based tools to access their voices were reported. Most statutory documents portrayed parental rather than children's voices concerning aspects of their health, care, and education. This study highlights the need to establish the use of evidence-based tools for ascertaining the voices of children with complex neurodevelopmental disorders and including them in decision making about their health, care and education needs.

Predictors of school concern across the transition to secondary school with developmental language disorder and low language ability: A longitudinal developmental cascade analysis.

BACKGROUND: Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well-being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability. AIMS: To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well-being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition. METHODS & PROCEDURES: Participants (aged 10-11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school. OUTCOMES & RESULTS: Regression analyses showed pre-transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well-being for the LL group, and by social competence for the TD group. Post-transition concern was predicted by emotional well-being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well-being for the TD group. CONCLUSIONS & IMPLICATIONS: This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well-being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research. WHAT THIS PAPER ADDS: What is already known on the subject There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge This study reveals differences between language ability groups in the predictors of school concern both pre- and post-transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well-being, and a longitudinal link between social competence and emotional well-being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work? This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents.

Examining the relationship between oral language skills and executive functions: Evidence from Greek-speaking 4-5-year-old children with and without Developmental Language Disorder.

BACKGROUND: Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above. AIMS: The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD. METHODS AND PROCEDURES: Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility). OUTCOMES AND RESULTS: Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children. CONCLUSIONS AND IMPLICATIONS: These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

A multinational study exploring adolescent perception of school climate and mental health.

School climate is a topic of increasing importance internationally. The current study investigated the established measurement invariance of an eight-factor school climate scale using a multinational sample of secondary students. School climate factor means across 14 international groups were compared and findings on the association between school climate factors and mental health were also investigated. Findings, from this study, illustrate several cross-national similarities regarding the ways in which secondary students perceive school climate and the influence of school climate on student mental health. These findings can support school psychologists' efforts to identify strategies and supports that improve the school environment in areas that are most consistently related to student experiences, such as school safety and school connectedness. Implications, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Consistency of Parental and Self-Reported Adolescent Wellbeing: Evidence From Developmental Language Disorder.

Research on adolescent wellbeing in Developmental Language Disorder (DLD) has previously been examined through measures of parent (proxy) or self-reported wellbeing, but never has a study included both and enabled comparison between the two. The current study reports parent and self rated wellbeing of adolescents with DLD and Low Language (LL) ability, as well as their typically developing (TD) peers. It also examines consistency between raters and factors influencing correspondence. Adolescents aged 10-11 with DLD (n = 30), LL (n = 29) or TD (n = 48) were recruited from eight UK primary schools. A battery of standardized language, psychosocial and wellbeing assessments, including the KIDSCREEN-27 were administered. Adolescent ratings of wellbeing were similar across groups on three of the five wellbeing dimensions, but those with DLD had lower self-reported Autonomy and Parental Relations than their TD peers, and both the DLD and LL group had lower School Environment scores than their TD peers. By parental report, the DLD and LL group were considered to have lower wellbeing on all five wellbeing dimensions relative to their TD peers. Paired sample t-test analyses indicated a high level of variance between parent and adolescent reported wellbeing for multiple wellbeing domains, especially Psychological Wellbeing. Importantly, predictors of the level of agreement between parent and adolescent reported psychological wellbeing differed between groups: cognitive reappraisal and sociability predicted this level of agreement for adolescents with LL, while social competence predicted agreement in DLD and TD. This study emphasizes the necessity of allowing adolescents of all language abilities to report their own wellbeing, as their perspective does not align with that of their parents. It also highlights the importance of including the full spectrum of need when investigating the impact of language ability on consistency between proxy and self-reported wellbeing.

Symptom Checklist-90-Revised: A structural examination in relation to family functioning.

The accurate assessment of psychopathological behaviours of adolescents and young adults is imperative. Symptom Checklist-90-Revised (SCL-90-R) is one of the most comprehensive and widely used scales addressing this purpose internationally. Interestingly, associations between the different SCL-90 symptoms and family functioning have been highlighted. Nevertheless, the scale's factorial structure has often been challenged. To contribute in this area, this study scrutinizes the psychopathological dimensions of the Symptom Checklist-90-Revised (SCL-90-R) in a large cohort of high school students (Mean age = 16.16; SD = .911) from Greece. It addresses this aim by: a) using first order and bi-factor confirmatory factor analysis, and exploratory structural equation models and; b) investigating the factors' associations with family functioning. A total of 2090 public Greek High School students completed the SCL-90-R and the Family Adaptability and Cohesion Scale IV (FACES-IV) covering family functioning, satisfaction and communication. Six different solutions, yielded by separate permutations of CFA, ESEM, and bifactor models, were evaluated. Based on global fit, the clarity, reliabilities and the family functioning links of the dimensions in the models, the ESEM oblique model with the theorized nine factors emerged as the optimum. This model had adequate fit, and symptom dimensions were well defined. Also six of the nine factors demonstrated external associations with family functioning, satisfaction and communication. The clinical assessment benefits of these results are discussed.

Consistency between provision, outcomes and functioning needs in statutory documents for young children with developmental disabilities in England.

BACKGROUND: It is widely accepted that early childhood intervention for children with disabilities should address the assessment-intervention cycle holistically. Documenting both assessment and intervention is important to support provision effectively. In England, the official document that describes needs and provision for children with special educational needs and disabilities is the Education Health and Care plan. This document requires inter-professional collaboration and a focus on children's holistic participation, rather than diagnosis. AIM: To examine the consistency between provision, outcomes and needs of young children with disabilities in England, as described in their Education Health and Care plans. METHODS: The plans of 68 young children were examined and the relationships between documented needs, outcomes and provision actions analysed. RESULTS: provision is more related to children's individual needs, than to their diagnoses, when needs are described in sufficient detail; interdisciplinarity leads to higher quality documentation of provision and outcomes. However, more needs to be done to support professionals in developing higher quality needs descriptions and interdisciplinary collaborations. IMPLICATIONS: Training and interdisciplinarity with a common language between professionals have the potential to improve currently observed challenges regarding consistency between provision, needs and outcomes.

The Underreporting of Vision Problems in Statutory Documents of Children with Williams Syndrome and Down Syndrome.

Vision problems can lead to negative developmental outcomes. Children with Williams syndrome and Down syndrome are at higher risk of vision problems, and these are less likely to be detected due to diagnostic overshadowing and difficulty accessing eye-care. Education, Health and Care (EHC) plans are statutory documents, introduced by the Children and Families Act 2014 in England, with the intention of integrating provision across these domains. Vision issues should be reported in these plans, and recommendations made about appropriate adjustments for them. We analysed the EHC plans from 53 children with Down or Williams syndrome. Our results showed significant underreporting, especially for children with Williams syndrome, and little explanation of what adjustments should be made. We also report pockets of good practice.

Online and Face-to-Face Performance on Two Cognitive Tasks in Children With Williams Syndrome.

There has been an increase in cognitive assessment via the Internet, especially since the coronavirus disease 2019 surged the need for remote psychological assessment. This is the first study to investigate the appropriability of conducting cognitive assessments online with children with a neurodevelopmental condition and intellectual disability, namely, Williams syndrome. This study compared Raven's Colored Progressive Matrices (RCPM) and British Picture Vocabulary Scale (BPVS) scores from two different groups of children with WS age 10-11 years who were assessed online (n = 14) or face-to-face (RCPM n = 12; BPVS n = 24). Bayesian t-tests showed that children's RCPM scores were similar across testing conditions, but suggested BPVS scores were higher for participants assessed online. The differences between task protocols are discussed in line with these findings, as well as the implications for neurodevelopmental research.

"No policy is an island": how the ICF international classification system may support local education planning in England.

Background: A crucial issue in special educational needs and disability policy and provision is the documentation of children's functioning, for which many countries have a statutory document. In England this is the education health and care plan. Recent research challenges the quality of these plans. Purpose: To provide evidence on the usefulness of the international classification of functioning, disability and health as a system with potential to support the development of higher quality plans in England. Methods: Twenty-five professionals participated in a one-day training session on the international classification of functioning disability and health, with a focus on designing higher quality SMART targets to be included in children's plans. Results: Overall, participants regarded the system as useful. Comparison of targets written before and after the training show improvements in relevance, specificity and on the extent to which they were action-oriented and measurable. Conclusions: Results are discussed in light of international lessons learned around the potential of the international classification of functioning disability and health to support policy change. A "no policy is an island" approach is proposed, suggesting local policy-makers should open horizons beyond geographical boundaries in evidence-based decision-making for supporting children with disabilities.Implications for rehabilitationThe ICF can be regarded as a useful framework for supporting professionals developing targets for children with Education Health and Care (EHC) plans in England.For developing SMART targets with the ICF, professionals can use the taxonomy to look for detailed aspects of functioning, relevant to a certain developmental stage.Using the ICF can support in making more measurable targets in EHC plans if the universal qualifier scale is applied when describing detailed aspects of functioning.Professionals trained on the ICF recognise its usefulness for writing EHC targets.More in-depth training is recommended for supporting the development of more holistic biopsychosocial EHC plans in England.

The views and aspirations of young people with autism spectrum disorders and their provision in the new Education Health and Care plans in England.

Background: The new special educational needs and disability legislation in England has introduced Education Health and Care plans as statutory documents for children with special educational needs, and has extended provision beyond compulsory education, placing transition in a compelling position. This policy recognises the need to include the views, wishes and aspirations of children and young people in the development of provision to cater for their needs. For young people with autism spectrum disorders and their families, transition to post-16 education and employment could be challenging. This study aimed to explore how voices of young people with autism spectrum disorders are captured in their Education Health and Care plans.Methods: These views were collected from the Education Health and Care plans of 12 young people with autism spectrum disorders. These plans were analysed inductively and deductively through content analysis, using the International Classification of Functioning, Disability and Health: Children and Youth Version as a coding framework.Results: Discrepancies were found between plans concerning the ways in which the voices of young people with ASD were elicited. A total of 189 functioning codes were identified, with a prevalence of activities and participation codes to reflect their views, followed by body functions and lastly environmental factors.Conclusion: These disparities are discussed in light of the biopsychosocial model of functioning and health, and the new English policy. Implications for adopting the International Classification of Functioning framework to give voice to young people with autism spectrum disorders are also discussed.Implications for rehabilitationYoung people with autism spectrum disorders face many challenges in their transition to post-16 education and employment.Engaging young people with autism spectrum disorders in matters that affect their own lives contribute to the development of provision that is aligned with their wishes and aspirations.Practitioners collaborating in the development of Education Health and Care plans should ensure that young people are effectively involved in the development of their own plans.The International Classification of Functioning, Disability and Health, Children and Youth Version provides a systematic framework and language for coding and recording data from different sources with which to capture young people's views.

Expectations of the transition to secondary school in children with developmental language disorder and low language ability.

BACKGROUND: A successful transition from primary to secondary school for typically developing (TD) children is associated with academic and psychosocial outcomes. Children with developmental language disorder (DLD) tend to have pervasive needs in both of these domains, yet little is known about their experience of this transition. We have no information concerning the transition for children with low language (LL). AIM: (1) To explore the expectations of the transition to primary school for children with DLD, children with LL proficiency, and their TD peers; (2) to examine the predictors of transition concerns for each group. SAMPLE: Children aged 10-11 in the final year of primary school with DLD (n = 30), LL (n = 29), or TD (n = 48) were recruited from eight UK primary schools in the summer term. METHODS: A battery of standardized language and psychosocial assessments, including the School Concerns Questionnaire (SCQ; Rice et al. British Journal of Educational Psychology, 81, 2011, 244), was administered. RESULTS: The TD group had significantly lower levels of school concern than DLD and LL groups while DLD and LL groups did not significantly differ. Scholastic competence predicted overall concerns of children with DLD; social competence predicted TD overall concerns; and no variables predicted overall concerns of children with LL. Exploration of school concern subfactors highlighted the importance of emotion recognition for all groups and social competence for children with LL. CONCLUSIONS: Results indicate that school provision to facilitate a successful transition may most usefully target different areas depending on pupils' language level.

Views of professionals about the educational needs of children with neurodevelopmental disorders.

BACKGROUND: Professionals play a key role in supporting children with special educational needs in schools. However, the views of those working with neurodevelopmental disorders are less known. AIMS: This study examined the views of professionals (including teachers, teaching assistants, educational psychologists, speech and language therapists, physio and occupational therapists etc.) working with children with Williams Syndrome (WS), Down Syndrome (DS) or with Autism Spectrum Disorders (ASD) in terms of how informed professionals are about the disorder and their views about the type of support these children need to be receiving. METHODS AND PROCEDURES: Professionals working with 77 children with ASD, 26 with DS and 38 with WS completed an online questionnaire. OUTCOMES AND RESULTS: Professionals in all three groups highlighted relevant areas of difficulty for these children, but they did not recognise some of the less phenotypical difficulties that children with a specific disorder may experience. In addition, there was a disconnect between the difficulties identified by the professionals and the type of specialist support that may be necessary. CONCLUSIONS AND IMPLICATIONS: Although professionals have a lot of knowledge about the specific neurodevelopmental disorders, further evidence-based training would allow more effective support for children with neurodevelopmental disorders in the classroom but also equip professionals better and raise their confidence in meeting these children's needs.

Comparing parental stress of children with neurodevelopmental disorders: The case of Williams syndrome, Down syndrome and autism spectrum disorders.

BACKGROUND: Although parental stress is higher for children with neurodevelopmental disorders (NDs), it is unclear how this stress compares to more common NDs. The current study compared stress in parents of children with Williams syndrome (WS), Down syndrome (DS) and autism spectrum disorders (ASD). The impact of individual and contextual factors was also explored. METHOD: Parents of children with WS (n = 107), DS (n = 79) and ASD (n = 79) completed a background questionnaire, a parental stress questionnaire and a satisfaction with life questionnaire. RESULTS: Although all groups displayed similar levels of parental stress, the factors that influenced this stress differed between the groups. There were also differences for life satisfaction and relationships between parental stress and individual and contextual factors. CONCLUSIONS: Although parents of children with NDs are not at an increased risk of parental stress, the results suggest that interventions should be syndrome-specific.

Evaluating the quality of outcomes defined for children with Education Health and Care plans in England: A local picture with global implications.

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities. This study aimed to evaluate the outcomes defined for children with education, health and care plans in England. 236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age. The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes. Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children's main need. There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures.