Expressive vocabulary intervention for four 2- to 3-year-old children with cerebral palsy and speech/language difficulties: A single-case A-B study.

PURPOSE: To evaluate a parent-delivered expressive vocabulary intervention using focused stimulation for young children with cerebral palsy (CP). METHOD: A single case A-B design was used. Use of expressive target words was evaluated during the baseline (A) and intervention (B) phases. Untrained expressive words were used as control behaviour. Four 2- to 3-year-old boys with CP and their parents participated. All participants had an expressive vocabulary of less than 50 words at study intake. Following training, parents delivered the intervention daily at home for 5 weeks. Generalisation of the intervention was measured with a parent-rated vocabulary checklist. RESULT: Two participants showed clear gains and one participant showed a smaller gain in target words. Two of these three participants did not improve on control words, but one participant increased his use of both target and control words. One participant did not increase his use of either control or target words. All participants improved on parent-reported expressive vocabulary, and for two children, improvements were large. CONCLUSION: Parent-delivered focused stimulation may lead to gains in expressive vocabulary in children with CP and speech and language difficulties. The intervention would be suitable for larger single-case studies with more experimental control.

Child Maltreatment and Self-rated Health: Mediating Effect of Parent-child Conversation and Moderating Effect of Gender.

Child maltreatment seriously affects children's psychological and social well-being, as well as their physical health. The study aimed to explore the impact of violence experienced by children on their self-rated health. It also examined whether this effect is mediated by parent-child conversations and whether it varies based on the child's gender. The study was based on the Child Victim Survey of 2013 (FSD2943) in Finland. Mediation and moderation models were tested. According to the analyses, violence experienced by a child at the hands of their parents weakened the parent-child relationship, which, in turn, negatively impacted the child's self-rated health. Further, the higher the frequency of experienced violence, the more negative are the health consequences. However, girls had stronger negative health consequences as a result of low frequency of violence than boys. Social workers should pay particular attention to the dynamics within the family when assessing the possibility of child maltreatment.

Introducing a self-managed early communication resource for parents - A mixed methods feasibility study of the Swedish "ComAlong online".

BACKGROUND: Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online. METHODS: ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used. RESULTS: Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis. CONCLUSIONS: This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Web-based service delivery programmes and digital technology offer promising access to parent-mediated interventions to support children with communication difficulties, but the empirical evaluations of such programmes are limited.Parents perceive web-based, self-managed resources teaching supportive strategies to promote child communication, in this case ComAlong online, easy to use, and such resources may improve child communication and increase competence in parents.Parents want to have access to web-based communication resources, such as ComAlong Online, early in the child's life, and a chat function with experts, a parent forum, and the possibility of creating personalised playlists of videos and podcasts are desired functionality.

Associations between parents' adult attachment, Co-parenting and parent-child relationships: an actor-partner interdependence model.

This study used the Actor-Partner Interdependence Model to examine how parents' adult attachment influences their their own and the partners' co-parenting and parent-child relationships. Participants were from a cross-sectional sample of 1313 Chinese heterosexual married couples (fathers' Mage = 39.74, SD = 5.61; mothers' Mage = 37.55, SD = 5.04) whose biological children were pupils (Mage = 10.25, SD = 2.35). Results revealed that: (a) Couple members' actor effects from adult attachment avoidance to positive and negative co-parenting and parent-child closeness and conflict were found both significant; (b) The actor effects from adult attachment anxiety to negative co-parenting and parent-child conflict were found significant, whereas only partner effect from attachment avoidance to positive co-parenting and from attachment anxiety to parent-child conflict were significant. The results highlight the negative effects of parents' attachment avoidance and anxiety on their partners' parenting function.

Parental Overprotection and Locus of Control as the Mechanisms Explaining the Relationship Between Parent and Child Anxiety: A Multiple Mediation Model.

The study probes the role played by parenting control practices and parental locus of control in the relationship between parent and child anxiety. The study particularly aims at probing these matters in light of the parental gender-specific role, striving to improve our understanding of the differential etiological contribution of mothers' and fathers' anxiety and parental practices to child's anxiety. The study consisted of 316 parents (159 mothers and 157 fathers) who reported their own and their child's anxiety using valid instruments. The general path model used in the study exhibited an adequate fit to the data, generally confirming our theory regarding the direct and indirect associations between parent-child anxiety. Using SEM multiple group analysis for parental gender, a strong-direct unique association was found between parent and child anxiety. For mothers, this association was partially mediated by maternal overprotection. Finally, maternal external locus of control was positively associated with child anxiety, after accounting for the effects of all other maternal variables. The study's findings and limitations are profoundly discussed in light of parental gender differences.

Validation of the Parent Version of the Nighttime Fears Scale (NFS-P) for Children Aged 3-8 Years.

BACKGROUND: Nighttime fears are highly prevalent in children, ranging from normative fears to triggering fear-related anxiety disorders. The lack of available assessment instruments recently prompted the development of the Nighttime Fears Scale (NFS) for children aged 8-12 years. The present study aimed to adapt and psychometrically evaluate the parent-reported version for children aged 3-8 years (NFS-P) as a complement for younger children. METHODS: Two hundred eighty-four Spanish-speaking parents (47% girls) completed the NFS-P and anxiety measures. RESULTS: Confirmatory factor analyses supported a four-factor structure of the NFS-P. Strong internal consistency and validity evidence were obtained. No significant differences were found in NFS-P scores between sexes and age groups. CONCLUSIONS: The findings offer support for the use of the NFS-P as a valuable instrument in clinical and research settings, supplementing the NFS for older children. Both scales provide an efficient means to comprehensively assess the presence and intensity of typical nighttime fears across preschool and school years.

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial.

Background: Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. Methods: This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. Findings: From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, ηp 2 = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support. Interpretation: A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited. Funding: Emerging Researcher First Grant from the Health Research Council of New Zealand.

Caregiver training improves child feeding behaviours in children with paediatric feeding disorder and may reduce caregiver stress: A systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis was to synthesise the evidence from randomised controlled trials for caregiver training on child and family outcomes for children with paediatric feeding disorder. METHOD: A systematic review was conducted in accordance with PRISMA guidelines. Searches of Medline, CINAHL, PsychInfo, and EMBASE were conducted using the key concepts of paediatrics, feeding disorders, parents/caregivers, and training. Eligible studies included randomised controlled trials published in peer-reviewed articles, testing the impact of caregiver training on outcomes for children with paediatric feeding disorder. RESULT: Eight articles met the inclusion criteria, involving 575 participants from three countries. Seven articles were included in the meta-analyses, providing high certainty evidence that caregiver training improves child feeding behaviours and reduces unhelpful caregiver mealtime strategies compared with no intervention. Uncertainty remains in regard to impact on caregiver stress and intervention intensity. CONCLUSION: Caregiver training is an effective strategy for improving outcomes in children with paediatric feeding disorder. Further research is required to determine the most effective methods of caregiver training, including the intensity of treatment required to attain clinically important benefits for families with different levels of need.

Italian Version of QI-Disability for QoL Evaluation in Children and Adolescents with Intellectual Disability: Translation and Cross-Cultural Adaptation Process.

Children and adolescents with Intellectual Disability (ID) experience a worse Quality-of-Life (QoL) relative to typically developing peers. Thus, QoL evaluation is important for identifying support needs and improving rehabilitation effectiveness. Nevertheless, currently in Italy there are not tools with this scope. This study aims to translate and cross-culturally adapt the Quality-of-Life Inventory-Disability (QI-Disability) into Italian. The process consisted in forward-backward translation, cross-cultural adaptation and cognitive debriefing. Eventually, QI-Disability was conceptually and semantically equivalent to the original one. A validation study is necessary to make the tool available in Italian clinical practice and educational contexts to improve these children's QoL.

Caring for a Child with a Cleft Lip and/or Palate: A Narrative Review.

Raising a child with healthcare needs places additional demands on caregivers. In 2012, Nelson and colleagues authored a review of 57 papers pertaining to parents' experiences of caring for a child with cleft lip and/or palate (CL/P). Thanks in large part to this review, available literature on this topic has grown considerably. The aim of the present review was to update and critically appraise recent literature, with the wider goal of assessing progress in the field and setting recommendations for future work. All original, peer-reviewed articles pertaining to the psychological adjustment of parents of children with CL/P living in high-income countries (published May 2009 to May 2024) were examined. A total of 126 articles were included. Findings were narratively synthesised according to three salient themes: Emotional Impact; Social Experiences; and Care Delivery. Recent research has built on Nelson et al.'s recommendations, addressing some prior gaps in knowledge. Nonetheless, some areas remained largely unexplored and critical methodological limitations were still evident. Recommendations for clinical practice include: improved informational resources for parents and non-specialist health professionals, regular audit of services in collaboration with parents and families, routine psychological screening for known risk factors and integrated psychological support from diagnosis onward. Recommendations for future research include the design of multicentre, prospective, longitudinal studies with sufficient sample sizes and appropriate control/reference groups, inclusion of families from diverse ethnic and socioeconomic backgrounds, further examination of factors contributing to psychological growth, the development and evaluation of psychological interventions, and cross-condition learning.

Psychometric Properties of the Japanese Translation of the Parent Overprotection Measure for Mother and Father Reports.

The Parent Overprotection Measure (POM) is a promising scale to measure parent overprotection toward a child from the parent's perspective. However, no Japanese translation of the scale has been developed, and whether the POM can be applied to a Japanese population is unknown. This study translated the POM into Japanese and examined its psychometric properties. Parents of 380 children aged 4 to 7 years (including 190 mothers and 190 fathers) completed online questionnaires. Exploratory and confirmatory factor analyses (CFA) indicated that the Japanese translation of the POM has a bi-factor structure, including one general factor (general overprotection) and two specific factors (care/attention and control/prevention). The measurement invariance of reports from mothers' and fathers' perspectives was confirmed by multiple group CFA. The McDonald's Omega was acceptable for all factors, but the general overprotection factor explained most scale variance. Pearson's correlation coefficients were more than .20 between the control/prevention factor and child anxiety symptoms in both mother and father reports. The correlation between the control/prevention factor and parent anxiety according to fathers' reports also exceeded .20. These results provided the factor structure and supported the reliability of the POM among a Japanese population; however, further investigation of the validity of the scale is needed.

Bridging The Gap: Essential Role of Parents and Caregivers In Their Child's Management in the Pediatric Intensive Care Unit.

The importance of parental involvement in the care and management decisions made for children hospitalized in the pediatric intensive care unit (PICU) is examined in this editorial. Initial days and weeks in a PICU can be challenging for the child and family due to the emotional intensity and medical complexity of the therapy a child receives. Regardless of the result, families may feel uncertain and anxious that their child may die or have a terrible outcome. The majority of pediatric patient deaths in hospitals happen in the PICU. Recognizing and supporting the crucial role of parents or caretakers in informed decision-making and management of their child's condition is essential for advancing prevention, detection, and treatment efforts.

Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study.

This single-participant case study examines the feasibility of using custom virtual reality (VR) gaming software in the home environment for low-dose Hand Arm Bimanual Intensive Training (HABIT). A 10-year-old with right unilateral cerebral palsy participated in this trial. Fine and gross motor skills as well as personal goals for motor outcomes were assessed before and after the intervention using the Box and Blocks Test, Nine-Hole Peg Test, and Canadian Occupational Performance Measure. Movement intensities collected via the VR hardware accelerometers, VR game scores, and task accuracy were recorded via the HABIT-VR software as indices of motor performance. The child and family were instructed to use the HABIT-VR games twice daily for 30 minutes over a 14-day period and asked to record when they used the system. The child used the system and completed the 14-hour, low-dose HABIT-VR intervention across 22 days. There was no change in Box and Blocks Test and Nine-Hole Peg Test scores before and after the intervention. Canadian Occupational Performance Measure scores increased but did not reach the clinically relevant threshold, due to high scores at baseline. Changes in motor task intensities during the use of VR and mastery of the VR bimanual tasks suggested improved motor efficiency. This case study provides preliminary evidence that HABIT-VR is useful for promoting adherence to HABIT activities and for the maintenance of upper extremity motor skills in the home setting.

Parent Narratives Provide Perspectives on the Experience of Care in Trisomy 18.

Trisomy 18 syndrome, also known as Edwards syndrome, is the second most common autosomal chromosome syndrome after Down syndrome. Trisomy 18 is a serious medical disorder due to the increased occurrence of structural defects, the high neonatal and infant mortality, and the disabilities observed in older children. Interventions, including cardiac surgery, remain controversial, and the traditional approach is to pursue pure comfort care. While the medical challenges have been well-characterized, there are scant data on the parental views and perspective of the lived experience of rearing a child with trisomy 18. Knowledge of the parental viewpoints can help clinicians guide families through decision-making. Our aim was to identify parents' perspectives by analyzing a series of narratives. In this qualitative study, we collected 46 parent narratives at the 2015 and 2016 conferences of the Support Organization for Trisomy 18 & 13 (SOFT). The participants were asked to "Tell us a story about your experience." Inductive content analysis and close reading were used to identify themes from the stories. Dedoose, a web-based application to analyze qualitative data, was used to code themes more systematically. Of the identified themes, the most common included Impact of trisomy 18 diagnosis and Surpassing expectations. Other themes included Support from professionals, A child, not a diagnosis, and Trust/lack of trust. We examined the voice and the perspectives of the parents in their challenges in caring for their children with this life-limiting condition. The exploration of the themes can ideally guide clinicians in their approach to the counseling and care of the child in a shared decision-making approach.

Telehealth general case parent training for children at risk for autism.

Parent-mediated interventions for infants and young children with an increased likelihood of autism may help ameliorate developmental concerns; however, generalization of parents' teaching strategies to novel child target skills has not been consistently demonstrated. This study expanded our parent training program, Parent Intervention for Children at-Risk for Autism (PICARA), by incorporating telehealth general case training (PICARA-TGCT) to promote generalization of teaching skills. Five parent-child dyads participated. Child target skills were chosen from the categories of imitation, receptive language, and expressive language. A concurrent multiple-baseline-across-participants design was used to evaluate the effect of training across two cohorts of parent-child dyads. Dependent variables included the percentage of correct parent teaching skills and the percentage of child correct responses. Parent teaching skills increased across all participants for both trained and untrained child target skills, as did child skills. This study provides support for PICARA-TGCT as an efficacious and efficient early intervention model.

Daily and Half-yearly Associations between Boundary Diffusion and Parent-adolescent Relationship Quality after Divorce.

Boundary diffusion is a particular risk after divorce and has been associated with adolescents' adjustment problems. Yet, its potential impact on parent-adolescent relationship quality is less straightforward, as previous findings support both an alienation and conflict perspective. Therefore these associations (daily and half-yearly) were examined in recently divorced families, addressing both within-dyad changes and between-dyad differences. Data were collected among a sample of N = 133 (pre)adolescents (Mage = 11.76; 51.5% boys) from 76 divorced families, using a measurement burst design: Every six months, 14 consecutive days of daily diaries were collected, for 5 waves. Between dyads, adolescents who experienced more boundary diffusion than others, also reported more conflict with both their parents. Within dyads, when adolescents experienced more boundary diffusion than usual by one of their parents (actor), warmth decreased and conflict increased between this parent and the adolescent, that same and the following day. Adolescents also engaged in more conflict with the other parent that day. These findings mostly supported the conflict perspective: Post-divorce boundary diffusion appears to be a general risk factor for parent-adolescent conflict with both parents, and from day-to-day boundary diffusion was linked to a deteriorated parent-adolescent relationship quality, especially with the parent that triangulated or parentified them. There were no significant long-term associations, nor did any moderator (age, gender, living arrangement) explain heterogeneity in effects.

Race and ethnic differences in step- versus biological parent support to adult children.

Objective: This brief report examines differences in step- versus biological family support between White, Black, and Hispanic families in the United States. Background: The increasing share of stepfamilies reflects a potential shift in family relationships. Although research finds that stepfamilies are generally less likely to engage in instrumental support than biological families, recent work suggests that the relationship between family structure and family behaviors may vary across racial/ethnic groups. Method: Using data from the 2015-2017 Add Health Parent Study, this report examines racial/ethnic differences in step- versus biological family support between parents and adult children. Specifically, parents' likelihood of and hours of providing instrumental support to adult children are assessed. Results: Findings from this report indicate for Black and White families, stepfamilies are less likely to provide instrumental support to their adult children than biological families. Among Hispanic families, however, stepfamilies are not more or less likely to provide support than biological families. When hours of instrumental support are examined, White stepfamilies provide fewer hours of support than biological families, whereas no difference is found for Black or Hispanic families. Conclusion: Findings from this study contribute to broader work that calls for more nuanced understanding of the differential effects of family structure across social groups. Future research should consider applying within-race/ethnicity analyses when examining the association between family structure and intergenerational support.

The Eye of the Beholder: Attitudes toward divorced parents and perception of children's happiness in Peru and Spain.

Studies of divorce's effects on children have been oriented toward the parents' characteristics, ignoring their extended families. In the current study we collected data from 414 participants, both divorced parents and the children's extended families in Peru (155) and Spain (259). Participants completed a questionnaire on attitudes toward the parents, and the Short Dark Tetrad questionnaire. Multivariate tests were conducted on participants' responses, showing that negative attitudes toward parents are not very strong but that attitudes toward fathers are more negative than attitudes toward mothers. Custodial parents are perceived less negatively, and parents who share custody are perceived the least negatively. Extended family members hold more negative attitudes against parents than the parents themselves. Mothers have significantly more negative attitudes toward fathers than the fathers towards mothers. Dark traits are a significant predictor of negative attitudes toward the mother but not toward the father. The perception of unhappiness in the child was predicted by negative attitudes toward the parents. Non-parents tend to evaluate both parents more negatively compared to parents' mutual perceptions. There was an effect on dark traits, negative attitudes against parents, and perception of unhappiness in the child. Peruvians scored significantly higher in all variables.

Reappraising a Parent can Occur With Non-suggestive Questions: Changing Emotions and Memories of Emotion.

Whether it is possible to reappraise parents using non-suggestive questions, and whether this has an impact on emotions and memories, is of great interest in both life and psychotherapy. Past research has shown reappraisals of past situations is associated with changes in memories of emotions. In previous work we showed memories of love could be affected by reappraisals, but did not analyze that dataset on other memories of emotion. The current paper investigates the effect of reappraisals toward participants' mothers on the emotions: happiness, interest, sadness, and anger (and on memories of those emotions in childhood). Results show that emotions appeared to be significantly changed by reappraisals. In Experiment 1 (N = 301; Mage = 36), we found memories of emotion were affected, especially memory of happiness in childhood, but to a lesser degree compared to current emotions. This offered some confirmation of the cognitive appraisal view of memories of emotions. Experiment 2 (N = 202; Mage = 36) with pretest and posttest measures showed some similar patterns, but with slightly muted effects. Therapists and clients should be aware that non-suggestive prompts might lead to reappraisals of parents, with knock on effects on emotions and memories. Whether this should be part of informed consent in therapy is open to debate.

Anchoring Vignettes: A Useful Tool to Measure and Correct for Cultural Bias in Parent Reports on Their Child's Mental Health?

Parent report measures developed in the Western world are commonly used to assess children's mental health, but their cross-cultural comparability is questionable. The present study examines the use of anchoring vignettes to assess and adjust for bias in five countries: the United States, Mexico, Germany, China, and Russia. Parents (N = 500) rated their child's mental health and vignettes depicting internalizing and externalizing problem behaviors in an online survey. Vignette ratings were used to assess bias and for rescaling. Cross-national comparisons of vignette scores revealed differences in the use of the scale range and overall level of vignette scores. Measurement invariance across countries improved after rescaling, resulting in weak invariance for internalizing and strong invariance for externalizing problem behavior. Rescaled scores revealed cross-national differences that were masked using the raw score. Results confirm the lacking cross-national comparability in parent reports of child mental health, and anchoring vignettes appear to be a useful tool for reducing bias.