The long shadow of accumulating adverse childhood experiences on mental health in the United Arab Emirates: implications for policy and practice.

Introduction: This study investigates the cumulative effects of adverse childhood experiences (ACEs) on adult depression, anxiety, and stress in Abu Dhabi, controlling for demographic factors, lifestyle, and known health and mental health diagnoses. Methods: Utilizing a cross-sectional design and self-report measures, the research aims to fill a critical gap in understanding the specific impacts of ACEs in the UAE. Based on a multi-site, cross-sectional community sample of 697 residents of Abu Dhabi. Results: The findings reveal significant variances in current screening values for depression, anxiety, and stress attributable to ACEs after controlling for demographic factors, lifestyle risk factors, and adult diagnoses of health and mental health conditions. Discussion: The results underline the lifelong impact of ACEs and reinforce the importance of early identification and intervention. In particular, the implications for policy and practice in understanding and mitigating ACEs long-term effects on mental health are considered.

Infant and Early Childhood Mental Health (IECMH) and Early Childhood Intervention: Intentional Integration.

Infant and Early Childhood Mental Health (IECMH) is a multidisciplinary field of inquiry, practice, and policy concerned with enhancing the social-emotional competence of infants and young children. Early Childhood Intervention (ECI) is a system of services that supports infants and toddlers with disabilities and their families. ECI providers promote a child's development in all domains, including social-emotional. The purpose of this paper is to describe how two systems, Early Childhood Intervention and Infant Early Childhood Mental Health, collaborate when serving children who have developmental delays or disabilities and their families and other caregivers. We will discuss two models used to promote social-emotional development, the Pyramid Model and IECMH Consultation, and provide three examples that demonstrate how ECI and IECMH intersect at both the family, classroom, and system levels.

Inclusion, Participation, Belonging = Surviving, Thriving, Flourishing.

PURPOSE: To share my perspectives on how pediatric physical therapists support children with disabilities and their families to maximize their potential to flourish. KEY POINTS: Best practice supports the inclusion of people with disabilities in all aspects of society. Policy statements from governmental agencies, research universities, advocacy, and non-governmental organizations all support inclusion. The concept of belonging and how pediatric physical therapists can promote belonging is less familiar to pediatric physical therapists than inclusion and participation. Essential elements necessary to bring about a sense of belonging in young children will be presented, leading to a discussion on the role of the pediatric physical therapist and key implications for the early childhood system of care. CONCLUSIONS: Pediatric physical therapists support children with disabilities and their families to maximize the potential of every child. I propose that to do this, we must focus our interventions to promote a child's active participation in community life and build programs and relationships that promote belonging. CLINICAL RELEVANCE: Interventions for children with disabilities will be successful by focusing on the outcomes that promote inclusion, participation, and belonging.

Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates.

BACKGROUND: Adverse Childhood Experiences have been associated with poor health outcomes later in life. OBJECTIVE: The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi. PARTICIPANTS AND SETTING: A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi. METHODS: The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors. RESULTS: Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk. CONCLUSIONS: The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.

Moving beyond Inclusion to Belonging.

This paper explores the concepts of inclusion, participation, and belonging in the context of development for children with disabilities. The importance of creating an environment that embraces diversity, encourages active engagement, and nurtures a sense of belonging for children is discussed. The authors provide insights into the benefits of inclusive practices, strategies to enhance participation, and methods to foster a sense of belonging in children with disabilities. The authors argue that service providers and service systems must move beyond fostering social inclusion and inclusive education, although emphasized globally, and focus on promoting participation and ultimately belonging to ensure that children with disabilities are full members of their communities.

The intersection of gross motor abilities and participation in children with autism spectrum disorder.

Many children with autism spectrum disorder (ASD) demonstrate movement difficulties in addition to problems with social communication and interactions, and repetitive or restrictive behaviors. The goal of early intervention for children with disabilities is to promote participation in routines and activities, but little is known about the role gross motor abilities contribute to participation for young children with ASD. The purpose of this study was to examine relationships between gross motor abilities and participation in preschool-aged children with ASD. Twenty-two children with ASD participated in the study. Gross motor skills were measured using the Peabody Developmental Motor Scales, Second Edition. Participation was measured using the Preschool Activity Card Sort. Children who had greater gross motor skills also demonstrated greater participation in self-care, high demand leisure, and social interaction activities. Results also identified activities that may be difficult for preschoolers with ASD. Findings suggest that early childhood intervention providers consider the impact of gross motor deficits within the context of participation in daily routines and activities.

The Interdependence of Motor and Social Skill Development: Influence on Participation.

Participation is a major outcome area for physical therapists serving young children with disabilities. Contemporary models of disability such as the International Classification of Function, developmental theories such as the system perspective, and evidence-based early childhood practices recognize the interdependence of developmental domains, and suggest that change in 1 area of development influences change in another. Physical therapy provided in naturally occurring activities and routines, considered the preferred service delivery method, promotes participation of young children with disabilities. Research indicates that: (1) children develop skills, become independent, and form relationships through participation; and (2) with developing skills, children can increasingly participate. The purpose of this Perspective article is to synthesize the literature examining the relationship between motor skill development and the social interaction dimension of participation in young children. Current research examining the influence of motor skill development on social interactions in children with autism spectrum disorder will be discussed, exemplifying the interdependence of developmental domains. Implications for physical therapist practice and recommendations for future research are provided.

Concurrent Validity of Two Standardized Measures of Gross Motor Function in Young Children with Autism Spectrum Disorder.

AIMS: This study provides information on how two standardized measures based on different theoretical frameworks can be used in collecting information on motor development and performance in 4- and 5-year-olds with autism spectrum disorder (ASD). The purpose of the study was to determine the concurrent validity of the Miller Function and Participation Scales (M-FUN) with the Peabody Developmental Motor Scales, Second Edition (PDMS-2) in young children with ASD. METHODS: The gross motor sections of the PDMS-2 and the M-FUN were administered to 22 children with ASD between the ages of 48 and 71 months. Concurrent validity between overall motor scores and agreement in identification of motor delay were assessed. RESULTS: A very strong correlation (Pearson's r =.851) was found between the M-FUN scale scores and the PDMS-2 gross motor quotients (GMQs). Strong agreement in identification of children with average motor skills and delayed motor skills at 1.5 standard deviations below the mean was also found. CONCLUSIONS: This study supports the concurrent validity of the M-FUN with the PDMS-2 for young children with ASD. While both tests provide information regarding motor delay, the M-FUN may provide additional information regarding the neurological profile of the child.

Relationships Between Gross Motor Skills and Social Function in Young Boys With Autism Spectrum Disorder.

PURPOSE: The purpose of this study was to examine the relationship between gross motor skills and social function in young boys with autism spectrum disorder. METHODS: Twenty-one children with autism spectrum disorder participated in the study. The Peabody Developmental Motor Scales Second Edition and the Miller Function and Participation Scales were used to assess gross motor skills. The Social Skills Improvement System Rating Scales was used to assess social function. RESULTS: Moderately high correlations were found between overall gross motor and social skills (r = 0.644) and between the core stability motor subtest and overall social skills (r = -0.672). Specific motor impairments in stability, motor accuracy, and object manipulation scores were predictive of social function. CONCLUSIONS: This study suggests that motor skills and social function are related in young boys with autism. Implications for physical therapy intervention are also discussed.

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities.

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Health in hope: finding the soul of primary care.

Discusses the importance of offering hope to clients, no matter what their circumstances. Hope can be hard to find in situations of extreme poverty, and poverty breeds hopelessness. But hope promotes healthy behavior, like increased consumption of fruits and vegetables, regular exercise, safer sex, smoking cessation, and resumption of medications. That is the power of hope working in the heart of a patient to do what no clinician can: make good decisions, forgo bad habits, and see health as a priority and reality in life. Foster hope. Hope is healthy.

The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review.

AIM: The purpose of this study was to review published research on the use of the Gross Motor Function Measure (GMFM-88) and (GMFM-66) as outcome measures to determine if these tools detect changes in gross motor function in children with cerebral palsy (CP) undergoing interventions. METHODS: A comprehensive literature search was conducted using Medline and PubMed to identify studies published from January 2000 through January 2011 that reported the accuracy of GMFM-88 and GMFM-66 to measure changes over time in children with CP undergoing interventions. The keywords used for the search were "GMFM" and "CP". Two of the authors (M.A. and S.B.) reviewed the titles and abstracts found in the databases. The methodological quality of the studies was assessed by using the Critical Review Form-Quantitative Studies. RESULTS: Of 62 papers initially identified, 21 studies fulfilled the inclusion criteria. These articles consist of three longitudinal studies, six randomized controlled trials, four repeated measure design, six pre-post test design, a case series and one non-randomized prospective study. The included studies were generally of moderate to high methodological quality. The studies included children from a wide age range of 10 months to 16 years. According to the National Health and Medical Research Council, the study designs were level II, III-2, III-3 and IV. CONCLUSION: The review suggests that the GMFM-88 and GMFM-66 are useful as outcome measures to detect changes in gross motor function in children with CP undergoing interventions. Implications for Rehabilitation Accurate measurement of change in gross motor skill acquisition is important to determine effectiveness of intervention programs in children with cerebral palsy (CP). The Gross Motor Function Measure (GMFM-88 and GMFM-66) are common tools used by rehabilitation specialists to measure gross motor function in children with CP. The GMFM appears to be an effective outcome tool for measuring change in gross motor function according to a small number of randomized control studies utilizing participant populations of convenience.

Development and content validity of the Therapy Behavior Scale.

The purpose of this study was to develop an assessment instrument that would allow clinicians to (1) evaluate behaviors of infants and toddlers during therapeutic intervention based on their own observations; (2) be applicable in a home-based or an outpatient therapeutic setting; and (3) be appropriate for use with infants and toddlers from birth to three years of age regardless of their developmental level or level of disability. Six pediatric therapists participated in the development and content evaluation of the instrument, Therapy Behavior Scale (TBS) with its subsequent revision into the TBS Version 1.0. Three raters pilot tested the scale with seven infants and toddlers. The results supported the content validity of the TBS Version 1.0 and led to the development of the TBS Version 1.1. Further research is needed to validate the newest version of the scale and to establish its intra-rater and interrater reliability.

The pediatric physical therapist's role in promoting and measuring participation in children with disabilities.

PURPOSE: The purposes of this article were to discuss participation relative to the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) model, evaluate 3 current pediatric participation measures that have been designed to assess participation, and review research findings relevant to participation in children and adolescents with disabilities. KEY POINTS: The concept of participation has been challenging to define and measure. Successful participation of children and adolescents with disabilities in daily life activities is influenced by individual, family, and environmental factors. Currently available tools designed to measure participation of children and adolescents have strengths and limitations, which should be considered when selecting tools for use in clinical practice. CONCLUSION: Pediatric physical therapists can increase participation of children and adolescents with disabilities by measuring and promoting meaningful outcomes in the individual, family, and environmental components of the ICF-CY.

Hippotherapy--an intervention to habilitate balance deficits in children with movement disorders: a clinical trial.

BACKGROUND: Clinical observations have suggested that hippotherapy may be an effective strategy for habilitating balance deficits in children with movement disorders. However, there is limited research to support this notion. OBJECTIVE: The purposes of this study were to assess the effectiveness of hippotherapy for the management of postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. DESIGN: A repeated-measures design for a cohort of children with documented balance deficits was used. METHODS: Sixteen children (9 boys and 7 girls) who were 5 to 16 years of age and had documented balance problems participated in this study. Intervention consisted of 45-minute hippotherapy sessions twice per week for 6 weeks. Two baseline assessments and 1 postintervention assessment of balance, as measured with the Pediatric Balance Scale (PBS), and of function, as measured with the Activities Scale for Kids-Performance (ASKp), were performed. RESULTS: With the Friedman analysis of variance, the PBS and the ASKp were found to be statistically significant across all measurements (P<.0001 for both measures). Post hoc analysis revealed a statistical difference between baseline and postintervention measures (P≤.017). This degree of difference resulted in large effect sizes for PBS (d=1.59) and ASKp (d=1.51) scores after hippotherapy. A Spearman rho correlation of .700 indicated a statistical association between PBS and ASKp postintervention scores (P=.003). There was no correlation between the change in PBS scores and the change in ASKp scores (r(s)=.13, P>.05). LIMITATIONS: Lack of a control group and the short duration between baseline assessments are study limitations. CONCLUSIONS: The findings suggest that hippotherapy may be a viable strategy for reducing balance deficits and improving the performance of daily life skills in children with mild to moderate balance problems.

Collaborative learning and technology skills development: evaluation of an online annual grantee meeting.

Annual meetings provide the opportunity to communicate with colleagues with similar professional interests and bolster training initiatives. However, the cost of face-to-face meetings, including travel expenses and lost work time, is high. Although face-to-face meetings offer unique advantages, fiscal considerations compel consideration of alternatives. Distance Learning Grantees (Division of Research, Training and Education, MCH Bureau, Health Resources and Services Administration) and MCH project staff conducted their annual grantee meeting online in 2010. The meeting featured project updates and technical skills training over the course of a three-day meeting. Direct costs of the online meeting were low, and evaluations indicated that all participants were satisfied with the online format.

Synthesis of epoxybenzo[d]isothiazole 1,1-dioxides via a reductive-Heck, metathesis-sequestration protocol.

An atom-economical purification protocol, using solution phase processing via ring-opening metathesis polymerization (ROMP) has been developed for the synthesis of tricyclic sultams. This chromatography-free method allows for convenient isolation of reductive-Heck products and reclamation of excess starting material via sequestration involving metathesis catalysts and a catalyst-armed Si-surface.

"Click"-capture, ring-opening metathesis polymerization (ROMP), release: facile triazolation utilizing ROMP-derived oligomeric phosphates.

Soluble, high-load ring-opening metathesis polymerization (ROMP)-derived oligomeric triazole phosphates (OTP) are reported for application as efficient triazolating reagents of nucleophilic species. Utilizing a "Click"-capture, ROMP, release protocol, the efficient and purification-free, direct triazolation of N-, O-, and S-nucleophilic species was successfully achieved. A variety of OTP derivatives were rapidly synthesized as free-flowing solids on a multigram scale from commercially available materials.

Automated synthesis of a 184-member library of thiadiazepan-1,1-dioxide-4-ones.

The construction of a 225-member (3 × 5 × 15) library of thiadiazepan-1,1-dioxide-4-ones was performed on a Chemspeed Accelerator (SLT-100) automated parallel synthesis platform, culminating in the successful preparation of 184/225 sultams. Three sultam core scaffolds were prepared based upon the utilization of an aza-Michael reaction on a multifunctional vinyl sulfonamide linchpin. The library exploits peripheral diversity in the form of a sequential, two-step [3 + 2] Huisgen cycloaddition/Pd-catalyzed Suzuki-Miyaura coupling sequence.