Childhood abuse and unplanned pregnancies: a cross-sectional study of women in the Norwegian Mother and Child Cohort Study.

OBJECTIVE: To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse. DESIGN: A cross-sectional study. SETTING: The study is based on the Norwegian Mother and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway. SAMPLE: Women participating in the MoBa for the first time, ≥18 years of age who responded to questions regarding childhood abuse and pregnancy planning (n = 76 197). METHODS: Data were collected using questionnaires. We conducted analyses using modified Poisson regressions and the relative excess risks due to interaction (RERI). Sensitivity analyses were performed. MAIN OUTCOME MEASURE: An unplanned pregnancy (yes/no). RESULTS: Exposure to childhood emotional (adjusted relative risk [RR] 1.14, 95% CI 1.10-1.19), physical (adjusted RR 1.11, 95% CI 1.04-1.18) and sexual (adjusted RR 1.20, 95% CI 1.14-1.27) abuse increased the risk of having an unplanned pregnancy. The effects could not be explained by the collider stratification bias. The different combinations of categories of abuse did not show any interaction effects. CONCLUSIONS: Childhood emotional, physical and sexual abuses separately increase the risk of having an unplanned pregnancy. The results indicate that victims of childhood abuse are in greater need of support to achieve their reproductive goals. TWEETABLE ABSTRACT: Childhood abuse increases the risk of having an unplanned pregnancy. #reproductivehealth #epitwitter.

Aided language modelling, responsive communication and eye-gaze technology as communication intervention for adults with Rett syndrome: three experimental single case studies.

PURPOSE: To examine the effect of a communication intervention package on expressive communication and visual attention in individuals with Rett syndrome. MATERIALS AND METHODS: A modified withdrawal (A-B1-A1-B2-A2) single case experimental design with a direct inter-subject replication across three participants was applied. Three women with Rett syndrome participated. The study took place over a six-week period and comprised 32 sessions with each participant. All sessions were video recorded. During the intervention the communication partner used aided language modelling on a gaze-controlled device in combination with using responsive partner strategies. Expressive communication was assessed as synthesised words per minute and unique synthesised words per minute. Visual attention was assessed as rate of focused gazes (1 s or longer) in interaction. RESULTS: An intervention effect was found on the rate of unique words for all participants. The rate of words increased for two participants when the intervention was introduced but no withdrawal effect could be seen. An intervention effect on visual attention could be seen for one participant. The intervention appeared to have social validity as reported by caregivers. CONCLUSION: Aided language modelling (ALM), while using responsive partner strategies and a gaze-controlled device may be used with adult individuals with Rett syndrome to increase their rate of expressive communication. Detailed observational measures revealed individual learning patterns, which may provide clinically valuable insights.Implications for RehabilitationAdults with Rett syndrome may benefit from access to gaze-controlled devices in combination with responsive partner strategies.Responsive partner communication may be effective for some individuals with Rett syndrome to increase their rate of synthesised utterances.Rate of focused gazes may be considered as an outcome measure for individuals with oculomotor difficulties when introducing aided language modelling.

Behavior in term, small for gestational age preschoolers.

AIMS: To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems. STUDY DESIGN: Follow-up study at 5 years of age. SUBJECTS: A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants. OUTCOME MEASURES: The Personality Inventory for Children and the Yale Children's Inventory (completed by the mothers), and child behavior during psychometric testing. RESULTS: Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants. CONCLUSION: Being born moderately SGA is not a significant risk factor for preschool behavior problems.

Pupils with mild mental retardation in regular Swedish schools: prevalence, objective characteristics, and subjective evaluations.

Pupils in regular Swedish schools who met the psychometric criterion of mental retardation were identified and described. Using a national longitudinal data set, we compared a group of 13-year-old pupils (N = 116) not officially classified as having mental retardation to their peers without mental retardation across measures of school achievement, social background, self-evaluations of school experiences, and upper secondary school education. The results showed that the former group was low-achieving and had poor self-evaluations; however, some pupils in the general population shared these characteristics.

Early identification of children with developmental disabilities.

This paper provides an overview of research into early identification of children with developmental disabilities in child healthcare, especially those disabilities related to cognitive impairment. The review covers the following related topics: definition of the target group, the predictive value of developmental screening instruments and psychomotor tests, risk indexes, early intervention and evaluation of developmental screening programmes. Empirical research into child development and the predictive value of developmental tests is extensive. However, proportionally few, mostly cohort or case-control, studies focusing on evaluation of developmental screening programmes conducted within a clinical setting were found. Some sensitivity and most specificity rates reported fell within what is considered acceptable for developmental screening performed in the pre-school years, i.e. a sensitivity of more than 70% and a specificity between 70% and 80%. Overall, between 1-6% of the children screened were identified. Typically, most children with severe disabilities were identified prior to the screening or excluded from the studies reviewed. The shortcomings of developmental screening (instruments) and difficulties in early identification are discussed.

Maternal child-rearing attitudes, IQ, and socioeconomic status as related to cognitive abilities of five-year-old children.

The effects of maternal child-rearing attitudes, as measured by the Child Rearing Practices Report, on 5-yr.-old children's Verbal IQ and Performance IQ were investigated in a Scandinavian sample of 108 boys and 126 girls. The maternal child-rearing attitude of Restrictiveness, as defined by scores on the Report, showed negative relations to the cognitive measures. However, the significant negative relation between Restrictiveness and Verbal IQ, obtained for both sexes, disappeared when the effects of maternal IQ and socioeconomic status were controlled. The maternal child-rearing attitude of Nurturance, as defined by scores on the Report, was significantly related to Verbal IQ and Performance IQ for boys only. Significant relationships between scores on Nurturance and cognitive abilities of boys remained when the effects of maternal IQ and socioeconomic status were controlled.

Living conditions of adults with intellectual disabilities from a gender perspective.

BACKGROUND: The role of gender has been a neglected issue in research on intellectual disability (ID). People with ID are generally treated as a homogenous group that are largely categorized by their level of ID. This study compared living conditions of women and men with ID and related the results to similarities and differences among the general population in corresponding age groups. METHODS: Persons with ID born in Uppsala County between 1959 and 1974 constituted the study sample. Information on the living conditions of 110 persons with ID was collected using questionnaires completed by relatives and staff. Information on living conditions of the general population was obtained through national welfare statistics conducted by Statistics Sweden (SCB). RESULTS: In both samples corresponding diversities were revealed for type of employment/daily activities, where women worked in traditional female job sectors and men were occupied with traditional male jobs. Women and men with ID participated to about the same extent in recreational and cultural activities and on only four of the 19 activities listed in the questionnaire (visits to the cinema and library, reading books and practising hobbies alone) significant differences were observed. Among women and men in the general population, we found gender-related differences in 13 of the activities listed. However, with the exception of women more frequently visiting the library and reading books, the two samples demonstrated no corresponding gender-related differences. For the remaining six domains (finances, family and social relations, housing, transport, community participation and personal safety), no differences were noted between women and men with ID. This finding contrasted sharply with the differences found between women and men in the general population. CONCLUSIONS: Surprisingly, the comparison yielded few differences in living conditions between women and men with ID compared with those found in women and men of the general population. This finding suggests that people with ID were treated as gender-neutral persons rather than as women and men with individual preferences and needs. Thus, it appears that having ID is a more important determinant than gender regarding living conditions for women and men with ID.

A follow-up study of mortality, health conditions and associated disabilities of people with intellectual disabilities in a Swedish county.

BACKGROUND: In the planning of services and health care for individuals with intellectual disability (ID), information is needed on the special requirements for habilitation and medical service and associated disabilities. MATERIAL AND METHODS: An unselected consecutive series of 82 adult persons with ID was studied. The medical examination consisted of the individual's health condition, associated impairments and disabilities. Medical and habilitation services and support were studied. RESULTS: The results indicated that 71% of the persons in the series had severe and 29% mild ID. Forty-seven per cent of the persons with severe ID and 35% of those with mild ID had one or more additional central nervous system (CNS) disabilities. Of the persons with ID, 99% had access to a family doctor and 84% attended regular health visits. Notably, half of persons were referred to a specialist examination as a consequence of their present medical examination. Half of the persons with mental health problems were previously undiagnosed and only a few of these had access to a psychiatrist. CONCLUSION: Our study clearly demonstrates the magnitude and importance of neurological and psychiatric impairments in ID. The findings suggest a strong need for multidisciplinary health service.

Early identification and prognosis: parental developmental assessment of 18-month-old children.

The overall purpose of the study was to develop a screening instrument for the identification of developmental delay which could be administered entirely by parents. Reliability, concurrent and predictive validity was investigated in a Swedish population of 3,245 18-month-old children. The prevalence of mental retardation and learning disabilities implied by educational support provided in the regular school system was investigated in follow-up studies at 8 and 14 years. At 8 years, 20 children were administratively classified as mentally retarded. At 18 months they were among lowscorers or attrition cases. Among the remaining lowscorers 51.2% at 8 years and 26.6% at 14 years received special education in the normal school, i.e. were true positives. The rates of false negatives, i.e. children scoring normally at 18 months who received special education at 8 and 14 years, were 18.5% and 4.6% respectively. The prevalence of administratively classified mentally retarded was 0.62% at 8 years and 0.65% at 14 years. When the cases receiving special education in regular classes were added the prevalence figures were 2.1% at 8 years and 1.29% at 14 years. Apart from showing that parants can and will fill out a questionnaire on the developmental progress of their children that can be used for predictive purposes the study also points at the relatively inherent in the concept of mental retardation and true prevalence of especially mild mental retardation.

Parental developmental assessment of 18-month-old children: reliability and predictive value.

The reliability and predictive validity of a parental screening instrument based on the Griffiths Mental Developmental Scale was investigated in a Swedish population of 3245 18-month-old children. Parental and professional assessments were compared. 2 per cent of low-scoring children were tested with the Griffiths Scale, and correlation with parental assessment was 0.87. The prevalence of mental retardation and of learning disabilities were investigated in follow-up studies at eight and 14 years, and these studies identified all mentally retarded children at those ages among the low-scoring or attrition cases at 18 months. Other learning disabilities were reported for 51.2 per cent of low-scoring children, compared with 18.5 per cent of controls. A comparison between parental assessment scores and test scores at 18 months with follow-up results showed that the two assessment methods yielded similar predictions.

Psychometric evaluation of a Swedish version of the Reiss Screen for Maladaptive Behavior.

BACKGROUND: People with intellectual disability (ID) are afflicted by mental health problems to a greater extent than other individuals, and the coexistence of ID and mental health problems involves diagnostic as well as treatment difficulties. METHODS: A Swedish version of the Reiss Screen for Maladaptive Behavior (RSMB), an instrument used for identification of mental health problems in people with intellectual disability (ID) was evaluated in terms of inter-rater agreement, internal consistency, item grouping and criterion validity based on a random sample and a clinical group of adults with ID. RESULTS: The Swedish version of the RSMB had moderate-to-low inter-rater agreement on specific items and good internal consistency. The total score was considered to be a fairly reliable measure of a positive or negative result on the RSMB. A principal component analysis yielded seven interpretable components. A close resemblance in sets of items between the Swedish version and the original version of RSMB was found for three subscales: Aggressive Behaviour, Avoidance Disorder and Depression (Behavioural Signs). The outcome of the criterion validity analysis indicated a higher rate of false negatives than false positives. CONCLUSIONS: The potential influence of concurrent psychopharmacological treatment is discussed. It is concluded that the Swedish version of the RSMB can be used as intended by staff as a primary screening device for the identification of mental health problems among people with ID in a Swedish setting.

Classification, prevalence, prevention and rehabilitation of intellectual disability: an overview of research in the People's Republic of China.

The People's Republic of China is a developing country with all the problems and challenges that face such countries all over the world. Progress has been hampered by scarcity of resources, and a lack of relevant information and appropriate skills, as well as by the stigma traditionally attached to people with intellectual disability. The present rapid economic development has made possible further improvement and expansion of educational opportunities, and health and rehabilitation services. According to a recent census and sample surveys conducted in the People's Republic of China, the overall prevalence rate of people with disabilities was estimated to 4.9%. Thus, China has more individuals with disabilities than any other country in the world. According to these figures, the prevalence of intellectual disability in the population is approximately 1%. For children younger than 14 years of age, the prevalence is around 2%, which accounts for 66% of all handicapped children, making it the most frequent childhood disability. Today, the existing medical facilities, and educational and social welfare organizations cannot meet the tremendous need of care and services. The problems of the large number of disabled children and adults are a major challenge for contemporary Chinese society. This paper is devoted to research pertinent to intellectual disability in China. With a few exceptions, only publications in the English language were included in this review, which makes the overview selective rather than comprehensive. Publications on classification systems and diagnostic criteria, screening methods and assessment instruments, prevalence rates, aetiology and risk factors, prevention and intervention efforts, special education, and families with children with intellectual disability are presented.

Predictors of developmental delay at 18 months and later school achievement problems.

The aim of the study was to examine the predictive value of the variables of parental assessment score, pre-, peri-, and postpartum optimality, sex, socioeconomic status (SES), and maternal education with respect to developmental delay at 18 months, and intellectual disability and school achievement problems at 8 and 14 years. The sample studied comprised 101 children (53 low scorers and 48 controls) originally from a total population of 2783 children assessed by their parents at 18 months using a screening instrument. Data were analysed by logistic regression. The results yielded moderate but statistically significant correlations between predictor and outcome variables. Optimality score and maternal education were the best predictors of developmental delay at 18 months. At 8 years, parental assessment score and maternal education constituted the best predictors of school achievement problems. At 14 years, SES together with parental assessment score were included in the model, when school achievement problems were predicted. Parental assessment score showed the strongest association with school achievement problems at both 8 and 14 years, when children with intellectual disability were included in the analysis. The exclusion of children with intellectual disability from the analyses yielded a stronger association between maternal education (at 8 years) and SES (at 14 years) and school achievement problems. The overall classification accuracy of the models varied between 67% and 88%. Specificity varied from 65% at 18 months to 95% at 14 years. Sensitivity varied from 70% at 18 months and 55% (all cases) and 42% (children with intellectual disability excluded) at 14 years.

Occurrence of mental health problems in Swedish samples of adults with intellectual disabilities.

OBJECTIVE: The aim of this study was to investigate the occurrence of mental health problems in adults with intellectual disabilities (ID) and the number of adults with ID receiving care at general mental health clinics. METHOD: The Reiss Screen for Maladaptive Behaviour and the Psychopathology Inventory for Mentally Retarded Adults were used to investigate mental health problems in samples from two Swedish counties. Adults with ID receiving psychiatric care at general mental health clinics were investigated via the mental health services register in one county. RESULTS: The overall occurrence of mental health problems in adults with ID ranged from 34% to 64%. The most common mental health problems were aggressive, self-injurious behaviours, signs of depression, anxiety or adjustment problems. The occurrence of adults with ID among patients receiving out- or in-patient psychiatric care was approximately 1%. Between 70% and 90% of these persons had a mild level of ID. CONCLUSION: The overall occurrence of mental health problems was similar to reported overall figures in comparable studies conducted in the US, UK and Denmark. The number of adults with ID registered for out- or in-patient psychiatric care was low compared with the occurrence of mental health problems based on the screening results.

Reduced optimality as an indicator of developmental status at 18 months and school achievement at 8 years.

Birth records of 97 children assessed at 18 months and found to be developmentally delayed were scored according to the optimality concept developed by Prechtl. These children were compared to a control series of 81 children. In order to evaluate the predictive validity of the parental developmental assessments performed at 18 months the children had been screened for school achievement problems at the age of eight years, yielding a distribution of true and false positives and true and false negatives. Rates of reduced optimality were compared to investigate firstly, the relationship between reduced optimality and developmental delay at 18 months and secondly, whether the follow-up distribution of true and false positives at eight years could be related to reduced optimality. The overall relationship between reduced optimality and developmental delay at 18 months and reduced optimality and school achievement problems at eight years was also investigated. The 15 low scoring cases registered as mentally retarded differed significantly from controls on total mean reduced optimality. Retarded and non-retarded low-scorers differed significantly on post partum sub-scores only. When the eight-year follow-up groups were compared both retarded and non-retarded true positives differed significantly from true negatives on total mean reduced optimality. The difference in post-partum reduced optimality between retarded and all other follow-up groups but non-retarded true positives reached statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Gender and its contribution to the prediction of cognitive abilities at 5 years.

Gender-related differences in the prediction of five year-olds' cognitive abilities from measures of distal environment, proximal environment and infant test scores were examined in a random sample of 93 boys and 90 girls. Distal environmental data included maternal IQ, maternal and paternal education. Proximal environmental data included two variables derived from the Home Screening Questionnaire: the Home Questions and the Toy Checklist. The Bayley MDI was administered at age 13 months, whereas WPPSI-R was used as cognitive outcome measure at age 5 years. The relationship between paternal education and child IQ, and between proximal environmental variables and child IQ was significantly stronger for boys than for girls. The associations between proximal environment and IQ in boys, were accounted for by the distal environmental variables. Bayley MDI correlated significantly higher with girls' IQ compared to boys' IQ. Findings are discussed in terms of parental gender-differentiated socialization processes.

Cognitive development of term small for gestational age children at five years of age.

AIM: To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS: IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS: The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS: Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.