Offord Centre for Child Studies, McMaster University, Chedoke Site, Central Building, Room 310, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neurosciences, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration - J Wing, 100 West 5th, Hamilton, Ontario L8N 3K7, Canada. Electronic address: firstname.lastname@example.org.
The aim of this study was to test for measurement invariance and examine differences in global self-concept between adolescents with and without physical illness or developmental disability. The sample consisted of adolescents 10-19 years who participated in the Canadian National Longitudinal Survey of Children and Youth (N=8491). Multiple group confirmatory factor analysis was used to test for measurement invariance. Twenty-three percent (n=1966) of participants had a physical illness or developmental disability. Support was found for strict measurement invariance between groups suggesting adolescents in both groups perceived items similarly, indicating that comparisons between adolescents with and without physical illness or developmental disability are meaningful. Controlling for several sociodemographic characteristics, evidence suggested that self-concept is lower in adolescents with physical illness or developmental disability, ß=-0.24, p=0.0005, compared to their healthy peers. Future work should attempt to understand the processes leading to compromised self-concept in adolescents with physical illness or developmental disability.
The Helsinki High-Risk Study monitors women treated for schizophrenia-spectrum disorders in Helsinki mental hospitals before 1975, their offspring, and controls.
To compare the development of high-risk and control group children, and investigate which factors predicted future psychiatric disorders.
We examined information from childhood and school health record cards of 159 high-risk and 99 control group offspring. Logistic regression was used to assess whether developmental abnormalities predicted later mental disorders.
Compared with controls, children in the high-risk group had more emotional symptoms before school age, attentional problems and social inhibition at school age, and neurological soft signs throughout. In this group pre-school social adjustment problems (OR=9.7, 95% CI 1.8-51.8) or severe neurological symptoms (Fisher's test, P=0.006) predicted future schizophrenia-spectrum disorder. Social adjustment problems and emotional symptoms during school age predicted future non-psychotic psychiatric disorders.
Our study supports the validity of neurological, emotional, social and behavioural markers as vulnerability indicators of psychotic and other mental disorders, particularly among children genetically at high risk of psychosis.
This population-based study examined correlates of three parenting behaviors (positive interactions, consistency, and ineffective parenting) that have been shown to differ in children with neurodevelopmental disorders (NDDs), with and without externalizing behavior problems (EBPs), as compared to children with neither condition.
The sample of children aged 4-11 (N = 14,226) was drawn from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Analyses examined the associations of child, parental, and social context factors with parenting behaviors, and whether they differed by child health group.
Child age, family functioning, and social support variables were significant predictors of all three parenting behaviors. Significant interaction effects highlight the importance of the child's sex, birth order, and support received from community or social service professionals, and that these factors have differential impacts on parenting behaviors depending on the child's health group.
Other Child, parent, and social context factors are associated with parenting behaviors but these associations vary by the child's health group. Parenting behaviors differ for children with NDDs with and without EBPs. These findings offer important implications for practice and research and point to the importance of considering multiple contexts of influence, as well as their interactions, in understanding differences in parenting behaviors.
An overarching question in health policy concerns whether the current mix of public and private health coverage in the United States can be, in one way or another, expanded to include all persons as it does in Canada. As typically high-end consumers of health care services, people with disabilities are key stakeholders to consider in this debate. The risk is that ways to cover more persons may be found only by sacrificing the quantity or quality of care on which people with disabilities so frequently depend. Yet, despite the many comparisons made of Canadian and U.S. health care, few focus directly on the needs of people with disabilities or the uninsured among them in the United States. This research is intended to address these gaps. Given this background, we compare the health care experiences of working-age uninsured and insured Americans with Canadian individuals (all of whom, insured) with a special focus on disability. Two questions for research guide our inquiry: (1) On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access, utilization, satisfaction with, or quality of health care services within or between the United States and Canada? (2) After controlling covariates, when examining each level of disability severity, are there any significant differences in these measures of access, utilization, satisfaction, or quality between U.S. insured and Canadian persons?
Cross-sectional data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed with particular attention to disability severity level (none, nonsevere, or severe) among three analytic groups of working age residents (insured Americans, uninsured Americans, and Canadians). Differences in three measures of access, one measure of satisfaction with care, one quality of care measure, and two varieties of physician contacts are compared. Multivariate methods are then used to compare the healthcare experiences of insured U.S. and Canadian persons on the basis of disability level while controlling covariates.
In covariate-controlled comparisons of insured Americans and Canadians, we find that people with disabilities report higher levels of unmet need than do their counterparts without disabilities, with no difference in this result between the nations. Our findings on access to medications and satisfaction with care among people with disabilities are similar, suggesting worse outcomes for people with disabilities, but few differences between insured U.S. and Canadian individuals. Generally, we find higher percentages who report having a regular physician, and higher contact rates with physicians among people with disabilities than among people without them in both countries. We find no evidence that total physician contacts are restricted in Canada relative to insured Americans at any of the disability levels. Yet we do find that quality ratings are lower among Canadian respondents than among insured Americans. However, bivariate estimates on access, satisfaction, quality, and physician contacts reveal particularly poor outcomes for uninsured persons with severe disabilities in the United States. For example, almost 40% do not report having a regular physician, 65% report that they need at least one medication that they cannot afford, 45% are not satisfied with the way their care is provided, 40% rate the overall quality of their care as fair or poor, and significant reductions in contacts with two types of physicians are evident within this group as well.
Based on these results, we find evidence of disparities in health care on the basis of disability in both Canada and the United States. However, despite the fact that Canada makes health insurance coverage available to all residents, we find few significant reductions in access, satisfaction or physician contacts among Canadians with disabilities relative to their insured American counterparts. These results place a spotlight on the experiences of uninsured persons with disabilities in America and suggest further avenues for research.
The aim of the present study was to investigate the relationship between age of neuromotor milestone attainment and risk of adult schizophrenia. 5765 mothers of the Copenhagen Perinatal Cohort recorded 12 developmental milestones during the child's first year of life. Cohort members were followed until they were 46-48 years old through record linkage with the Danish Psychiatric Central Research Register. The age at which milestones were met in the 92 individuals who later developed schizophrenia was compared with milestone attainment in the 691 individuals who developed other psychiatric disorders and in the 4982 cohort controls who were never admitted to a psychiatric department. Group comparisons were adjusted for gender, mother's age, father's age, parental social status, breadwinner's education, single mother status and parity. Individuals who developed schizophrenia reached all developmental milestones later than controls and differed significantly from the controls with respect to the mean age of reaching the 12 milestones. Five developmental milestones in particular (smiling, lifting head, sitting, crawling, and walking) differed significantly. Individuals who later developed psychiatric disorders other than schizophrenia reached most developmental milestones earlier than those who developed schizophrenia, but later than the controls. The two psychiatric groups only differed significantly with respect to age of walking without support. The findings corroborate and methodologically extend previous research from prospective longitudinal cohort studies suggesting developmental delays observable as early as within the first year of life. These early developmental delays may not only characterize schizophrenia, but may be associated with a range of psychiatric disorders.
Individuals with developmental disabilities often experience challenges in acquiring toileting skills, which highlights a need for effective toilet training strategies that can be readily disseminated to caregivers. The purpose of this multiple baseline study was to evaluate the effectiveness of a modified rapid toilet training workshop provided to the parents of six children with developmental disabilities. In the workshop, parents were taught to implement an instructional protocol that included increased fluid intake, positive reinforcement for correct toileting, scheduled toilet sittings, scheduled chair sittings to teach initiation, neutral redirection for accidents, and procedures to enhance maintenance and generalization. Following the workshop, parents implemented the toilet training protocol at home with their children for 5-8 days, with telephone support from a researcher. Results indicate that the workshop resulted in increased in-toilet urination and defecation and decreased accidents for the five children who completed the study. The results are discussed in relation to previous and future research and implications for practice.
Seven Swedish mothers with an intellectual disability were interviewed for this exploratory study, aimed at charting such mothers' views and experiences of their encounters with different health and social service professionals. Three distinct themes emerged from the interviews. First, the mothers experienced the interaction to be marred by lack of comprehensibility, resulting from inadequate information and their perception of not being treated properly. Second, despite their reservations about the nature of the interaction, several of the mothers also reported having received support that had strengthened their parental ability and had been experienced as empowering. Third, several of the mothers also clearly perceived themselves as subjects needing support. The results, overall, indicated that the interaction between the mother and the professionals suffered from a certain paternalism in the attitude of the latter.
The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1-3 completed the PEGS with occupational therapists who work in school settings. Children from 6-9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.
The aims were to investigate mental health problems with the Strength and Difficulties Questionnaire (SDQ) in children born extremely preterm/extremely low birth weight (EP/ELBW) without severe disabilities compared to controls, and to identify peri-, or neonatal factors possibly predicting later mental health problems. A national Norwegian cohort of 11-year-old EP/ELBW children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness and/or deafness, was assessed. Parents and teachers completed the SDQ. Mean scores and scores =90th percentile for the control group, combined (parent and/or teacher reporting the child =90th percentile), and pervasive ratings (both parent and teacher reporting the child =90th percentile) were presented. The controls consisted of an unselected population of all 11-year-old children born in 1995 who attended public or private schools in Bergen. Of the eligible children, 216 (64%) EP/ELBW and 1882 (61%) control children participated. The EP/ELBW children had significantly higher scores and/or increased risk of parent, teacher, combined, and pervasive rated hyperactivity/inattention, emotional-, and peer problems (OR 2.1-6.3). Only parents reported the EP/ELBW children to be at an increased risk of conduct problems (OR 1.6, 95% CI 1.1-2.6). Only low maternal education at birth was significantly associated with mental health problems at 11 years of age (OR 2.5, 95% CI 1.2-5.4). EP/ELBW children without severe disabilities had increased risk of symptoms of hyperactivity/inattention, emotional-, and peer problems. None of the peri- or neonatal factors were significantly associated with later mental health problems, except for low maternal education.