To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.1997.tb07414.x

Development and reliability of a system to classify gross motor function in children with cerebral palsy

How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

/pdf/from-neurons-to-neighborhoods-the-science-of-early-childhood-3bfl5g72ow.pdf

From Neurons to Neighborhoods: The Science of Early Childhood Development

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Modern Applied Statistics With S

ContextThe cognitive and behavioral outcomes of school-aged children who were
born preterm have been reported extensively. Many of these studies have methodological
flaws that preclude an accurate estimate of the long-term outcomes of prematurity.ObjectiveTo estimate the effect of preterm birth on cognition and behavior in
school-aged children.Data SourcesMEDLINE search (1980 to November 2001) for English-language articles,
supplemented by a manual search of personal files maintained by 2 of the authors.Study SelectionWe included case-control studies reporting cognitive and/or behavioral
data of children who were born preterm and who were evaluated after their
fifth birthday if the attrition rate was less than 30%. From the 227 reviewed
studies, cognitive data from 15 studies and behavioral data from 16 studies
were selected.Data ExtractionData on population demographics, study characteristics, and cognitive
and behavioral outcomes were extracted from each study, entered in a customized
database, and reviewed twice to minimize error. Differences between the mean
cognitive scores of cases and controls were pooled. Homogeneity across studies
was formally tested using a general variance-based method and graphically
using Galbraith plots. Linear meta-analysis regression models were fitted
to explore the impact of birth weight and gestational age on cognitive outcomes.
Study-specific relative risks (RRs) were calculated for the incidence of attention-deficit/hyperactivity
disorder (ADHD) and pooled. Quality assessment of the studies was performed
based on a 10-point scale. Publication bias was examined using Begg modified
funnel plots and formally tested using the Egger weighted-linear regression
method.Data SynthesisAmong 1556 cases and 1720 controls, controls had significantly higher
cognitive scores compared with children who were born preterm (weighted mean
difference, 10.9; 95% confidence interval [CI], 9.2-12.5). The mean cognitive
scores of preterm-born cases and term-born controls were directly proportional
to their birth weight (R2 = 0.51; P<.001) and gestational age (R2 = 0.49; P<.001). Age at evaluation had
no significant correlation with mean difference in cognitive scores (R2 = 0.12; P = .20).
Preterm-born children showed increases in externalizing and internalizing
behaviors in 81% of studies and had more than twice the RR for developing
ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78). No differences were noted in cognition
and behaviors based on the quality of the study.ConclusionsChildren who were born preterm are at risk for reduced cognitive test
scores and their immaturity at birth is directly proportional to the mean
cognitive scores at school age. Preterm-born children also show an increased
incidence of ADHD and other behaviors.

https://jamanetwork.com/journals/jama/articlepdf/195181/JMA10039.pdf

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

New Ballard Score, expanded to include extremely premature infants.

The objective of this study was to identify the relationship between the degree of uncertainty in the child’s chronic condition and family distress. Data were collected from parents (173 mothers, 150 fathers) of young children (12 to 30 months old) who had been diagnosed with a chronic physical health impairment within the past 12 months. Children were divided into separate groups, first based on the predictability of their symptoms and next based on the degree of certainty in their life expectancy. Using analysis of covariance, sex-stratified comparisons were made between the predictability groups and then between the life expectancy groups and five subscales of the Impact-on-Family Scale. Parents of young children with chronic conditions with intermittently unpredictable symptoms reported significantly more family distress than parents of children with more predictable symptoms. No significant differences were found for mothers or fathers between the degree of uncertainty in the child’s life expectancy ...

Uncertainty in childhood chronic conditions and family distress in families of young children

Long-term perspective on premature infant outcome and contemporary intervention issues.

To investigate the possible association of chronic otitis media and school learning problems, past and current middle ear status in 53 learning-disabled (LD) children was compared to that of 56 control children without learning problems. A history of recurrent otitis media was obtained in 23% of the LD children and in 9% of the control children. Thirty-eight percent of LD children and 16% of control children had hearing abnormalities on pure tone audiometry; 49% of LD children and 21% of control children had abnormal tympanometry. LD children had significantly more middle ear malfunction than control children. Chronic, undetected middle ear problems may play a role in the etiology of some school learning disabilities.

Middle ear function in learning-disabled children.

Objective To identify parents' perceptions of helpful vs unhelpful types of social support received in managing the care of preadolescents with chronic conditions. Design Multimethod cohort study with 1-year follow-up. Setting General community. Participants Volunteer, consecutive sample of parents of 124 preadolescents with a variety of chronic conditions. Methods In-depth, in-home interviews conducted with parents. Quantitative data from the Social Support Assessment questionnaire was used to assess and compare sources and types of helpful support at baseline and 1year later. Content analytic methods were used to categorize unsupportive behaviors described by parents during the first interview. Results Both mothers and fathers reported that other family members were the primary source of helpful emotional and tangible support, while health care providers were the primary source of helpful informational support. The amount of perceived support from family members, community members, and service providers stayed relatively stable over time, except that fathers reported a significant increase in helpful emotional and informational support from extended family members from baseline to 1 year later. Also, 388 incidents of unsupportive behaviors were identified; the majority of these behaviors were attributed to health professionals and extended family members. Conclusion While patterns of perceived support remained relatively stable over a 1-year period, reports of unsupportive behaviors suggest gaps in service and problems that must be addressed to improve the care that children with chronic conditions and their families receive.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/189680/poa7479.pdf

Parents' Perceptions of Helpful vs Unhelpful Types of Support in Managing the Care of Preadolescents With Chronic Conditions

We questioned parents of 182 young children with a variety of chronic health conditions concerning the amount of emotional, informational, and tangible social support they received from the family, community, and service providers. We also asked parents to describe nonsupportive or hurtful behaviors received from family or community members. Both mothers and fathers reported that family members provided the most emotional and tangible social support and service providers the most informational support. The amount of perceived support from all sources increased over time, but 78% of mothers and 60% of fathers reported at least one instance of nonsupport from these same sources, primarily from extended family members and health professionals. We encourage health professionals to show respect and to provide timely, accurate information in a sensitive manner to parents whose child has a chronic health condition and to assist parents in handling nonsupportive behaviors from family and friends.

Forrest C. Bennett

Papers

Uncertainty in childhood chronic conditions and family distress in families of young children

Long-term perspective on premature infant outcome and contemporary intervention issues.

Middle ear function in learning-disabled children.

Parents' Perceptions of Helpful vs Unhelpful Types of Support in Managing the Care of Preadolescents With Chronic Conditions

Social support in families of children with chronic conditions: supportive and nonsupportive behaviors.