Elizabeth K. Hughes

Outcomes of children with mild-profound congenital hearing loss at 7 to 8 years: a population study.

Objectives Improved long-term outcomes of hearing loss at a population level is the underlying reason for interventions such as newborn hearing screening programs. Therefore, high-quality population surveys are needed for older children across the spectrum of hearing losses that might be detected by such programs, against which to assess future secular improvements. Measured outcomes should cover a broad range of parameters, including health-related quality of life. Design Population-based cohort study (CHIVOS, the Children with Hearing Impairment in Victoria Outcome Study). Setting: State of Victoria, Australia. Participants: Eighty-six 7- to 8-yr-old children born in Victoria, who were (a) fitted with hearing aids for congenital hearing loss by 4.5 yr and (b) had no intellectual or major physical disability. Measures: Standardized measures of language (CELF and PPVT), articulation (Goldman-Fristoe Test of Articulation), cognition (WISC), reading, adaptive functioning, health-related quality of life, parent developmental concerns, parent- and teacher-reported intelligibility and behavior, and teacher-reported school functioning. Results Response rate was 67% (N = 89). Of the 86 able to be included in analyses, 53 were boys; 22% had mild, 31% moderate, 17% severe, and 29% profound hearing loss; the mean nonverbal IQ was 104.6 (SD 16.7). The sample scored far below (1.3 to 1.7 SDs) the normative populations on the PPVT and on the Receptive, Expressive and Total CELF scores. On average, children’s reading age was delayed nearly 10 mo. For every outcome measure except physical health, these children scored significantly worse than the relevant normative population. Language and vocabulary scores worsened with increasing severity of hearing loss, but adaptive functioning, health-related quality of life, academic skills and behavior did not. Conclusions Comprehensive data such as these highlight the continuing plight experienced by hearing-impaired children, and will help evaluate over time whether outcomes for children with hearing loss are improving at a population level.

The normative development of emotion regulation strategy use in children and adolescents: a 2-year follow-up study.

BACKGROUND Emotion regulation involves intrinsic and extrinsic processes responsible for managing ones emotions toward goal accomplishment. Research on emotion regulation has predominantly focused on early developmental periods and the majority of emotion regulation research examining the pre-adult years has lacked a comprehensive theoretical framework. The current study examined the use of two strategies of emotion regulation during childhood and adolescents, as conceptualised within Grosss (1998) process-oriented model. METHODS To determine the use, norms and development of the Expressive Suppression and Cognitive Reappraisal strategies, the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) was administered to 1,128 participants aged between 9 and 15 years. Three data collection phases, each one year apart, enabled investigation of developmental patterns in the use of the two strategies. RESULTS As predicted, Suppression use was found to be lower for older participants compared to their younger peers, and over time participants reported less use of this strategy. Older participants also scored lower on Reappraisal but stability over time was found. Also as expected, males reported more Suppression use compared to females. CONCLUSIONS By documenting the development and norms for Cognitive Reappraisal and Expressive Suppression in a community sample of children and adolescents, the current study makes a significant contribution to our understanding of these two ER strategies during these developmental periods.

Hearing impairment : a population study of age at diagnosis, severity, and language outcomes at 7-8 years

Background: Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection. Aims: To study impact of age of diagnosis and severity of HI in a population cohort of 7–8 year old children. Methods: Eighty eight 7–8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models. Results: Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI. Conclusions: More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7–8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.

Child and adolescent emotion regulation: the role of parental emotion regulation and expression.

This paper reviews current literature relating to parent and child emotional functioning, specifically their emotion regulatory skills and emotional expression. Included are considerations regarding theoretical, methodological, and sampling strengths and weaknesses of existing literature. On the basis of the review, several directions for future research are proposed. First, it is argued that consistency in the measurement of emotion regulation is necessary, including assessment of more refined theoretical conceptualizations of regulatory types, skills, or strategies. Second, it is argued that emotion regulation developmental research examining the post-early childhood period is necessary in order to contribute to a more comprehensive understanding of youths’ emotion regulation. Finally, it is argued that greater examination of paternal influences on child emotional functioning, in addition to maternal influences, is required. Consideration of these issues in future emotion regulation research will ideally contribute to a greater understanding of the mechanisms involved in child and adolescent development of optimal regulatory capacities.

Parent-Reported Health-Related Quality of Life in Children With Congenital Hearing Loss: A Population Study

OBJECTIVE To report 1) health-related quality of life (HRQoL) in 7- to 8-year-old children with congenital hearing loss and 2) effects of severity and age of diagnosis on parent-reported child HRQoL. METHODS SETTING State of Victoria, Australia. DESIGN Two population-based cohorts of 7- to 8-year-old children. PARTICIPANTS Cohort 1 consisted of 83 children (51 boys) fitted with hearing aids or cochlear implants for congenital hearing loss by 4.5 years, born before universal newborn hearing screening, and without intellectual disability (the Children with Hearing Impairment in Victoria OUTCOME Study). Cohort 2 consisted of 895 children representative of the Victorian 7- to 8-year-old school population (the 1997 Health of Young Victorians Study). OUTCOME The 28-item parent-proxy Child Health Questionnaire measure of HRQoL. RESULTS Response rate for cohort 1 was 67%; 22% had mild, 33% had moderate, 17% had severe, and 29% had profound hearing loss; and the mean nonverbal IQ was 105.4 (SD = 16.5). Children with hearing loss scored significantly more poorly than the normative sample on 6 Child Health Questionnaire scales (Role/Social-Physical, Behavior, Mental Health, Parent Impact-Emotional, Parent Impact-Time, and Family Activities) and on the Psychosocial Summary Score. HRQoL was poorer with milder losses, accounting for 10% and 11% of variance in the Physical and Psychosocial Summary scores, respectively. Age at diagnosis did not contribute significantly to the Summary scores, but only 11 children were diagnosed <6 months of age. CONCLUSIONS Parent-reported psychosocial well-being of 7- to 8-year-old children with hearing loss is poorer than that of their hearing peers. Future studies should determine whether HRQoL has improved after introduction of universal newborn hearing screening.

Eating Disorders with and without Comorbid Depression and Anxiety: Similarities and Differences in a Clinical Sample of Children and Adolescents

OBJECTIVE This study aimed to describe and compare the demographic and clinical characteristics of children and adolescents with an eating disorder (ED) and comorbid depression or anxiety. METHOD Data were drawn from intake assessments of children and adolescents at a specialist ED clinic. Demographic characteristics (e.g. age and gender) and clinical characteristics (e.g. body mass, binge eating and purging) were compared between 217 ED participants without comorbidity, 32 with comorbid anxiety, 86 with comorbid depression and 36 with comorbid anxiety and depression. RESULTS The groups with comorbid depression had more complex and severe presentations compared with those with an ED and no comorbid disorder and those with comorbid anxiety alone, especially in regard to binge eating, purging, dietary restraint and weight/shape concerns. DISCUSSION Depression and anxiety were differentially related to clinical characteristics of EDs. The findings have implications for understanding the relations between these disorders and their potential to impact outcome of ED treatments.

A Case-Control Study of Emotion Regulation and School Refusal in Children and Adolescents

The current study aimed to investigate emotion regulation (ER) strategy use in a sample of 21 clinic-referred children and adolescents (10-14 years old) presenting with school refusal, all of whom were diagnosed with at least one anxiety disorder. Being the first known study to examine ER and school refusal, hypotheses were guided by previous research on anxiety. It was hypothesized that the school refusal sample would report less healthy ER strategy use compared to an age- and sex-matched nonclinical sample (n = 21). As expected, the school refusal sample reported less use of cognitive reappraisal and greater use of expressive suppression to regulate their emotions than did the nonclinical sample. Although preliminary, the findings provide important information regarding the emotional functioning of children and adolescents presenting with school refusal. Future directions for research and implications for improved prevention and intervention programs are discussed.

Emotion regulation moderates relationships between body image concerns and psychological symptomatology

The study investigated the moderating role of emotion regulation (ER) in relationships between body image concerns and psychological symptomatology. A community sample of 533 boys and girls (11-20 years) completed measures assessing body image thoughts and feelings, domain-specific and general ER strategies, drive for thinness, and bulimic, depressive and anxiety symptoms. Results indicated that ER moderated relationships between body image concerns and both bulimic and depressive symptoms, but not relationships between body image concerns and drive for thinness or anxiety symptoms. Adolescents who reported frequent body image concerns were more likely to have higher levels of bulimic symptoms if they tended to use avoidance and internal dysfunctional ER strategies. Furthermore, adolescents who reported frequent body image concerns were more likely to have higher levels of depressive symptoms if they used positive rational acceptance and internal functional strategies infrequently. Implications of the findings for prevention and intervention are discussed.

Reciprocal Relationships Between Parent and Adolescent Internalizing Symptoms

Previous investigations of the association between parent and adolescent internalizing problems have been largely restricted to the unidirectional effect of parent symptoms on their children. This study therefore aimed to investigate potential reciprocal relationships between parent and adolescent internalizing symptoms. One-hundred and seventy-seven adolescents ages 14 to 18 years and their parents (172 mothers, 124 fathers) completed measures of depressive and anxiety symptoms at two time points, 6 months apart. Results supported reciprocity between maternal and adolescent internalizing symptoms but not between paternal and adolescent internalizing symptoms. In addition, the relationship between maternal symptoms and later adolescent symptoms was found to be partially mediated by maternal parenting self-esteem. The study highlights the potential impact of adolescent internalizing problems on maternal well-being, a phenomenon previously neglected in the literature.

Implementation of family-based treatment for adolescents with anorexia nervosa

Although the implementation of new treatment models can be a challenging process for health care services, the outcomes can be greatly beneficial to patients and service providers. This article describes the process of change experienced within our multidisciplinary specialist eating disorder service when we implemented a new evidence-based model of care focusing on outpatient family-based treatment (FBT). Clinical outcomes were positive, including a 56% decrease in admissions, a 75% decrease in readmissions, and a 51% decrease in total bed days. Of families referred to FBT, 83% completed treatment and 97% of completers achieved >90% of their expected body weight. Despite these gains, many challenges were experienced, including misgivings about the suitability of FBT and difficulties in adhering to changes in professional roles. We describe these challenges, describe how they were overcome, and review factors perceived to be critical to the programs success, including integration of medical and mental health services, communication, and training.