Lex Wijnroks

Attention development in infants and preschool children born preterm: a review.

A potential mechanism that can explain preterm childrens heightened risk for the development of later cognitive and behavioral problems is attention. Attention is the ability of an infant or child to orient to, to shift between and to maintain focus on events, objects, tasks, and problems in the external world, processes which are all dependent on the functioning of attentional networks in the brain. The aim of this paper is to provide a review of the literature on attention development in children born preterm during the first 4 years of life. First, research examining the differences between preterm and full-term children indicates that early attention development in infants born preterm is less optimal and that these differences increase when infants grow into toddlers. Second, studies investigating individual differences within preterm populations reveal the influence of both biological factors and environmental factors. Third, individual differences in early orienting and sustained attention have been shown to be predictive of later attentional, cognitive and behavioral functioning in children born preterm. The importance of long-term follow-up studies, with a focus on individual developmental trajectories in orienting, sustained and executive attention, is emphasized.

Rethinking Stress in Parents of Preterm Infants: A Meta-Analysis

Background With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress. Methods and Findings A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants. Conclusions Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.

Qualitative analysis of therapeutic motor intervention programmes for children with cerebral palsy: an update

This study presents a comprehensive evaluation of therapeutic motor interventions for children with or at risk for cerebral palsy (CP), examining 50 studies covering the period from 1990 to 2001. The purpose was to review noticeable changes in the scientific quality of the studies and to highlight trends and changes in the nature of the evaluated programmes. Our results were compared with those of Vermeer and Bakx (1990) who reviewed the period from 1980 to 1989. It was concluded that fundamental research with adequate methodology was applied more often in the study period than in the period reviewed by Vermeer and Bakx. However, these developments did not lead to a substantial improvement in the scientific foundation of the interventions under study. Single case studies, combined with efforts to develop measures specifically for children with CP and with high sensitivity, might make more valuable contributions to the scientific justification of therapeutic interventions.

Children with asthma and physical exercise: effects of an exercise programme

Objective: To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis. Design: Intervention study: a randomized pretest–post-test control group design. Setting and subjects: Forty-seven children with clinically diagnosed asthma participated in the intervention study, including 34 boys and 13 girls, from 8 to 13 years of age (mean age 10.6). Interventions: The physical exercise programme consisted of regular group exercises and home exercises for a period of three months. It was based on a theoretical model describing the relationships between physical competence (condition), perceived physical competence, self-esteem and coping behaviour. Main outcome measures: Maximum incremental exercise test, endurance test, the Self-Perception Profile for Children (CBSK), the Asthma Coping Test (ACBT), lung function and exercise-induced bronchoconstriction. Results: The results showed significant effects of the intervention programme on physical condition. There was a significant improvement of 15 W on the maximal workload (Wmax) (p < 0.001), of 7% on VO 2max (oxygen uptake) (p = 0.002) and a significant decrease on heart rate submaximal of 6% (p = 0.001). There was also a significant improvement of 50% in running time measured with the endurance test (p = 0.021). Furthermore, a significant effect of the intervention was seen on coping with asthma (p = 0.003). Conclusion: It was concluded that participation in the physical exercise programme not only enhanced physical fitness, but also improved coping behaviour with asthma.

Individual differences in postural control and cognitive development in preterm infants

This study was aimed to examine whether individual differences in postural control at 6 months of age could predict cognitive development and attention in relatively healthy preterm infants 6–18 months later. Three groups of infants were identified on the basis of a behavioral observation during an exploration task: infants with an adequate postural control (N=33), infants who showed extension of the elbows consistently (N=23), and infants who demonstrated clear signs of hyperextension of neck and trunk (N=9). In contrast to infants with an adequate postural control, infants who showed signs of hyperextension or elbow extension scored significantly lower on several cognitive measures (Bayley mental scale and tasks for problem solving) and were significantly more often not attending to a task, 6–18 months later. This study showed that individual differences in postural control could predict later cognitive development and inattention of infants who were born prematurely.

Early maternal stimulation and the development of cognitive competence and attention of preterm infants

The aim of the study was to investigate the relationship between several dimensions of maternal interactive behaviours, and cognitive development and attention in preterm infants. Of special interest was the question of whether high levels of maternal stimulation and activity may have negative consequences for the development of preterm infants. Sixty-six preterm infants and their mothers were followed longitudinally and videotaped in interaction situations at home, at the infant age of 6, 9 and 12 months. Mothers behaviours were scored on involvement, sensitive responsiveness, non-intrusiveness and level of activity. Moreover, infant cognitive status was assessed at 6, 12 and 24 months of age, using the Bayley Scales of Infant Development. Infant ability in problem solving and attention were assessed in two problem solving tasks at 18 and 24 months of age. The results showed that infant cognitive status at 12 and 24 months was best predicted by maternal involvement and infant responsiveness. No significant relationships were found between maternal interactive behaviours and infant ability in problem solving and attention. More importantly, there was no indication that high levels of maternal stimulation or intrusiveness may have a negative impact on later cognitive development and attention in preterm infants.

Transparency and tuning of rehabilitation care for children with cerebral palsy: A multiple case study in five children with complex needs

Purpose: Generally, there is a lack of knowledge whether and how parent-identified problems, treatment goals and treatment activities are tuned in the treatment of children with cerebral palsy. This study aimed to observe whether parent-identified problems and treatment goals were documented (‘transparency’ of the rehabilitation process), and to examine the relationship (‘tuning’) of parent-identified problems to treatment goals and to treatment activities of children with cerebral palsy in pediatric rehabilitation in the Netherlands. Method: Five school-aged subjects with cerebral palsy were observed in detail during physical, occupational, and speech therapy, and their written reports were studied. Parent-identified problems, treatment goals, and treatment activities were linked to the ICF components, domains and categories and the amount of agreement was determined by code comparison. Results: Only two children with a total of six parent-identified problems could be documented. Forty-five treatment goals were identified and 72 treatment activities were observed. The analyses indicated some tuning of parent-identified problems, goals and activities in all subjects, but only four of the treatment activities were perfectly tuned to treatment goals as well as to parent-identified problems. Conclusions: We conclude that transparency and tuning of the pediatric treatment process described in the present study could be improved substantially. Several suggestions for improving the transparency and tuning of the treatment process are discussed.

The relations between intellectual disabilities, social information processing, and behavior problems.

Social information processing (SIP) in children with mild intellectual disabilities (MID) has been said to differ from SIP in children without MID. However, findings have been inconsistent and MID have been confounded with behaviour problems. It is not clear whether SIP is uniquely related to intellectual disabilities, to the behaviour problems of children with MID, or to both. In the present study, 56 children with MID and 31 children without MID between the ages of 10 and 14 years therefore completed a number of SIP tasks involving video vignettes and their externalizing behaviour problems were assessed. It was hypothesized that intellectual disabilities would be related to both SIP and behaviour problems. Findings show children with MID to encode more negative cues, generate more responses, and show more variability in their responses than children without MID. Children with MID also generated fewer assertive responses, evaluated assertive responses less positively, were less confident about the enactment of assertive responses, and selected fewer assertive responses than children without MID. Submissive responses were more often generated spontaneously by children with MID, more positively evaluated by them, and given more confidence for enactment by children with MID compared to children without MID. Regression analyses were conducted to assess the relations between SIP, MID, and behaviour problems. Variance in the generation of submissive responses was related to both intellectual disabilities and externalizing behaviour problems. Variance in the encoding of cues, the number of responses generated, the variability of generated responses, the evaluation of assertive and submissive responses, self-efficacy, and the selection of assertive responses was found to be related to intellectual disabilities. Variance in the generation of aggressive responses was related to externalizing behaviour problems. In other words, not responding assertively was related to intellectual disabilities while responding aggressively was related to behaviour problems.

Family-centred services in the Netherlands: validating a self-report measure for paediatric service providers

Objective: To validate the Dutch translation of the Canadian Measure of Processes of Care for Service Providers questionnaire (MPOC-SP) for use in paediatric rehabilitation settings in the Netherlands. Design: The construct validity, content validity, face validity, and reliability of the Dutch MPOC-SP were determined. Subjects: The 163 service providers that participated in the validation study represented seven childrens rehabilitation centres and affiliated schools in the Netherlands (overall response rate 55.6%). In this sample 19 disciplines were represented. Main measures: The MPOC-SP consists of 27 items (assessing four domains) and was designed to examine how service providers think about the quality of care they provide and to assess the extent to which these services are family centred. Fifty-three service providers filled out an additional face validity questionnaire. Results: All items correlated best and significantly with their own scale score (rs 0.48-0.82, P < 0.001). The Pearsons correlation coefficients were all significant and confirmed that the four scales measure different aspects of a same construct, namely family-centred service. The content validity and the face validity of the Dutch MPOC-SP were good, indicating the questionnaire measures relevant aspects of family-centred service delivery in paediatric rehabilitation settings in the Netherlands. The test-retest analyses (intraclass correlation coefficient (ICC) 0.83-0.89) and the internal consistency analyses (alpha 0.65-0.84) showed that the Dutch MPOC-SP is a reliable tool. Conclusions: The Dutch MPOC-SP is a reliable and valid instrument to measure the family-centredness of service delivery.

Quality of paediatric rehabilitation from the parent perspective: validation of the short Measure of Processes of Care (MPOC-20) in the Netherlands

Objective: In the present study we aim to assess the reliability and validity of the 20-item version of the Dutch Measure of Processes of Care (MPOC). Design: The reliability, concurrent validity, predictive validity and construct validity of the Dutch MPOC-20 were determined. A subset of MPOC-20 data was extracted from a large Dutch MPOC (56-item version) database. Subjects: Participants were 405 mothers and 22 fathers of children aged 1-18 years recruited through nine paediatric rehabilitation centres in the Netherlands. Main measures: The participants filled out the MPOC-20 items, the Client Satisfaction Questionnaire (CSQ), and two additional questions about satisfaction with services and the amount of stress they experienced. Results: The internal consistency analyses (alphas 0.75-0.87) and the test-retest analyses (intraclass correlation coefficients (ICCs) 0.78-0.91) showed that the Dutch MPOC-20 is a reliable tool. The concurrent validity of the Dutch MPOC-20 was confirmed by positive correlations between MPOC-20 scale scores and the CSQ (r 0.39-0.69), and between MPOC-20 scale scores and an overall satisfaction variable (r 0.37-0.66). The predictive validity of the Dutch MPOC-20 was supported by moderately negative correlations between MPOC-20 scores and a stress variable (r -0.27 to -0.44). The construct validity of the Dutch MPOC-20 was confirmed by significant scale intercorrelations (r 0.41-0.84) and a factor analysis. Conclusions: The 20-item version of the MPOC (Dutch MPOC-20) is a reliable and valid measure of the family-centredness of paediatric rehabilitation.