Melanie Barwick

The Interface between ADHD and Language Impairment: An Examination of Language, Achievement, and Cognitive Processing

Language impairments are commonly observed among children referred for psychiatric services. The most frequent psychiatric diagnosis of children with language impairment (LI) is Attention Deficit Hyperactivity Disorder (ADHD). It is not clear whether there are differences between children with ADHD and comorbid LI and children with other psychiatric disorders who are also comorbid for LI. In the present study the language, achievement, and cognitive processing characteristics of 166 psychiatrically referred 7-14-year-old children were examined using a 2 x 2 (ADHD, LI) design to examine four groups: children with ADHD + LI, children with ADHD who have normally developing language, children with psychiatric diagnoses other than ADHD with a language impairment (OPD + LI) or without a LI (OPD). Results indicated that children with LI were at the most disadvantage regardless of the nature of the psychiatric diagnosis. Contrary to prediction, working memory measures, used to tap the core cognitive deficit of ADHD in executive functions, were more closely associated with LI than with ADHD. It was concluded that caution must be exercised in attributing to children with ADHD what might be a reflection of problems for children with language impairment generally. As most therapies are verbally based it is notable that language competence is rarely evaluated systematically before such therapies are undertaken.

WATCH, WAIT, AND WONDER: TESTING THE EFFECTIVENESS OF A NEW APPROACH TO MOTHER-INFANT PSYCHOTHERAPY

This research compared two forms of psychodynamic psychotherapeutic interventions for 67 clinically referred infants and their mothers. One was an infant-led psychotherapy delivered through a program called Watch, Wait, and Wonder (WWW). The other was a mother- infant psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately 5 months. A broad range of measures of attachment, qualities of the mother- infant relationship, maternal perception of parenting stress, parenting competence and satisfaction, depression, and infant cognition and emotion regulation were used. The WWW group showed a greater shift toward a more organized or secure attachment relationship and a greater improvement in cognitive development and emotion regulation than infants in the PPT group. Moreover, mothers in the WWW group reported

Language, Social Cognitive Processing, and Behavioral Characteristics of Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined characteristics of social cognitive processing, psychiatric disorder, and behavioral ratings of 380 children aged 7 to 14 years who had been referred consecutively for child psychiatric services with identified and unsuspected language impairments and with normally developing language. The results indicated that children with language impairments generally exhibited greater deficits in social cognitive processing, and particularly emotion decoding and social problem solving, than children who have language that is developing normally. Differences in psychiatric diagnosis and behavior problems were observed only between children with previously identified language impairments and children with normally developing language; children with previously identified language impairments were more likely to be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) and to be rated by both parents and teachers as having more severe attentional problems. In addition, teachers rated them as more socially withdrawn. The results suggest that it is important to incorporate measures of both social cognition and language functioning routinely into clinical assessment, something that currently is rarely done.

Epidemiology and management of painful procedures in children in Canadian hospitals

Background Children being cared for in hospital undergo multiple painful procedures daily. However, little is known about the frequency of these procedures and associated interventions to manage the pain. We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management. Methods We reviewed medical charts for infants and children up to 18 years of age who had been admitted to 32 inpatient units at eight Canadian pediatric hospitals between October 2007 and April 2008. We recorded all of the painful procedures performed and the pain management interventions that had been implemented in the 24-hour period preceding data collection. We performed descriptive and comparative (analysis of variance, χ2) analyses. Results Of the 3822 children included in the study, 2987 (78.2%) had undergone at least one painful procedure in the 24-hour period preceding data collection, for a total of 18 929 painful procedures (mean 6.3 per child who had any painful procedure). For 2334 (78.1%) of the 2987 children who had a painful procedure, a pain management intervention in the previous 24 hours was documented in the chart: 1980 (84.8%) had a pharmacologic intervention, 609 (26.1%) a physical intervention, 584 (25.0%) a psychologic intervention and 753 (32.3%) a combination of interventions. However, for only 844 (28.3%) of the 2987 children was one or more pain management interventions administered and documented specifically for a painful procedure. Pediatric intensive care units reported the highest proportion of painful procedures and analgesics administered. Interpretation For less than one-third of painful procedures was there documentation of one or more specific pain management interventions. Strategies for implementing changes in pain management must be tailored to the type of hospital unit.

Language, Achievement, and Cognitive Processing in Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined the language, achievement, and cognitive characteristics of 380 children, aged 7 to 14 years, consecutively referred to child psychiatric services. Among those children referred solely for psychiatric problems, 40% had a language impairment that had never been suspected. Children with previously identified and unsuspected language impairments were similar with respect to receptive and expressive language and on measures of cognitive processing. Although both groups of children with language impairments exhibited poorer academic achievement than children with normal language, children with previously identified language impairments had the lowest achievement. The milder achievement problems of children with unsuspected language impairment may explain why their problems had not been suspected. Both the clinical and theoretical implications of the findings are discussed. Heightened awareness concerning the high frequency of language impairment and other cognitive processing problems in children referred for psychiatric assessment and treatment should lead to more systematic examination of language functioning and evaluation of the impact of language and communication functioning on therapeutic outcomes.

Standards for Reporting Implementation Studies (StaRI) Statement

Implementation studies are often poorly reported and indexed, reducing their potential to inform initiatives to improve healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aimed to develop guidelines for transparent and accurate reporting of implementation studies. Informed by the findings of a systematic review and a consensus-building e-Delphi exercise, an international working group of implementation science experts discussed and agreed the StaRI Checklist comprising 27 items. It prompts researchers to describe both the implementation strategy (techniques used to promote implementation of an underused evidence-based intervention) and the effectiveness of the intervention that was being implemented. An accompanying Explanation and Elaboration document (published in BMJ Open, doi:10.1136/bmjopen-2016-013318) details each of the items, explains the rationale, and provides examples of good reporting practice. Adoption of StaRI will improve the reporting of implementation studies, potentially facilitating translation of research into practice and improving the health of individuals and populations.

The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation

BackgroundIdentification of psychometrically strong instruments for the field of implementation science is a high priority underscored in a recent National Institutes of Health working meeting (October 2013). Existing instrument reviews are limited in scope, methods, and findings. The Society for Implementation Research Collaboration Instrument Review Project’s objectives address these limitations by identifying and applying a unique methodology to conduct a systematic and comprehensive review of quantitative instruments assessing constructs delineated in two of the field’s most widely used frameworks, adopt a systematic search process (using standard search strings), and engage an international team of experts to assess the full range of psychometric criteria (reliability, construct and criterion validity). Although this work focuses on implementation of psychosocial interventions in mental health and health-care settings, the methodology and results will likely be useful across a broad spectrum of settings. This effort has culminated in a centralized online open-access repository of instruments depicting graphical head-to-head comparisons of their psychometric properties. This article describes the methodology and preliminary outcomes.MethodsThe seven stages of the review, synthesis, and evaluation methodology include (1) setting the scope for the review, (2) identifying frameworks to organize and complete the review, (3) generating a search protocol for the literature review of constructs, (4) literature review of specific instruments, (5) development of an evidence-based assessment rating criteria, (6) data extraction and rating instrument quality by a task force of implementation experts to inform knowledge synthesis, and (7) the creation of a website repository.ResultsTo date, this multi-faceted and collaborative search and synthesis methodology has identified over 420 instruments related to 34 constructs (total 48 including subconstructs) that are relevant to implementation science. Despite numerous constructs having greater than 20 available instruments, which implies saturation, preliminary results suggest that few instruments stem from gold standard development procedures. We anticipate identifying few high-quality, psychometrically sound instruments once our evidence-based assessment rating criteria have been applied.ConclusionsThe results of this methodology may enhance the rigor of implementation science evaluations by systematically facilitating access to psychometrically validated instruments and identifying where further instrument development is needed.

Becoming an Evidence-Based Service Provider: Staff Perceptions and Experiences of Organizational Change

In 2006, Ontario’s Policy Framework for Child and Youth Mental Health identified a need to improve the dissemination of what works in mental health practice and put it into practice. While an encouraging policy direction, the operationalization of evidence-based practice (EBP) implementation in child and youth mental health systems requires further consideration and the provision of support at the organizational and workforce levels. Thus far, the field of implementation science has identified that the implementation of effective and efficient behavioral health treatment programs involves a number of factors beyond that of consulting the research evidence and committing to the adoption of a particular practice. The range of factors identified as important in EBP implementation is captured in several frameworks and has been synthesized in a Consolidated Framework for Implementation Research (CFIR). This framework provides an overarching typology or meta-theory of relevant implementation constructs: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. The CFIR identifies constructs for which evidence supports their influence (positively or negatively, as specified) on implementation but does not specify the interactions between these constructs. We know little of how the process of implementation unfolds in real-world settings, and thus stand to learn a great deal through practice-based implementation studies done in partnership with community-based providers. Here, we have selected to explore the process through an exploratory case study. Given the paucity of literature examining implementation processes within the pediatric behavioral healthcare field, the present study used an exploratory framework to follow a change initiative involving the implementation of multiple EBPs over a four-year period in a large pediatric behavioral health service provider organization. In this paper, we report on staffIn 2006, Ontario’s Policy Framework for Child and Youth Mental Health identified a need to improve the dissemination of what works in mental health practice and put it into practice. While an encouraging policy direction, the operationalization of evidence-based practice (EBP) implementation in child and youth mental health systems requires further consideration and the provision of support at the organizational and workforce levels. Thus far, the field of implementation science has identified that the implementation of effective and efficient behavioral health treatment programs involves a number of factors beyond that of consulting the research evidence and committing to the adoption of a particular practice. The range of factors identified as important in EBP implementation is captured in several frameworks and has been synthesized in a Consolidated Framework for Implementation Research (CFIR). This framework provides an overarching typology or meta-theory of relevant implementation constructs: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. The CFIR identifies constructs for which evidence supports their influence (positively or negatively, as specified) on implementation but does not specify the interactions between these constructs. We know little of how the process of implementation unfolds in real-world settings, and thus stand to learn a great deal through practice-based implementation studies done in partnership with community-based providers. Here, we have selected to explore the process through an exploratory case study. Given the paucity of literature examining implementation processes within the pediatric behavioral healthcare field, the present study used an exploratory framework to follow a change initiative involving the implementation of multiple EBPs over a four-year period in a large pediatric behavioral health service provider organization. In this paper, we report on staff

Standards for Reporting Implementation Studies (StaRI) Explanation and Elaboration document

Objectives Implementation studies are often poorly reported and indexed, reducing their potential to inform the provision of healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aims to develop guidelines for transparent and accurate reporting of implementation studies. Methods An international working group developed the StaRI guideline informed by a systematic literature review and e-Delphi prioritisation exercise. Following a face-to-face meeting, the checklist was developed iteratively by email discussion and critical review by international experts. Results The 27 items of the checklist are applicable to the broad range of study designs employed in implementation science. A key concept is the dual strands, represented as 2 columns in the checklist, describing, on the one hand, the implementation strategy and, on the other, the clinical, healthcare or public health intervention being implemented. This explanation and elaboration document details each of the items, explains the rationale and provides examples of good reporting practice. Conclusions Previously published reporting statements have been instrumental in improving reporting standards; adoption by journals and authors may achieve a similar improvement in the reporting of implementation strategies that will facilitate translation of effective interventions into routine practice.

Knowledge translation efforts in child and youth mental health: a systematic review.

The availability of knowledge translation strategies that have been empirically studied and proven useful is a critical prerequisite to narrowing the research-to-practice gap in child and youth mental health. Through this review the authors sought to determine the current state of scientific knowledge of the effectiveness of knowledge translation approaches in child and youth mental health by conducting a systematic review of the research evidence. The findings and quality of the 12 included studies are discussed. Future work of high methodological quality that explores a broader range of knowledge translation strategies and practitioners to which they are applied and that also attends to implementation process is recommended.