Muthanna Samara

Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders

Background Participant drop-out occurs in all longitudinal studies, and if systematic, may lead to selection biases and erroneous conclusions being drawn from a study. Aims We investigated whether drop out in the Avon Longitudinal Study of Parents And Children (ALSPAC) was systematic or random, and if systematic, whether it had an impact on the prediction of disruptive behaviour disorders. Method Teacher reports of disruptive behaviour among currently participating, previously participating and never participating children aged 8 years in the ALSPAC longitudinal study were collected. Data on family factors were obtained in pregnancy. Simulations were conducted to explain the impact of selective drop-out on the strength of prediction. Results Drop out from the ALSPAC cohort was systematic and children who dropped out were more likely to suffer from disruptive behaviour disorder. Systematic participant drop-out according to the family variables, however, did not alter the association between family factors obtained in pregnancy and disruptive behaviour disorder at 8 years of age. Conclusions Cohort studies are prone to selective drop-out and are likely to underestimate the prevalence of psychiatric disorder. This empirical study and the simulations confirm that the validity of regression models is only marginally affected despite range restrictions after selective drop-out.

Parenting behavior and the risk of becoming a victim and a bully/victim: A meta-analysis study

OBJECTIVE Being bullied has adverse effects on childrens health. Childrens family experiences and parenting behavior before entering school help shape their capacity to adapt and cope at school and have an impact on childrens peer relationship, hence it is important to identify how parenting styles and parent-child relationship are related to victimization in order to develop intervention programs to prevent or mitigate victimization in childhood and adolescence. METHODS We conducted a systematic review of the published literature on parenting behavior and peer victimization using MEDLINE, PsychINFO, Eric and EMBASE from 1970 through the end of December 2012. We included prospective cohort studies and cross-sectional studies that investigated the association between parenting behavior and peer victimization. RESULTS Both victims and those who both bully and are victims (bully/victims) were more likely to be exposed to negative parenting behavior including abuse and neglect and maladaptive parenting. The effects were generally small to moderate for victims (Hedges g range: 0.10-0.31) but moderate for bully/victims (0.13-0.68). Positive parenting behavior including good communication of parents with the child, warm and affectionate relationship, parental involvement and support, and parental supervision were protective against peer victimization. The protective effects were generally small to moderate for both victims (Hedges g: range: -0.12 to -0.22) and bully/victims (-0.17 to -0.42). CONCLUSIONS Negative parenting behavior is related to a moderate increase of risk for becoming a bully/victim and small to moderate effects on victim status at school. Intervention programs against bullying should extend their focus beyond schools to include families and start before children enter school.

Pervasive behavior problems at 6 years of age in a total-population sample of children born at <= 25 weeks of gestation

OBJECTIVE. The goal was to test whether extremely preterm children have more pervasive behavior problems than classroom peers, by using parent and teacher consensus reports. Is there an excess number of extremely preterm boys with behavior problems? METHODS. A total-population study of all extremely preterm children in the United Kingdom and Ireland was performed. All children born at ≤25 weeks of gestation in the United Kingdom and Ireland between March and December 1995 were assessed at 76 months of age (range: 62–87 months) (EPICure study). Pervasive behavior problems were defined as scoring >90th percentile on parent and teacher reports with a standard behavior scale, the Strengths and Difficulties Questionnaire. Of the 241 of 308 survivors who responded (78% of survivors), 200 had full reports on behavior problems from teachers and parents; they were compared with 148 control children. RESULTS. A total of 19.4% of extremely preterm children (boys: 23.2%; girls: 15.6%), compared with 3.4% of control children (boys: 4.6%; girls: 2.5%) had total behavior scores in the clinical range. Hyperactivity (extremely preterm: 30.6%; control: 8.8%) and conduct problems (extremely preterm: 12.5%; control: 5.4%) could be accounted for by cognitive deficits, but attention (extremely preterm: 33.3%; control: 6.8%), peer (extremely preterm: 25.4%; control: 5.4%), and emotional (extremely preterm: 13.5%; control: 4.1%) problems were not explained by poor cognitive functioning. Extremely preterm boys had behavior problems in excess of gender differences found in the control group in hyperactivity, attention, and prosocial problems, and the impact on parents and teachers was greater for extremely preterm boys than girls. CONCLUSIONS. Pervasive behavior problems are more frequent in children born at the limits of viability than previously reported for larger preterm populations. Extremely preterm boys seem most vulnerable, and the impact on parents and teachers is considerable.

A content analysis of school anti‐bullying policies: progress and limitations

Schools in England are legally required to have an anti‐bullying policy, but the little research so far suggests that they may lack coverage in important areas. An analysis of 142 school anti‐bullying policies, from 115 primary schools and 27 secondary schools in one county was undertaken. A 31‐item scoring scheme was devised to assess policy. Overall, schools had about 40% of the items in their policies. Most included improving school climate, a definition of bullying including reference to physical, verbal and relational forms, and a statement regarding contact with parents when bullying incidents occurred. But many schools did not mention other important aspects, and there was low coverage of responsibilities beyond those of teaching staff; following up of incidents; management and use of records; and specific preventative measures such as playground work and peer support. There was infrequent mention of homophobic bullying, and of cyberbullying. There was little difference between policies from primary and secondary schools. Findings are discussed in terms of national policy, and ways to support schools in maximising the potential of their policies for reducing bullying.

Eating Problems at Age 6 Years in a Whole Population Sample of Extremely Preterm Children.

Aim  The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years.

Who escapes or remains a victim of bullying in primary school

The stability of both direct and relational victimization and factors that contribute to remaining, escaping or becoming a victim of bullying were investigated. 663 children at baseline aged 6-9 (years 2-4) were interviewed about their bullying experiences and parents completed a behaviour and health measure. Childrens perception of the degree of social hierarchical structuring and social prominence in their class was determined by peer nominations. 432 children participated in the follow-up either 2 or 4years after baseline aged 10-11 (year 6) and completed a bullying questionnaire. Relational victims and children from classes with a high hierarchical structure were more likely to have dropped out of the study compared to neutral children, and children from classes with a low hierarchical structure. Relative risk analyses indicated a twofold increased risk of remaining a direct victim at follow-up, compared to a child not involved at baseline becoming a victim over the follow-up period. In contrast, relational victimization increased but was not found to be stable. Logistic regression analyses revealed that being a girl, and receiving few positive peer nominations predicted remaining a direct victim. Becoming a relational victim at follow-up was predicted by a strong class hierarchy. The implications for future study of early recognition of likely long term victims and early preventative bullying initiatives are discussed.

How Schools Tackle Bullying, and the Use of Whole School Policies: Changes over the Last Decade.

Surveys were carried out to assess the UK government’s anti‐bullying pack Don’t suffer in silence in 1996 (after the first edition) and 2002 (after the second edition), to investigate what schools are doing about bullying, and the effect of anti‐bullying policies becoming a legal requirement. Schools in England were approached, randomly but within the constraint of having a spread across geographical regions. In 1996 109 schools and in 2002 148 schools were asked about school policy, interventions, and bullying frequency. Most schools moved from having a bullying policy as part of a broader policy on behaviour and discipline, to having a separate anti‐bullying policy. More schools attempted to survey the extent of bullying and there were changes in the use of particular interventions. Most interventions were rated as moderately useful. Some variations in use and satisfaction between different school levels were found. The implications of anti‐bullying work at schools and its success are discussed.

A content analysis of school anti-bullying policies: a follow-up after six years

An analysis was undertaken of 217 English school anti-bullying policies, from 169 primary schools and 48 secondary schools, using a 34-item scoring scheme. Findings were compared with an analysis of 142 schools six years earlier. Overall schools in the current analysis had about 49% of the items in their policies, a modest increase over the previous study. Most included a definition of bullying and statements about improving school climate but many schools did not mention other important aspects, and there was low coverage of cyberbullying, homophobic bullying, bullying based on disabilities, or faith; teacher–pupil bullying; responsibilities beyond those of teaching staff; following up of incidents; and specific preventative measures such as playground work, peer support, inclusiveness issues, and bullying to and from school. Several improvements in policies, significant for 20 out of 34 criteria were noted. Findings are discussed in terms of national policy, and ways to support schools in maximising the potential of their policies for reducing bullying.

Self and parent perspectives on health-related quality of life of adolescents born very preterm.

OBJECTIVES To test whether health-related quality of life (HRQL) based on societal standards differs between very low birth weight/very preterm (VLBW/VP) and full-term (FT) adolescents using self and parent proxy reports. Also, to examine whether self and parent reported HRQL is explained by indicators of objective functioning in childhood. STUDY DESIGN This prospective cohort study followed 260 VLBW/VP adolescents, 12 VLBW/VP adolescents with disability, and 282 FT adolescents. Objective functioning was assessed at 8.5 years; HRQL was assessed at 13 years with the Health Utilities Index Mark 3 (HUI3). RESULTS Adolescents reported more functional impairment than their parents especially in the psychological aspects of health. The mean difference in HUI3 multi-attribute utility scores between FT and VLBW/VP adolescents was small (parents: 0.91 [95% CI, 0.90, 0.92] vs 0.88 [95% CI, 0.86, 0.90]; adolescents: 0.87 [95% CI, 0.85, 0.89] vs 0.84 [95% CI, 0.82, 0.86]), but high for VLBW/VP adolescents with disabilities (0.18, 95% CI, -0.04, 0.40). Objective function did not predict HRQL in FT adolescents but contributed to prediction of HRQL in VLBW/VP adolescents without disabilities. Different indicators of objective functioning were important for adolescent vs parent reports. More variation in HUI3 scores was explained by objective function in VLBW/VP parent reports compared with adolescent reports (25% vs 18%). CONCLUSIONS VLBW/VP adolescents reported poorer HRQL than their FT peers in early adolescence. Improvement in HRQL as VLBW/VP children grow up is, at least partly, explained by exclusion of the most disabled in self reports by VLBW/VP adolescents and the use of different reference points by adolescents compared with parents.

Systematic review and meta-analysis : fussing and crying durations and prevalence of colic in infants

Objective To determine the mean duration of fussing and crying and prevalence of colic using modified Wessel criteria in infants in the first 3 months of life. Study design A systematic literature search was performed using the databases Medline, PsycINFO, and Embase. The major outcome measure was mean total fuss/cry duration during 24 hours at ages 1‐2 weeks (11 samples), 3‐4 weeks (6 samples), 5‐6 weeks (28 samples), 8‐9 weeks (9 samples), and 10‐12 weeks (12 samples). Results Of 5687 articles reviewed, 28 diary studies (33 samples) were suitable for inclusion in meta‐analysis; these studies included 8690 infants. No statistical evidence for a universal crying peak at 6 weeks of age across studies was found. Rather, the mean fuss/cry duration across studies was stable at 117‐133 minutes (SDs: 66‐70) in the first 6 weeks and dropped to a mean of 68 minutes (SD: 46.2) by 10‐12 weeks of age. Colic was much more frequent in the first 6 weeks (17%‐25%) compared with 11% by 8‐9 weeks of age and 0.6% by 10‐12 weeks of age, according to modified Wessel criteria and lowest in Denmark and Japan. Conclusions The duration of fussing/crying drops significantly after 8‐9 weeks of age, with colic as defined by modified Wessel criteria being rare in infants older than 9 weeks. Colic or excessive fuss/cry may be more accurately identified by defining fuss/cry above the 90th percentile in the chart provided based on the review.