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Biomedical subjects

H McConachie

Publications and source records attributed to H McConachie.

At least 19 recordsLinked to original sources
PubMed2006

Participation of disabled children: how should it be characterised and measured?

PURPOSE: The aim of the paper is to explore the issues involved in measuring children's participation. METHOD: The concept of participation as encapsulated in the International Classification of Functioning, Disability and Health (ICF) is discussed as it applies to children. The essential components of any measure of children's participation are outlined, including participation essential for normal development and survival, leisure activities, and educational participation. Some existing instruments are briefly reviewed in terms of their coverage of the essential components and the adequacy of their approach to measurement. RESULTS: Key issues regarding the content of an adequate measure of participation include the need to consider the child's dependency on the family, and their changing abilities and autonomy as they grow older. Instruments may be most appropriate where they ask the child directly, implying use of visual as well as verbal presentation. Their focus should be on 'performance' such as whether and how often an activity is taken part in, and not incorporate degree of assistance within the measurement scaling. CONCLUSIONS: Currently available measures of children's participation all have some limitations in terms of their applicability across impairment groupings, whether the child can directly respond, and in the ICF components covered. The feasibility of developing measurement instruments of children's participation at different ages is discussed.

Activities of Daily Living↗
PubMed2006

What services do young children with autism spectrum disorder receive?

BACKGROUND: In recent years, standards of good practice have been set for services to young children with autism spectrum disorders. METHODS: Data were analysed on children's use of local services during a 2-year follow-up of families involved in an evaluation of a group course for parents. Data collection began prior to publication of the standards. RESULTS: Families' reported experiences changed over time, but for most did not meet standards suggested: involvement with a multi-agency team of professionals, having someone who acted as a key worker, and the child accessing 15 h per week of specialist provision. CONCLUSION: The development of flexible and responsive services appears to have a long way to go to meet standards set in the Autistic Spectrum Disorders Good Practice Guidance (2002) and the National Autism Plan for Children (2003).

Autistic Disorder↗
PubMed2005

Is social support sometimes a mixed blessing?

BACKGROUND: Child behavioural problems in epilepsy originate from a poorly understood interplay between intrinsic, family and social factors. METHODS: We re-analysed data from a randomized controlled trial of antiepileptic treatment in rural India, using regression analysis to find risk factors for behavioural problems. RESULTS: Parental satisfaction with social support was positively and independently correlated with child behavioural problems (P=0.03). CONCLUSION: Our findings suggest parents' interactions within their informal social support network, contrary to expectation, may increase risk for behavioural problems in their children. We suggest a possible explanation for this correlation as well as follow-up studies to investigate the social support-as-risk factor hypothesis.

Adolescent↗
PubMed2003

Validation of the measure of processes of care for use when there is no Child Development Centre.

INTRODUCTION: Clinical governance requires measurement of the outcomes of health care. The Measure of Processes of Care (MPOC; King, Rosenbaum & King 1995) is a postal questionnaire developed in Canada to reflect parents' perceptions of the quality of services received. AIM: To examine the usefulness of the MPOC for the evaluation of services for children with disabilities and their families. METHODS: The MPOC was revised minimally for British idiom, taking out explicit references to a 'Centre'. Surveys of parents using child disability services were carried out in three rural and two urban communities, where there are no Child Development Centres, with a total of 495 analysable questionnaires returned. In addition, 32 parents using a home nursing service for children with multiple disabilities completed questionnaires. RESULTS: The rate of return ranged from 49% to 67%. Factor analysis confirmed a five-factor solution but only one factor mapped clearly onto the Canadian structure. Using the revised structure, the surveys provide evidence of the discriminating potential of the MPOC, comparing the perceptions of parents who do or do not have a care coordinator, and comparing recipients of a home nursing service with matched users of general services. CONCLUSIONS: The MPOC can be used as a measure of outcome for child disability services of differing organizational structures.

Adolescent↗
PubMed2001

Predicting patterns of interaction between children with cerebral palsy and their mothers.

Children with cerebral palsy (CP) have often been described as passive communicators. Their familiar conversation partners tend to direct and control interaction. Such conversation patterns may have various precursors: children's motor impairment, their intelligibility difficulties, and/or their level of cognitive development. To test the comparative influence of these factors, measures of motor function, speech, communication, cognitive and language skills were applied in 40 children (18 males, 22 females) with CP who were aged from 2 years 8 months to 10 years. These variables were correlated with measures relating to interaction patterns to investigate whether individual features predicted communication style. In this group, poor speech intelligibility was the main predictor of restrictive communication patterns, such as fewer child-initiated conversation exchanges, more simple child communicative acts such as yes/no answers and acknowledgements of the other partner's messages. Results support the provision of therapy to increase children's intelligibility, whether spoken or augmented, such as the introduction of communication aids and training programmes for parents.

Adult↗
PubMed2001

Difficulties for mothers in using an early intervention service for children with cerebral palsy in Bangladesh.

Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers' attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child's sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.

Bangladesh↗
PubMed2000

A randomized controlled trial of alternative modes of service provision to young children with cerebral palsy in Bangladesh.

OBJECTIVE: To compare the efficacy of an outreach program for young children with cerebral palsy with center-based and "minimal intervention" control groups. DESIGN: Randomized controlled trial conducted in a group of 85 children between the ages of 1.5 and 5 years. Urban children were allocated to a daily center-based mother-child group or to monthly training of their parents along with a pictorial guidance manual. Rural children were allocated either to parent training or health advice. Outcome measures were changes in children's adaptive skills, maternal stress and adaptation to the child, satisfaction with social support, and knowledge of handling a physically disabled child. RESULTS: Fifty-eight children were successfully followed up. The pattern of change in children's adaptive skills was as predicted (ie, least progress in the health advice group). Positive effects of intervention also included increased maternal knowledge and perceived helpfulness of support from formal sources. However, maternal adaptation increased most in the health advice group with minimal intervention. When children had attended a program at least 4 times, their skills improved, and mothers' adaptation did increase. CONCLUSIONS: Outreach training for mothers in Bangladesh can help them to improve the skills of their young children with cerebral palsy and is perceived as helpful.

Bangladesh↗
PubMed2000

Predictors of stress in mothers of children with cerebral palsy in Bangladesh.

OBJECTIVE: To identify the stress experienced by mothers of young children with cerebral palsy in Bangladesh and to determine predictive factors. METHODS: We recruited 91 mothers of children with cerebral palsy ages 1.5 to 5 years as they sought services at an urban and a rural center for their children. Mothers were interviewed with the Self-Report Questionnaire and other family background and child behavior measures. The children were examined by a pediatrician and by a psychologist. RESULTS: Out of 91, 38 (41. 8%) mothers were at risk for psychiatric morbidity. Significantly associated factors included living in the rural area within a poor family, with a relatively older child. The strongest predictor of maternal stress in multivariate analysis was child behavior problems, especially those related to burden of caring. CONCLUSIONS: Ensuring practical help for mothers and advice on managing common behavior problems are important components of intervention, as they may directly help to relieve stress on mothers of young disabled children in developing countries.

Adaptation, Psychological↗
PubMed2000

Parents' perceptions of disclosure of the diagnosis of cerebral palsy.

The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107 children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and coping strategies. Dissatisfaction with how the diagnosis had been disclosed was greater where children had been premature and/or low birth weight, where they developed more severe degrees of physical disability, and where the diagnosis had been made later. Dissatisfaction was related to greater degrees of later self reported depression. The guidelines take account of the findings, in particular the need for early close liaison between neonatology and community paediatric services. Suggestions are made for how to ensure implementation and monitoring of good practice.

Adaptation, Psychological↗
PubMed1999

A model for the assessment and management of children with multiple disabilities.

Children with multiple disabilities present complex management problems, both for their families and for the professionals involved in their care. For any one child, the list of functional and medical problems that need to be addressed is frequently reflected in an even longer list of involved professionals, leading to conflicting advice and problems in co-ordination of care. A hierarchical model for assessment and management is proposed, which highlights the interdependency of apparently different areas of functioning. The model aims to assist both parents and professionals in determining priorities, to improve interdisciplinary working, and to underpin staff training. Illustrative case studies indicate the importance of resolving issues in areas such as visual functioning, positioning and nutrition before integrated functions such as communication skills can be addressed successfully.

Child↗
PubMed1998

Outcome of recommendations for augmentative communication in children.

Some children with severe motor disorders have unintelligible speech, and may be recommended augmentative communication systems, such as a symbol chart or a voice output aid. The paper reports the outcome after 15-18 months for 35 children of recommendations for augmentative communication. Using structured questionnaires, parents were asked whether equipment was provided as recommended. Their perception of success in children's use of augmentative aids was recorded and related to potentially influential factors. Twenty-five symbol systems, 10 speech output devices and 11 switches were received; 18 symbol systems were used for communication and 10 were used frequently. Seven speech output devices were used for communication but only two were reported to be used frequently. Factors leading to more successful outcomes include early receipt of the aid, perceived adequate local training in the use of the aid, and children aged 6 years or more at initial assessment. The findings also suggest that referring professionals will need to be better informed about the nature and limitations of augmentative communication aids, and that improved local professional input and careful interagency planning and co-ordination are required to achieve optimal outcome.

Adolescent↗
PubMed1998

Mortality of urban and rural young children with cerebral palsy in Bangladesh.

Bangladesh has a high child mortality rate. However, little is known about the outcome for young children who have cerebral palsy (CP). Ninety-two children with CP with a mean age of 3 years 3 months at entry into the study were followed for up to 3 years as part of an intervention study. Eight children died: two of 49 (4%) from an urban area and six of 43 (14%) from a rural area. Extrinsic factors such as infections and drug reactions preceded all the deaths, but those who died were mostly severely malnourished and among the more severely disabled of the total group. Eighty-nine percent of rural children in the study were from low-income families. Intervention programmes for severely disabled children in developing countries must include primary health care and feeding programmes as well as rehabilitation services to address both the needs of the child and empowerment of the mother and the family.

Bangladesh↗
PubMed1998

Peer problems of children with hemiplegia in mainstream primary schools.

A representative sample of 55 mainstreamed 9-10-year-olds with hemiplegia were compared with all classmates on sociometric measures of popularity and friendship, and with 55 matched controls on measures of victimization. Children with hemiplegia were more rejected and less popular, had fewer friends, and were more often victimized; they were not more likely to be bullies themselves. These differences were not fully accounted for by group differences in teacher-estimated IQ and behaviour. Possible explanations range from neurologically determined deficits in mentalizing skills to peer prejudices about children with disabilities. The development of appropriate intervention strategies should be a high priority, particularly since peer problems not only result in current distress but also predict psychosocial problems in the future.

Child↗
PubMed1997

In-service training for schools on augmentative and alternative communication.

For children to progress in their use of augmentative communication systems, in-service training of staff in schools is required. This paper presents preliminary evaluation of a training package entitled 'My Turn to Speak'. Nineteen participants and 10 comparison staff were filmed before and after a five-session training workshop, interacting in the classroom in naturally occurring situations with a non-speaking physically disabled child. Significant improvements in the quality of adults' facilitation of the children's communication was discernible at follow-up, four months after completion of the training. However, teachers were found to alter their behaviour more quickly after training than non-teaching staff. The requirements for setting up successful multidisciplinary training are discussed.

Child↗
PubMed1995

How parents can help young visually-impaired children to communicate.

A study of parents' strategies to communicate with their young visually-impaired children has implications for all health visitors working with young children, write Vanessa Moore and Helen McConachie. The study highlights the important role of naturally-occurring communicative exchanges between parent and young child in promoting language development.

Blindness↗
PubMed1992

Communication aids for children: procedures and problems.

This paper describes the organisation and procedures of the Communication Aids Centre for children at the Wolfson Centre, London, including a model for assessment and recommendation of appropriate aids, such as symbol charts, switches and speech synthesisers. Of the children seen over an 18-month period, most had cerebral palsy and two-thirds were wheelchair-dependent. Almost half were assessed before the age of five years. A detailed follow-up of nine children is presented which reveals how long children may have to wait for the provision of an aid in the UK. Possible problems in establishing use of an aid are discussed; these include inadequate training of children and their communication partners. Suggestions for future improvements of communication-aids services are explored.

Adolescent↗