Goal setting is essential in pediatric rehabilitation to enhance participation and meaningful goals. This study examined the construct validity, internal consistency, and test-retest reliability of the Turkish version of the Perceived Efficacy and Goal-Setting System (PEGS) in children with disabilities. A methodological cross-sectional design was used with 120 children aged 7 to 9 years (90.9% cerebral palsy, 9.1% spina bifida), their caregivers, and teachers from three rehabilitation centers in Turkey. The adaptation process followed WHO guidelines. Data were collected with PEGS-Child, PEGS-Caregiver, PEGS-Teacher forms, and demographics. Exploratory and confirmatory factor analyses confirmed a single-factor structure consistent with the original, with factor loadings above 0.320 and acceptable fit indices (CFI > 0.90, RMSEA < 0.08). Cronbach's alpha ranged from 0.72 to 0.77. Test-retest reliability was high (ICC = 0.876-0.943). The Turkish PEGS is valid and reliable, supporting child participation in goal-setting and fostering collaboration between home and school.
The United Nations Conventions on the Rights of the Child recognises the importance of including children's voices in matters that concern them. Traditionally, parent-reported measures like the Focus on the Outcomes of Communication Under Six (FOCUS) have successfully been used to evaluate children's communication experiences through proxy means. However, available tools like the Speech Participation and Activity Assessment of Children (SPAA-C) and drawings remain underutilised as ways of listening to children's voices. This study explored whether relationships existed between tools designed to gather information about the child (i.e. proxy measurement) and activities designed to capture information with the child. Parents of 37 typically developing 4- to 6-year-old Jamaican Creole (JamC)-Jamaican English (JamE)-speaking children completed the FOCUS in English only, in keeping with previous work in the Jamaican context. Children completed the SPAA-C and drawings in both languages. Pearson correlations were used to describe relationships between the FOCUS and the SPAA-C. Children's drawings were analysed for themes and SPAA-C responses were categorised as positive, neutral, or negative. A Fisher's Exact Test explored associations between themes in children's drawings and SPAA-C responses. No significant correlations were observed between FOCUS scores, which are proxy-based and scores on the SPAA-C, which directly gather children's responses about their communication experiences. However, statistically significant associations were observed between SPAA-C responses and themes coded in children's drawings. These findings highlight the importance of extending beyond traditional proxy means of informing young Jamaican children's communication experiences by listening to children's voices directly.
Aim To identify the outcomes reported in published studies of intervention approaches used with non-degenerative childhood hyperkinetic movement disorders, including dystonia, dyskinesia, hypertonia, athetosis, chorea, cerebral palsy, involuntary movement, and kernicterus, and map them to the International Classification of Functioning, Disability and Health (ICF) framework. Method This was a scoping review that used the Arksey and O'Malley's framework. Medline, CINAHL plus, and EMBASE were searched from 2001 (when the ICF was approved for use by the World Health Assembly) to February 2025. Data were extracted and mapped to the ICF framework. Results A total of 294 studies included 159 surgical (e.g. deep brain stimulation, intrathecal baclofen pump), 81 pharmacological (e.g. levodopa, trihexyphenidyl, toxin injections), 51 non-pharmacological and non-surgical studies, and three studies reporting outcomes longitudinally. Neuromodulation, particularly deep brain stimulation, was reported in 122 studies. Over half of the non-pharmacological/non-surgical studies described the management of the underlying impairments. Outcomes were reported as measured objectively 650 times with 209 unique tools. The most evaluated ICF domain was body functions and structures (375 of 635, 59%), followed by activity (165 of 635, 26%), and participation (37 of 635, 5.8%). The least assessed domains were quality of life (28 of 635, 0.04%), goals (25 of 635, 0.04%), and environment (5 of 635, 0.007%). Interpretation The major focus of assessment of interventions for children with non-degenerative hyperkinetic movement disorders is on body structure and function. The voices of children remain unheard across all studies, with a lack of individualized measurement. Partnering with children to understand what meaningful outcomes mean to them will go a long way to address this gap.
Introduction This study aimed to explore the associations between different parent-child interaction patterns, school adjustment types, and multidimensional mental health indicators such as adolescent wellbeing indices and depressive symptoms and thereby provide insights for improving adolescent mental health. Methods Using questionnaire data from the China Education Panel Survey (CEPS) conducted from spring 2014 to spring 2015, this study focused on school-attending adolescents aged 12-18 years. Data from the Parent-Child Interaction Questionnaire, the School Adjustment Questionnaire, and the Mental Health Questionnaire were used. Cluster analysis using the K-means algorithm, combined with non-parametric tests and the analysis of variance (ANOVA) with multiple comparisons, identified distinct parent-child interaction patterns and school adjustment types and examined their associations with adolescent wellbeing indices and depressive symptoms. Results Depressive symptoms showed negative correlations with positive school adaptation, parent-child interaction frequency, and parent-child interaction content (r = -0.247, -0.123, -0.16, p < 0.001), while wellbeing exhibited positive correlations (r = 0.304, 0.135, 0.123, p < 0.001). Parental interaction patterns were categorized into high-frequency (35%), medium-frequency (38%), and low-frequency (27%) groups. School adaptation types were classified as high-involvement adaptation (50%), balanced adaptation (35.3%), and alienated adaptation (15%). Different parent-child interaction patterns significantly influenced adolescents' mental health (depression: F = 743.821, p < 0.001, ηp2 = 0.083; wellbeing: F = 795.63, p < 0.001, ηp2 = 0.079). Different school adaptation types also significantly influenced adolescents' mental health (depression: F = 135.777, p < 0.001, ηp2 = 0.022; wellbeing: F = 190.848, p < 0.001, ηp2 = 0.016). Multiple comparison analyses revealed significant differences between different parent-child interaction patterns and school adaptation factors in their prediction of adolescent mental health outcomes. The predictive effect on the wellbeing index was ΔR2 = 0.087 (F = 761.6, p < 0.001), while the predictive effect on depressive symptoms was ΔR2 = 0.064 (F = 529.3, p < 0.001). Conclusion The combination of high-frequency parent-child interaction and high-investment school adaptation is most conducive to enhancing adolescents' wellbeing and alleviating depressive symptoms. This finding provides theoretical guidance and empirical evidence for interventions addressing adolescent mental health issues.
Abstract Problem posing is widely recognised as a central mathematical activity, yet little is known about how preschool teachers coordinate the pedagogical and mathematical demands of posing problem situations for young children. This qualitative study examined 15 preschool teachers’ conceptions, reported classroom practices, professional learning needs, and performance across structured, semi-structured, and visually supported open problem-posing tasks. Teachers responded to two visual contexts construction materials and grocery shopping and produced 90 problem situations. Interview data were analysed through descriptive and pattern coding, while task responses were classified as not a problem, non-mathematical, impossible, insufficient, or sufficient. Teachers consistently valued play, concrete materials, everyday-life contexts, and child participation. However, these pedagogical orientations did not always become mathematically explicit and coherent problem situations. Of the 90 responses, 68 were sufficient, 16 insufficient, and 6 were not problems; no response was classified as non-mathematical or impossible. Performance was strongest in structured tasks and became more variable as task structure decreased. All responses classified as not a problem occurred in the open tasks. The two visual contexts yielded the same overall number of sufficient responses but foregrounded different mathematical possibilities. The findings suggest that preschool teachers’ problem-posing competence is best understood as the coordination of pedagogical appropriateness, an explicit mathematical relationship, and a meaningful requirement for children’s action. Open prompts did not automatically produce productively open mathematical problems; instead, they transferred greater responsibility for selecting the mathematical relationship, coordinating information with the requirement, and specifying a meaningful goal. Open task formats may therefore reveal, rather than automatically promote, this coordination. Implications are proposed for practice-based teacher education centred on comparing, revising, and discussing problem situations.
Endoscopic transgastric necrosectomy (ETN) has emerged as a preferred minimally invasive approach for managing walled-off necrosis (WON); however, its conventional indication remains confined to necrosis limited to the lesser sac. The applicability of this technique for extensive necrosis extending to the paracolic gutter and pelvic cavity remains poorly characterized, particularly in pediatric patients. We herein report the case of a 7-year-old boy with infected necrotizing pancreatitis, in whom imaging demonstrated necrosis extending from the lesser sac to the bilateral paracolic gutters, iliac fossae, and pelvic cavity. Following initial conservative management and CT-guided percutaneous drainage, endoscopic ultrasonography (EUS)-guided transmural drainage was performed at week 4, followed by ETN on day 40. During the procedure, the conventional indication was extended by leveraging the flexibility of the endoscope to navigate from the pancreatic tail into the left paracolic gutter and pelvic cavity, thereby achieving successful debridement without the need for additional percutaneous sinus endoscopy or video-assisted retroperitoneal debridement. The patient recovered uneventfully, with post-procedural CT confirming complete resolution and stents removed three months later. This case suggests that extended ETN may represent a safe and effective option for managing extensive WON beyond the lesser sac in children, potentially obviating the need for more invasive combined procedures.
Purpose Family Resource Centers (FRCs) are place-based programs with great potential to address rural access barriers and improve health outcomes, yet empirical evidence on these programs is lacking. Using multiple data sources from a longitudinal investigation in Wisconsin, this mixed-methods study analyzed whether and how FRCs address rural access barriers. Methods A convergent parallel mixed-methods design was used to gather, analyze, and interpret quantitative and qualitative data. Data from the Child Opportunity Index were used to compare opportunities in rural and nonrural areas statewide and among 646 rural and nonrural families who received support from one of 18 FRCs. Qualitative data gathered from interviews with nine FRC participants and 11 FRC staff were synthesized to describe rural access barriers and facilitators. To compare the types of support received by rural and nonrural families, baseline survey data collected from 646 FRC participants were analyzed using chi-square tests. To test whether FRC participation increased referral connections, follow-up survey data collected from 319 FRC recipients and a matched sample of 458 adults were analyzed via logistic regression. Findings Disparities between rural and nonrural ZIP codes were evident statewide and in FRC catchment areas. Qualitative analyses identified rural resource gaps, transportation barriers, and FRC facilitators of family engagement. Baseline survey responses indicated that rural families were more likely to receive resource referrals; nonrural families were more likely to participate in parenting programming and parent-child activities. Longitudinal analyses linked FRC participation to higher rates of resource connections. Conclusions FRCs address social determinants that disproportionately affect rural communities. Implications for public health intervention and policy are discussed.
Multicomponent family-based interventions can mitigate the adverse effects of poverty on family functioning. However, benefits are not uniform across families. Limited research has examined how distinct constellations of poverty-related risk shape engagement with and responsiveness to preventive interventions. Using a person-centered approach, this study tested whether pre-intervention risk classes predicted differential engagement with and response to the Fatherhood, Relationship, and Marriage Education (FRAME) intervention, a program based on the Family Stress Model and designed to strengthen parental coping, couple relationships, and parenting practices. Participants were 301 mother-father-child triads with household incomes at or below 200% of the federal poverty level. Building on prior research that identified four latent risk classes, we examined whether class membership predicted session attendance and moderated intervention effects on family relational and behavioral outcomes assessed six months post-intervention using combined mother and father reports. Results indicated heterogeneity in both engagement and intervention response. Families characterized by moderate economic stress and elevated parental depressive symptoms demonstrated the highest attendance and the most favorable response, particularly for couple relationship quality. Families in the lowest and highest risk classes received few benefits, with the lowest risk group experiencing adverse effects on some outcomes. Sensitivity analyses suggested additional gender-specific patterns, indicating that mothers' and fathers' responses may differ within certain risk classes. These findings highlight the value of identifying multidimensional risk classes when evaluating preventive interventions and support precision approaches to intervention delivery.
Background As survival improves among children with chronic lung disease, severe neurologic impairment, neuromuscular disorders, congenital airway anomalies, and long-term ventilator dependence, pediatric tracheostomy care has shifted from a procedure-centered issue to a sustained respiratory care challenge. Post-tracheostomy adverse events are still frequently framed as isolated complications rather than as part of a continuous airway-safety and home-transition pathway. Purpose This article synthesizes post-tracheostomy risk across four connected domains: acute airway-threatening events, chronic cannulation-related morbidity, hospital-to-home transition, and decannulation-related functional outcomes, and develops a pediatric longitudinal airway safety framework. Methods We conducted a structured narrative search and qualitative synthesis drawing primarily on recent pediatric guidelines, systematic and scoping reviews, multicenter studies, national database analyses, and qualitative investigations, with priority given to publications from 2010 onward. Results Major topics addressed include hemorrhage, false passage, accidental decannulation, tube obstruction, air leak syndromes, peristomal skin injury, respiratory infection, granulation tissue, airway stenosis or malacia, persistent tracheocutaneous fistula, dysphagia, impaired phonation, and caregiver burden. The framework differs from existing guidance and reviews by using phase of care and changing dominant risk as its organizing logic, linking each phase to the care setting, surveillance priorities, responsible teams, escalation thresholds, caregiver capability, and child- and family-centered outcomes. Conclusion A risk-stratified pathway connecting PICU care with community-based respiratory management may improve safety, reduce avoidable healthcare utilization, and better align clinical practice with the realities faced by children and families across the full trajectory of tracheostomy dependence.
Purpose Children diagnosed with bone tumors or soft tissue sarcomas often undergo limb salvage surgery or amputation, procedures that shape long-term functioning and quality of life (QOL). Patient-reported and caregiver-reported outcomes (PROs) provide essential insight into physical, psychosocial, and participation impacts, yet existing evidence is dispersed and methodologically heterogeneous. This scoping review mapped the PRO literature for children, survivors, and caregivers following cancer-related limb surgery and identified gaps limiting clinical care and research advancement. Methods Six databases were searched. Eligible studies included children with bone or soft-tissue sarcomas and their family caregivers that reported PROs or needs related to limb salvage or amputation. Two reviewers independently screened studies and charted data. Quantitative and qualitative findings were summarized descriptively and synthesized narratively across QOL domains. Results Twenty-seven studies fulfilled inclusion criteria. Physical functioning was the most assessed domain, with generally moderate-to-good outcomes and limited differences between limb salvage and amputation. Pain remained common months to years post-surgery. Psychosocial findings were mixed, reflecting peer acceptance but also body image, recreation, and school participation challenges. Only four studies included caregivers, who reported anxiety, depression, financial strain, and shifting family roles. Across studies, PRO measurement was highly heterogeneous, with inconsistent domains of assessment, measurement tool use, and timepoints. Conclusions Children and families experience complex functional and psychosocial impacts after limb surgery, underscoring needs for enhanced rehabilitation, pain care, school reintegration, and caregiver support.
