AIM Our aim was to develop an outcome measure, called Focus on the Outcomes of Communication Under Six (FOCUS), that captures real-world changes in preschool children's communication. Conceptually grounded in the World Health Organization International Classification of Functioning, Disability and Health framework, the FOCUS items were derived from observations of change provided by parents and clinicians after speech-language therapy.METHOD Participating families (n=165) were drawn from a convenience sample at partner institutions in Ontario, Newfoundland and Labrador, and Nova Scotia. All children had speech, language comprehension, and ⁄ or language production disorders and were receiving speech-language therapy. The age of the children ranged from 1 year 2 months to 5 years 6 months (mean=3.8y; SD=0.91y), and 119 children were male. Three test phases were completed. The measure was revised according to item analysis and parent ⁄ clinician feedback after phase 1 (n=74) and phase 2 (n=65). In phase 3 (n=26), the Pediatric Quality of Life Inventory (PedsQL), a health-related quality of life measure, was added to establish construct validity. RESULTSIn phase 1, item analysis revealed high internal consistency for both parents (Cronbach's a=0.87) and clinicians (Cronbach a=0.97). These values indicated redundancy, so 31 items were cut. Five items for young children were added. In phase 2, internal consistency remained high for both parents (Cronbach a=0.98) and clinicians (Cronbach a=0.83), indicating redundancy of items. Twenty-seven items were removed. In phase 3, parents and clinicians reliably scored the FOCUS in 10 minutes. They stated that it provided an accurate snapshot of the child's communication.Internal consistency for parents remained high (Cronbach a=0.96). Children with higher FOCUS scores at the end of treatment had higher PedsQL total scores (r=0.466, p=0.029). INTERPRETATIONThe FOCUS is a usable measure of a child's ability to communicate and participate in his or her community. It demonstrates high internal consistency and construct validity.Approximately 6% of preschool children have significant communication disorders.1 By the age of 3 years, these children are being socially isolated and ignored by their peers.2-4 In later years, communication disorders are associated with social isolation, academic failure, and an increased incidence of psychiatric disorders and arrests. 5,6 Effective and early speechlanguage therapy is critical to preventing these problems. 7,8 Evaluating the outcomes of treatment is essential for improving services in an evidence-based manner. 10 This revised framework was multidirectional, acknowledging that interventions at all levels are important and interlinked. 11,12 The ICF for Children and Youth (ICF-CY), a paediatric version of the ICF, was published in 2007. 13 These frameworks facilitated a shift in health care paradigms, empowering clinicians to set treatment goals that focus on participation in life situations. [14][15][16][17][18] To capture the real-w...
AimThe aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©),a tool designed to measure changes in communication skills in preschool children.MethodParticipating families' children (n=97; 68 males, 29 females; mean age 2y 8mo; SD 1.04y, range 10mo–4y 11mo) were recruited through eight Canadian organizations. The children were on a waiting list for speech and language intervention. Parents completed the Ages and Stages Questionnaire – Social/Emotional (ASQ-SE) and the FOCUS three times: at assessment and at the start and end of treatment. A second sample (n=28; 16 males 12 females) was recruited from another organization to correlate the FOCUS scores with speech, intelligibility and language measures. Second sample participants ranged in age from 3 years 1 month to 4 years 9 months (mean 3y 11mo; SD 0.41y). At the start and end of treatment, children were videotaped to obtain speech and language samples. Parents and speech–language pathologists (SLPs) independently completed the FOCUS tool. SLPs who were blind to the pre/post order of the videotapes analysed the samples.ResultsThe FOCUS measured significantly more change (p<0.01) during treatment than during the waiting list period. It demonstrated both convergent and discriminant validity against the ASQ-SE. The FOCUS change corresponded to change measured by a combination of clinical speech and language measures (κ=0.31, p<0.05).ConclusionThe FOCUS shows strong construct validity as a change-detecting instrument.
The unmanaged pain in children with spina bifida can have a substantial negative impact on quality of life. Better treatment and surveillance of pain and depression symptoms may significantly improve quality of life.
Abstract-Previous longitudinal cohort studies have suggested an association between baseline depressive symptoms and incident hypertension. We assessed this possible association using data from the Multi-ethnic Study of Atherosclerosis, a population-based prospective cohort study of 6814 US adults from 4 different racial/ethnic groups. Baseline users of antihypertensive medications and participants lost to follow-up were excluded leaving 3914 participants. Patients with baseline depressive symptoms (nϭ622) were defined using a high score on the Center 1 Although this association is not consistently documented in cross-sectional studies, 2 several longitudinal studies have supported an association between depressive symptoms and hypertension. These studies have been in multiple populations and all show an approximately 2-fold increase in the odds of hypertension among adults with baseline depressive symptoms. [3][4][5][6] However, all of these previous studies have limitations. These include being among young healthy patients, a lack of information on confounders, and being set in an earlier time period when clinical care was quite different. [3][4][5][6] These issues of study design make it unclear how relevant previous estimates of this association are to current populations.To assess this association in diverse populations, we examined the association between baseline depressive symptoms and increases in participant blood pressure after an average of 1.60 year in a multiethnic, population-based study. We collected information on depressive symptoms, 7 as reported by Center for Epidemiological Studies Depression Scale (CES-D) score. There was also information on other psychological variables such as anger 8 and anxiety 9 that might be potential confounders as these measures are available in the MESA cohort. 10 MethodsThe Multi-Ethnic Study of Atherosclerosis (MESA) is a populationbased study. The study was initiated to determine the risk factors for the development and progression of subclinical and clinical cardio-
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