MATERNAL AND CHILD CHARACTERISTICS DURING …Women & Infants’ Hospital Warren Alpert Medical...
Transcript of MATERNAL AND CHILD CHARACTERISTICS DURING …Women & Infants’ Hospital Warren Alpert Medical...
MATERNAL AND CHILD CHARACTERISTICS DURING MOTHER-CHILD PLAY SESSIONS: ASSOCIATIONS WITH CHILD LANGUAGE OUTCOMES AT 18-24 M FOR CHILDREN WITH CONG N A A NG OSSCONGENITAL HEARING LOSS
April 2, 2009
Presented by AUCD and supported by Cooperative Agreement from the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at Center for Disease Control and Prevention (CDC)
Webinar Agendag2
I Welcome & Introduction – Karla Kmetz Project Specialist I. Welcome & Introduction – Karla Kmetz, Project Specialist, AUCD-NCBDDD Cooperative Agreement
II. Presentation: Child Language Outcomes at 18-24 m for Children with Congenital Hearing Loss
Betty Vohr, MD, Lucille St Pierre BS, Julie Jodoin-Krauzyk, MEd, MA, Deborah Topol, BA, Richard Tucker, BAp
Organization: Warren Alpert Medical School of Brown University Women & Infants’ Hospital, affiliated with Paul V. Sherlock Center on Disabilities (RI UCEDD)
III. Question and Answer
Overview: AUCD-NCBDDD Cooperative Agreement
' Strengthen the nation's capacity to carry out public health and disability activities
Foster collaborations among AUCD, its network (UCEDD, LEND DDRC) members and NCBDDD LEND, DDRC) members, and NCBDDD
Provide technical assistance to State Disability and Health Grantees
E h th it f t t d ti ll b ti Enhance the capacity of states and creating collaborative systems change in the early identification, assessment, service coordination for children with autism spectrum disorder and related disabilities through Act Early Regional Summits
Strengthen expertise in the fields of birth defects and developmental disabilities through training of professionals in public health and related fields.
Facilitate a wide range of research, education, and dissemination activities.
Research Topics of Interests (RTOI)4
RTOI are specific research area of significance identified by scientists at NCBDDD CDC P t RTOI j t h f d th f ll i NCBDDD, CDC. Past RTOI projects have focused on the following areas:
Health Communication and Education P i f S d C di i Prevention of Secondary Conditions
Healthcare Cost Analysis Quality of Life Studies
D l l F d O Developmental Factors and Outcomes Health Promotion Interventions Co-Morbidity Prevalence Studies
Specific disabilities areas include: autism spectrum disorder, Down syndrome, Duchenne muscular dystrophy, epilepsy, Fragile X syndrome, hearing loss, fetal alcohol syndrome, spina bifida, and Tourette syndrome. fetal alcohol syndrome, spina bifida, and Tourette syndrome.
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Maternal and Child Characteristics duringMother-Child Play Sessions: AssociationsMother Child Play Sessions: Associations
with Child Language Outcomes at 18-24 m for Children with Congenital Hearing LossChildren with Congenital Hearing Loss
Betty Vohr, MDL ill S Pi BS J li J d i K k MEd MALucille St Pierre BS, Julie Jodoin-Krauzyk, MEd, MA,
Deborah Topol, Richard Tucker, BA
Women & Infants’ HospitalWarren Alpert Medical School of Brown University
Providence, RIo de ce,
Funded by cooperative agreements between the Rhode Island Department of Health and the Early Hearing Detection and Intervention Program at the Centers for Disease Control & PreventionHearing Detection and Intervention Program at the Centers for Disease Control & Prevention
and the Association of University Centers on Disabilities Grant UR3/CCU120033-01 AUCD-RTOI 2006-06-07-1
Family Perspectives Study
• Prospective study of a cohort of childrenProspective study of a cohort of children born and screened for HL in RI
• Home visits conducted at 6 10 12 16 &• Home visits conducted at 6-10, 12-16 & 18-24mI iti ll f d d b C ti• Initially funded by a Cooperative Agreement between CDC and RI DOH
• Funding received from AUCD for 36 and 48m assessments
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Study Design for Child Outcomes
Maternal Stress Words Hearing Loss
Study GroupsStudy Groups PredictorsPredictors OutcomeOutcome
PCIS Scores
Hearing loss
Produced
at 18-24
Hearing Loss
Typical HearingHearing loss
NICU Stay months
Objective: To assess the effects of maternal stress and maternal communicative effectiveness and hearing loss on words produced at 18 months for children with and
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without congenital hearing loss and to assess the effects of stay in the NICU.
Hypotheses↑ f l th i f t i t ti ill f t• ↑ successful mother-infant interactions will foster improved language outcomes for children with HL and hearing children. a d ea g c d e
• ↑ verbal involvement, Improved affective atmosphere, positive regard and global measures
f (of interaction (atmosphere, availability, and enjoyment), will a be associated with ↑ language skillsskills.
• Controlling behaviors, such as control/directiveness and intrusiveness, will be associated with ↓ language skills.
• ↑maternal stress will be associated with ↓language skills
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language skills.
Study SampleStudy Sample
• Study subjects were children withStudy subjects were children with permanent hearing loss born in Rhode Island from 10/15/02 to 1/31/05 (n=31)Island from 10/15/02 to 1/31/05 (n 31)
Child id tifi d ith t• Children identified with permanent congenital hearing loss were matched to
t l hild ( 40) ith h icontrol children ( n=40)with no hearing loss.
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Methods• Enroll families of infants with HL• Identify control matches• Informed consent: Schedule home visits• Matching Criteria (Gender NICU versus Well Baby• Matching Criteria (Gender, NICU versus Well-Baby
Nursery, Date of Birth (+/- 30 to 90 days), Hospital of Birth, Maternal Education, Race/Ethnicity, Health Insurance)
• Assessments at home visits– Demographics and Hollingshead SES– Parenting Stress Index– Parent Caregiver Interaction Scale
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– MacArthur Bates CDI
•Parent Caregiver Involvement Scale (PCIS)
10 minute play session coded by trained coders10 minute play session coded by trained codersFarran D, 1986
Six areas were coded for amount and quality of b h i di l d b th tbehaviors displayed by the parent
• Verbal Involvement• Responsiveness• Play Involvement• Control/Directives• Positive Regard
12• Negative Regard
Parent Caregiver Involvement S l (PCIS)Scale (PCIS)
Four items were scored on amount as overallFour items were scored on amount as overall indicatorsAvailability Acceptance Atmosphere EnjoymentAvailability, Acceptance, Atmosphere, Enjoyment
Fi it t d i d d tFive items are rated as independent scoresSensitivity, Scaffolding, Intrusiveness, Structuring/Intrusiveness, Hostility
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Definitions for PCISGeneral Impressions of Caregiver InvolvementGeneral Impressions of Caregiver Involvement with Child
• Availability – Parent response based on child’sAvailability Parent response based on child s expressed needs or cues
• Acceptance – Approval and acceptance of childAcceptance Approval and acceptance of child • Atmosphere – Synchrony between adult and child• Enjoyment – Amount of time that adult and child• Enjoyment – Amount of time that adult and child
seem to be delighted with each
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Definitions for PCIS: A C d d f A t d Q litAreas Coded for Amount and Quality• Verbal Involvement – Amount and quality of
caregiver’s verbal communicationscaregiver s verbal communications• Responsiveness- Caregiver’s reaction to child
initiations• Play involvement – Amount and quality of caregiver-
child play during session• Control/Directives Amount and quality of structure• Control/Directives – Amount and quality of structure
and directives by caregiver• Positive regard – Caregiver displays positive attitude g g p y p
toward child.• Negative regard – Negative emotions and
statements directed toward child15
statements directed toward child
Emotional Availability ScalesEmotional Availability Scales• Sensitivity- genuine interest and pleasure with y g p
child. Play creative and joyful for both• Scaffolding-Maintain appropriate level of
structure to allow success for childstructure to allow success for child• Intrusiveness-parenting behavior that prevents
child autonomy. Parent does not let child lead in lplay.
• Structuring/Intrusiveness-degree to which caregiver structures child’s play taking care to ca eg e st uctu es c d s p ay ta g ca e tofollow child’s lead. (Optimal score midpoint)
• Hostility-threatening or frightening interaction
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Parenting Stress Index*•Short form – 36 questions•Likert Scale 1 to 5: Strongly Agree to Strongly Disagree
•Total Stress Score (36-180)Total Stress Score (36 180)•Factor Scores (12-60)
Parental Distress– Parental Distress– Parent-Child Dysfunctional Interaction
Diffi lt Child– Difficult Child
*Abidin RR. Parenting Stress Index (PSI) Third Edition. Lutz, FL: Psychological
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g ( ) , y g
Assessment Resources, Inc; 1995.
CDI at 18m: Words & Sentences*P t I W d Child U i l d 680 it• Part I: Words Children Use includes 680 item vocabulary checklist for words produced and questions on how children use words.ques o s o o c d e use o ds
• Part II: Sentences & Grammar includes questions on word endings, word forms, word combinations, and sentence complexity.
P til il bl f• Percentile scores are available for:• words produced and
sentence complexity• sentence complexity.
*Fenson L Dale PS Reznick JS Thal D Bates E Hartung JP et al TheFenson L, Dale PS, Reznick JS, Thal D, Bates E, Hartung JP, et al. The McArthur Communicative Development Inventories: User's Guide and Technical Manual. San Diego: Singular Thomson Learning; 1993.
Data Analysis Analysis
– Hearing Loss vs. Hearing Controlsg g– T tests to analyze differences between
groupsgroups– Ҳ 2 to analyze differences among
proportionsproportions– Correlations – Regression Models to show relationships of
predictors with outcomes for the total cohort.
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Maternal Characteristics*HL Controls PHL(28)
Controls(30)
P
Age 32±6 35±5 .0987
Married 23(83%) 27(90%) 3859Married 23(83%) 27(90%) .3859
≤high school 2(7%) 1(3%) .5127Primary English 24(86%) 30(100%) .0319
Medicaid / No 4(13%) 6(21%) 4147Medicaid / No Ins.
4(13%) 6(21%) .4147
SES 39±14 48±10 .01
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Total Stress 67±10 70±17 .3892
*Mothers with multiples are counted once and assigned to most severe group
Infant CharacteristicsHL(31)
H Controls(40)
Female 12(39%) 16(40%) .9121
White 28(90%) 39(98%) 1917White 28(90%) 39(98%) .1917
NICU 19(61%) 26(65%) .7476
<37 wks 20(65%) 21(53%) .3093
Visit Age 22.5±2 21.8±2 NS
EI 30(97%) 13(33%) 000121
EI 30(97%) 13(33%) .0001
PCIS Scores for Moderate or High ResponsePCIS Scores for Moderate or High Response
120
100
120hearing lossControl
60
80
20
40
0Verb. Inv. Play Inv. Cont.
Direct.+ Regard Respons. Enjoyment
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Effects of Impact and Resources on Stress Total Cohort
Impact and Parenting Stress Resources and Parenting Stress
s
50607080
ng S
tres
s ea
n )
5060708090
ting
Stre
ssm
ean)
r=.49 R=-.41
304050
20 or less 21-25 26-30 31+
Pare
ntin (m
304050
110 orless
111-120 121-130 131-140 141-150
Pare
n (
Impact Resources
• Increasing impact was associated with ↑ stress• Increasing resources were associated with ↓ stress
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Parenting Stress and PCIS Scores Total Cohort
Parenting Stress and Availability
5ean)
Parenting Stress and Positive Regard
4ard
Total Cohort
01234
50 or 51 60 61 70 71 80 81 90 90+
Ava
ilabi
lity
(me
01234
50 or 51-60 61-70 71-80 81-90 90+Posi
tive
Reg
a(m
ean)
r=-.30 r=-.29
50 orless
51-60 61-70 71-80 81-90 90+
Parenting Stress
less
Parenting Stress
Parenting Stress and Enjoyment
45
mea
n)
Parenting Stress and Verbal Involvement
5
01234
50 or 51-60 61-70 71-80 81-90 90+Enjo
ymen
t (m
r=-.23R=-.41r=.19
012345
50 or 51-60 61-70 71-80 81-90 90+
r=-.29
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less
Parenting Stress
less
Parenting Stress
Words Produced @18-24 mWords Produced @18 24 mTotal Sample P Sample Excluding Ppincluding NICU
Infants
p gNICU Infants
N HL C l HL C lN HL29
Control40
HL11
Control14
Words 71 ± 112 134 ± 135 0 044 138±159 174±141 0 5496Words
WP %
71 ± 112
17 ± 23
134 ± 135
33 ± 42
0.044
0.003
138±159
31±32
174±141
40±27
0.5496
0.2525
<10th %
20 (69%) 13 (33%) 0.01 5(45%) 2(14%) 0.0849
25
%
PCIS Scores and Words ProducedTotal CohortTotal Cohort
PCIS Availability and Words Produced
PCIS Control and Directives and Words Produced
50
100
150
200
ords
Pro
duce
d (m
ean)
406080
100120140160
ords
Pro
duce
d (m
ean)r=.28
r= 190
3 4 5Availability
Wo
020
2 3 4 5
Control and Directives
Wo r=-.19
PCIS Sensitivity and Words Produced
160180200
(mea
n)
PCIS Atmosphere and Words Produced
160180
ced
r= 21
020406080
100120140
Wor
ds P
rodu
ced
(
020406080
100120140160
Wor
ds P
rodu
c(m
ean)
r=.21r=30
26
03 4 5 6 7 8 9
Sensitivity
Wo 0
2 3 4 5Atmosphere
Parenting Stress and Words Produced
0100200300
W o
r d
s r =-.33
050 orless
51-60 61-70 71-80 81-90 90+
Parenting Stress
W
PCIS Verbal Involvement and Words Produced
Parenting Stress
PCIS Verbal Involvement and Words Produced
50100150
rds
r=.19
050
2 3 4 5
Wo
27Verbal Involvement
Factors Associated with Fewer Words Produced: Correlation CoefficientsCo e at o Coe c e ts
AvailabilityVerbal InvolvementAtmosphere
-.29-.13
-.29
Stress
AtmosphereControl/Directiveness QSensitivity
-.41
-.16-.21
Resources Support
Stress
-.21-.33
.28;.19;.30; .33; .21
HL
Words Produced
-.24.22
NICU-.30
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Regressions to Predict Words ProducedRegressions to Predict Words Produced
Availability Control Dir Control Dir QAvailability Control Dir Control Dir Q
b p b p b p
NICU -68.2 0.022 -55.9 0.066 -63.1 0.030
Hearing Loss 63 5 0 028 72 1 0 012 74 4 0 008Hearing Loss -63.5 0.028 -72.1 0.012 -74.4 0.008
Total Stress -2.3 0.033 -2.9 0.004 -2.4 0.017
PCIS 26.5 0.160 -30.4 0.097 45.3 0.006
29Total R2 0.27 0.0005 0.27 0.0004 0.32 0.0001
Regressions to Predict Words ProducedRegressions to Predict Words Produced
Atmosphere Sensitivity Verbal InvolAtmosphere Sensitivity Verbal Invol
b p b p b p
NICU -63.7 0.029 -67.3 0.024 -67.8 0.024
Hearing Loss -65.0 0.021 -68.9 0.016 -70.2 0.015
Total Stress 2 5 0 013 2 5 0 018 2 5 0 021Total Stress -2.5 0.013 -2.5 0.018 -2.5 0.021
PCIS 36.3 0.046 15.0 0.225 15.6 0.404
30Total R2 0.29 0.0002 0.26 0.0006 0.25 0.0008
Conclusions at 18-24m• Child HL, NICU stay and ↑maternal stress were
assoc. with words produced at 18-24m.p• maternal control & directiveness during a play
session was assoc with 36 ↓ words whereassession was assoc. with 36 ↓ words whereas Control/directiveness Quality was assoc with 45 more words producedmore words produced
• maternal atmosphere during a play session was associated with 36 more words producedwas associated with 36 more words produced.
• Both maternal and child factors contribute to b f d d d t 18 24 th f
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number of words produced at 18-24 months for children.
• EI Providers should take all maternal andEI Providers should take all maternal and child factors into consideration when developing an Individualized Familydeveloping an Individualized Family Service Plan.
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