The purpose of this study was to assess the relationship between parental responsivity and language outcomes after a 24-session language intervention in a sample of 62 toddlers with significant developmental delays and fewer than 10 spoken words. The data for this secondary analysis were taken from a longitudinal study that evaluated language outcomes after augmented or spoken language intervention (Romski et al., 2010). Instances of parental responsivity increased from pre-intervention to post-intervention and directive behaviors decreased slightly across all intervention groups. The results suggest a relationship between parental responsivity and expressive language outcomes in children with developmental delay who use augmentative and alternative communication. These findings support the role of parents as social partners in language interventions.

Neural tube defects (NTD) are among the most common birth defects and the leading cause of infant mortality. NTDs occur when the neural tube fails to close during early fetal development. The two most common types of NTD are spina bifida and anencephaly. NTDs result in lifelong complications like musculoskeletal deformities and loss of strength. The etiology of NTDs is complex and involves still unclear environmental and genetic factors. However, one of the well-established risk factors of NTDs is folic acid deficiency. The prevalence of NTDs can be lowered by an adequate intake of folic acid in the periconceptual period. In 1996, the Food and Drug Administration mandated that 140 micrograms of folic acid be added to 100 grams of bleached grain products with the goal of reducing the prevalence of NTDs. In the years following this fortification mandate, studies have shown that blood folate levels have more than doubled on average, that there are demographic and socioeconomic disparities in blood folate gains and that NTD rates have declined. However, no studies after the mandate have examined changes in blood folate distribution and differences in NTD prevalence by a wide range of theoretically and biologically relevant risk factors after the mandate. Using a nationally representative sample of non-institutionalized women of reproductive age, I investigated the relationship between the fortification mandate and blood folate levels. I also examined changes in the range/spread of blood folate distribution after the mandate. Using data on US live births from 45 states and the District of Colombia, the second study examined whether (1) the disparities in blood folate changes translate into differences in NTD prevalence and (2) NTD risk factors moderate the association between the mandate and NTD prevalence,. The final study explored potential unintended impacts of the mandate on birth weight, low birth weight, very low birth weight, high birth weight, and physician-diagnosed developmental delay, asthma and allergies. For this study, I employed samples from the Natality files and the National Survey for Children's Health. The cumulative results of my research suggested that the mandate was associated with increases in blood folate concentration, with greater increases in higher quantiles of the blood folate distribution and that the spread of blood folate distribution after the mandate widened. Additionally, the mandate was associated with a decrease in the prevalence of NTDs in the entire US population although the impact of the mandate was moderated by race/ethnicity, maternal educational attainment, acute illness during pregnancy and infant region of birth. Furthermore, the mandate was associated with other unintended infant and child health outcomes such as average birth weight increases in the population and increased risks of developmental delay among six year olds. This research is the first of its kind to examine changes in the spread of blood folate distribution after the mandate and whether NTD risk factors moderate the association between the mandate and NTD prevalence. It is also the first study to explore potential impacts of the actual mandate (not prenatal folic acid supplementation) on other unintended infant and child health outcomes. The results add significantly to our understanding of the effects of the mandate and have important implications for health care providers, women of reproductive age and policy makers because of the potentially increased risk of developmental delay among children and the increasing disparity in blood folate concentrations after the mandate.

Background: Occupational therapy (OT) plays an important role in providing early childhood interventions for children with developmental delay. While paediatric OT has long been guided by developmental principles, occupation-centred interventions have been promoted during the last decades, but no unifying definition exists about the core features. Aims/Objectives: The aim of this paper is to (a) identify and describe how occupation-based and occupation-focused interventions are demonstrated in paediatric occupational therapy for infants and young children with developmental delay, (b) identify which outcomes these interventions address and (c) analyse which outcome measures are used. Material and Methods: Eight databases and 15 OT journals were searched. Included studies were peer-reviewed primary sources published in English since 1999, selected based on the terminology proposed by Fisher (2013). Nineteen papers met inclusion criteria. Results: Eight occupation-based, two occupation-focused and nine occupation-based and occupation-focused interventions were identified. Outcomes related mainly to occupational and play skill acquisition as well as mastery of co-occupations. A limited number of occupation-focused outcome measures was implemented. Conclusions: Several occupation-centred interventions have been researched. Gaps in knowledge exist regarding measures taking into account (co-)occupational performance and young children’s perspective. Significance: OTs might want to expand their scope of practice to include all occupational domains and increase parent-delivered interventions in natural environments. Measures used should be relevant to occupational performance and take into account the parent’s and children’s view. Use of uniform terminology can aid identification of evidence and clear placement of OT among other professionals.

Government promotes developmental assessment and early intervention for more than ten years, and has good results. In recent years, bicultural family increased and children born to foreign women increased to more than 10%. Some studies pointed out that the children born to foreign spouse are prone to specific developmental delay. However, the research about this topic is still little and the conclusions vary. This study analyzes the demography and results of children with developmental delay between native and foreign spouse family. And the present study explores the physiological factors, family environmental factors, the similarities and differences between the types of developmental delay. This study was performed in a Multidisciplinary Child Assessment Center in a regional education hospital. From 2005 to 2009, 482 children, aged less than 6 y/o (inclusive), diagnosed as developmental delay were enrolled, 404 born to native women, and 78 born to foreign women. The personal base data and results of assessment were analyzed by descriptive and logistic regression analysis. Diagnosis months was (42.57¡Ó16.79) months; male to female ratio was 2.33:1. Among the factors to affect developmental delay, parity, paternal age, maternal age, with or without care in the intensive care unit, place of residence, father¡¦s occupation, father¡¦s education level, maternal education are significant differences (p <. 05) between the two groups. Children born to foreign spouse are referred more by the education and welfare system (15.4% vs. 11.3%; p<.05), and children born to native spouse are referred more by the health care system (12.3% v.s. 5.1%; p<.05). The incidences, from high to low, of six types in the two groups are the same. They (native group v.s. foreign group, respectively) are language developmental delay (81.3% v.s. 84.6%), cognitive developmental delay (68.7% v.s. 79.2%, p=.046; if other factors are included and analyzed by logistic regression, the p value is >.05), motor developmental delay (62.8% v.s. 67.9%), emotional developmental delay (39.4% v.s. 46.2%), sensory perception developmental delay (1% v.s. 1.3%), and nonspecific developmental delay (1.5% v.s.3.8%). There are no significant difference between the two groups in the type of developmental delay (p>.05) and the amount of types of developmental delay (p=.113). Impact of various factors on type of developmental delay was evaluated by logistic regression analysis. Diagnosis age is related to cognitive and emotional developmental delay. Father¡¦s education level is related to cognitive developmental delay. Mode of partum, and delay of initial crying after birth are related to language developmental delay. With or without related physiological disorders is related to language developmental delay and emotional developmental delay. Father¡¦s occupation is related to emotional developmental delay. Father¡¦s education level and occupation are more important than the mother¡¦s, and the impact is significant. The nationality of the mother is not significant in types of developmental delay. In conclusion, in children diagnosed as developmental dealy, there are only few differences in physiological factors, but there are obvious differences in family environment factors between the two groups. The difference of family environment factors between these two groups is similar to the general community. The delay in the type of developmental delay and the amount of types of developmental delay are no significant difference. And some risk factors, particularly the role of the father, are related to particular types of developmental delay. These results will serve as the reference for Government in formulating health policy and social health promotion.

RNA interference (RNAi) potently and specifically induces gene knockdown, and its potential for reverse genetics in Caenorhabditis elegans is enormous. However, even in these nematodes, RNAi can be induced more effectively via enhanced RNAi (Eri) mutant backgrounds. With advances in small RNA sequencing, evidence has suggested that the eri pathway plays an endogenous gene regulatory role, which competes with experimentally introduced RNAi triggers for limiting resources. However, the nature, cellular location, and physiological consequences of this small RNA pathways competition remain unclear. To answer these questions, I first fully characterized the genetic phenotypes of all known Eri mutants. I discovered that different components of the eri pathway have subtle differences upon mutation, which affects more than exogenous RNAi. I then attempted to screen for novel enhanced RNAi mutants, guided by hypothetical mechanisms or tissues of expression not associated with known mutants. After these attempts, I fully characterized the genetic mechanisms that account for enhanced RNAi. Surprisingly, I discovered that the nuclear Argonaute nrde-3 and the peri-nuclear P-granule component pgl-1 are necessary and sufficient for an Eri response. Finally, I examined the impact of the competition among microRNA, endogenous siRNA, and exogenous RNAi pathways. I discovered that C. elegans develops slower upon perturbations to its normal flux of small RNA pathways. Insights from these phenotypes and genetic mechanisms shed light on the importance of small RNA biology and offer a novel suite of tools for sensitizing RNAi in broader contexts, especially given the deep evolutionary conservation of most eri-associated genes.

Although Autism Spectrum Disorder (ASD) is considered to be a lifelong condition, some toddlers experience diagnostic instability over time. In particular, some toddlers’ diagnosis changes between ASD and Global Developmental Delay (GDD). However, little is known about the subset of children who change diagnosis. In a total of 424 toddlers who either maintained or changed diagnosis, the current study identified predictors of change in diagnosis and severity in those who change from ASD to non-ASD (ASD-NON), ASD to GDD (ASD-GDD), non-ASD to ASD (NON-ASD), and GDD to ASD (GDD-ASD) between two years old and four years old. Initial ASD symptom severity and participation in intervention services were predictive of all transitions. Additionally, receptive language predicted ASD-NON transition and socioeconomic status predicted ASD-GDD transition. Implications for informing prognosis of children, identifying targets of intervention, refining of screening and diagnostic measures, and measuring change in severity regardless of categorical change are discussed.

There has been little published research literature that has focused on using siblings to teach their non-verbal siblings a manual sign to communicate using the mandmodel procedure. The mand- model procedure is a naturalistic teaching strategy which has been demonstrated to improve communication and social outcomes for children with disabilities. This study investigated sibling tutors teaching their sibling tutees to use the manual sign “more” to request a want or need. The four sibling tutees were between the ages of 25 and 26 months and their sibling tutors were between the ages of 9 and 14 years. A multiple probe design across subjects was used for this study. The mand-model procedure, the independent variable, was used by the sibling tutors to teach the sibling tutees the manual sign “more.” The effectiveness of the use of the manual sign “more” was the independent variable. All four of the sibling tutees were able to successfully learn the manual sign and used the sign across maintenance and generalization phases.

The general aim of this thesis was to gain understanding of what patterns of child and environment characteristics that promote and sustain health and positive functioning of children with and without developmental delay or disabilities. The focus was on promotion of strengths and competencies rather than on prevention of risk factors, with an emphasis on children’s functioning in every-day life. Both cross-sectional and longitudinal studies were conducted on representative samples of children. In Study I, participation in school activities were used as an outcome of positive functioning of children with disabilities. The findings indicated that autonomy, locus of control, child-peer interaction, and availability of activities were most influential in relation to participation in a pattern of child and environment factors. No significant difference was found across groups in type and degree of disability. Study II was conducted to gain knowledge of how young children perceive health. The interviews revealed that children perceived health in a multidimensional perspective, well represented by the health dimensions of ICF. The children largely related consequences of health to engagement. In Study III, engagement was used as an outcome of children’s interaction with their natural environment. The focus was to describe how children with and without developmental delay, divided into homogenous groups according to a pattern of child-environment interaction factors, engaged in developmentally appropriate behavior in their preschool and home environment. Groups of children with different patterns showed similar outcomes of engagement. Children with developmental delay were represented across groups, implying that developmental delay was less of a factor by itself influencing level of engagement. Study IV was longitudinal and the aim was to identify pathways of children’s engagement over time of children with and without developmental delay. Child-peer interaction seemed to promote high level engagement, while developmental delay only showed to be influential of low level engagement over time if combined with behavior problems. Children without developmental delay or behavior problems were met with greater teacher responsiveness, and at the same time teacher responsiveness predicted stable patterns of high level engagement or change to higher level engagement over time. The general finding in this thesis supported a both a multidimensional perspective of health and positive functioning, in where developmental delay and disability is viewed as a function of child and environmental characteristics. The results are discussed in a systemic perspective, in where the role of the delay or disability, as of other factors related to health and positive functioning in the whole child-environment system is determined by a multitude of factors. The dynamic character of children’s development makes it difficult to predict children’s future functioning, from isolated factors such as disability or developmental delay. Thus, a disability or developmental delay only becomes a risk factor of health, when combined with other risk factors that decrease the functioning of children in their every-day life.

abstract: About 1 in 68 children is diagnosed with Autism Spectrum Disorder (ASD) in the United States (Centers for Disease Control and Prevention [CDC], 2015). The prevalence of ASD within the population of all people with disabilities has increased, percentage changed from 1.8% to 7.1% in ten years (NCES, 2016). Music therapy, as a therapeutic intervention, has been used for children with autism since 1940s (Reschke-Hemandez, 2011). In the past 70 years' practice, music therapy research has explored the efficacy of music therapy in improving the multiple areas of functioning affected by the symptoms of autism. However, the results are varied. The objective of this study is to investigate the efficacy of music therapy on children with autism spectrum disorder using meta-analysis as the statistical analysis methodology to synthesis the research results from all the eligible studies in the field. After a comprehensive search of the literature and screening procedure, 11 studies were finally included in the meta-analysis. The results showed a medium to large effects (d = 0.73, CI [0.43-1.03]) of music therapy interventions for children with ASD. Subgroup analysis and meta-regression analysis are conducted for further exploration within the topic. / Dissertation/Thesis / Masters Thesis Music Therapy 2016

Orientador: José Angelo Barela / Banca: Denise Castilho Cabrera Santos / Banca: Raquel de Paula Carvalho / Resumo: Dois estudos foram realizados para investigar o efeito de esteira motorizada nas passadas de bebês com desenvolvimento típico e de risco de atraso desenvolvimental e no desenvolvimento motor global de bebês de risco de atraso desenvolvimental. O primeiro estudo teve como objetivo examinar o efeito da velocidade da esteira em passadas desencadeadas em bebês com desenvolvimento típico. Seis bebês, com idade entre 11 e 13 meses e iniciando o andar independente, foram filmados andando na esteira, nas velocidades de 0,1, 0,16, 0,22 e 0,28 m/s, com marcas passivas afixadas no centro articular do ombro, quadril, joelho e tornozelo e no 5o metatarso. As imagens foram digitalizadas com o software Ariel Performance Analysis System, obtendo variáveis espaço-temporais e angulares das passadas dos bebês. Nas velocidades de 0,22 e 0,28 m/s, foi observado aumento da velocidade e duração da passada, além de uma menor duração da fase de suporte na velocidade de 0,22 m/s. Ainda, nas velocidades de 0,22 e 0,28 da esteira, observou-se aumento da amplitude articular de quadril e joelho. Estes resultados sugerem que as velocidades de 0,22 e 0,28 m/s são as mais indicadas para desencadear passadas em bebês que estão iniciando o andar independente. O objetivo do segundo estudo foi examinar o efeito de intervenção em esteira motorizada na idade de aquisição do andar independente e de outros marcos motores em bebês de risco de atraso desenvolvimental. Para tanto, foram constituídos três grupos de bebês: bebês de risco de atraso desenvolvimental que foram submetidos a tratamento fisioterápico e programa de intervenção... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Two studies were proposed in order to investigate the treadmill effects on walking strides in typical developing infants and in infants at risk for developmental delay and on global motor development of infants at risk for developmental delay. The purpose of the first study was to investigate the effects of treadmill belt speed on induced walking strides of typical developing infants. Six infants aging between 11 and 13 months and acquiring independent walking were videotaped walking on a treadmill, belt speeds of 0.1, 0.16, 0.22, and 0.28 m/s, with passive reflective markers on shoulder, hip, knee, and ankle joint centers and on fifth metatarso. The walking images were digitized using the Ariel Performance Analysis System software, obtaining spatio-temporal and angular variables of the walking strides. In the speeds of 0.22 and 0.28 m/s, it was observed stride velocity and duration increasing besides a decreased of supportive phase at velocity of 0.22 m/s. Moreover, in the speeds of 0.22 and 0.28 m/s, it was observed increased hip and knee range of motion. These results indicate that 0.22 and 0.28 m/s velocities are the most indicated ones to induce walking strides in infants who are acquiring independent walking. The purpose of second study was to examine the effects of a motorized treadmill intervention in the age of independent walking acquisition and global motor development in infants at risk for developmental delay. Three groups were constitute: infants at risk for developmental delay submitted to a physical therapy and motorized treadmill intervention (Experimental Group - EG); infants at risk... (Complete abstract click electronic access below) / Mestre