Abstract Background and aims: Growing evidence supports the existence of clinically significant problems in social-emotional/behavioral (SEB) development among infants and toddlers and the importance of early identification of these problems. There is a lack of research on the occurrence and identification of problems in the SEB domain among the Finnish general population of 1 to 2-year-old children. The present study examined these important issues. Given the dearth of earlier research knowledge, particular emphasis was focused on analyzing possible moderating effects of the assessed child’s and informant’s gender on the results. Subjects and methods: Oulu toddler (N = 208, age 18 months), Oulu infant (N = 227, age 12 months), and Oulu Province (N = 1008, age 12 months) samples were collected during 2008–2013 in collaboration with child health centers. Both mothers and fathers completed questionnaires assessing their child´s SEB development (e.g. the Brief Infant-Toddler Social and Emotional Assessment; Briggs-Gowan & Carter, 2006) and the family’s sociodemographic characteristics. Child healthcare nurse (CHCN) worry reports concerning the children’s development and family well-being were also gathered. Main results and conclusions: In parental ratings, girls obtained higher SEB competence scores than boys, whereas boys got higher SEB problem scores than girls, particularly among the toddler sample. Thus, boys may have an elevated risk of parent-reported problem behaviors and delays in SEB competences even before the age of 2 years. Compared to fathers, mothers were prone to rate the toddlers higher in both SEB competences and problems, especially with regard to externalizing behavior problems and problems in boys. Elevated interparental rating differences were associated with relatively elevated maternal parenting stress. Therefore, it is recommended to gather data on young children’s SEB development from both parents when possible and to focus clinical attention on the issue if the parental reports differ significantly. Parents and CHCNs seldom recognized SEB problems and delays in competency as problematical in 1-year-old infants, even in the case of infants who were screened to be in the of-concern range on the age-appropriate measure of SEB development. Thus, further efforts are needed for developing the identification of early problems in SEB development by both parents and preventive child healthcare professionals in Finland. / Tiivistelmä Tausta ja tavoitteet: Kasvava näyttö tukee käsitystä, että kliinisesti merkittäviä sosioemotionaalisen ja käyttäytymisen (SEK) kehityksen ongelmia esiintyy jo vauva- ja taaperoikäisillä ja että näiden ongelmien varhainen tunnistaminen on tärkeää. SEK-kehityksen ongelmien esiintymisestä ja tunnistamisesta 1–2-vuotaiden väestössä Suomessa puuttuu tutkimustietoa. Tämä tutkimus arvioi näitä tärkeitä aiheita. Tutkimuksessa huomioitiin erityisesti sekä tutkittavan lapsen että arvioitsijan sukupuolen mahdollinen moderoiva vaikutus tuloksiin, koska aiempaa tutkimustietoa tästä näkökulmasta on vähän. Tutkittavat ja menetelmät: Oulu taapero (N = 208, ikä 18 kk), Oulu vauva (N = 227, ikä 12 kk) ja Oulun lääni (N = 1008, ikä 12 kk) -aineistot kerättiin vuosina 2008–2013 yhteistyössä lastenneuvoloiden kanssa. Sekä äidit että isät täyttivät lomakkeet, jotka arvioivat lapsen SEK-kehitystä (mm. the Brief Infant-Toddler Social and Emotional Assessment; Briggs-Gowan & Carter, 2006) ja perheen sosiodemografisia taustatekijöitä. Myös terveydenhoitajan raportit lapsen kehitykseen ja perheen hyvinvointiin liittyvistä huolista kerättiin. Päätulokset ja johtopäätökset: Vanhempien arvioimina tytöt saivat korkeampia pistemääriä SEK-taidoissa kuin pojat, kun taas pojat saivat korkeampia pistemääriä SEK-ongelmissa kuin tytöt, etenkin taaperoaineistossa. Pojilla saattaakin olla kohonnut riski vanhempien raportoimille käytösongelmille ja SEK-kehityksen viiveille jopa ennen 2 vuoden ikää. Isiin verrattuina äidit olivat taipuvaisia antamaan korkeampia pisteitä sekä SEK-taito- että -ongelmaosioissa taaperoikäisten aineistossa, etenkin koskien ulospäin suuntautuvia käytösongelmia ja poikien ongelmia. Suurentuneet eroavaisuudet vanhempien antamissa arvioissa olivat yhteydessä suhteellisesti kohonneeseen vanhemmuuden stressiin äideillä. Onkin suositeltavaa kerätä tietoa pienen lapsen SEK-kehityksestä kummaltakin vanhemmalta, jos mahdollista, ja kiinnittää kliinistä huomiota asiaan, jos vanhempien antamat tiedot eriävät merkittävästi. Vanhemmat ja terveydenhoitajat tunnistivat SEK-ongelmia ja taitojen puutteita harvoin huolenaiheiksi 1-vuotiailla, vaikka nämä vauvat olisivat seuloutuneet huolialueelle ikätasoon soveltuvalla SEK-kehityksen mittarilla. Tarvitaankin lisätoimia, jotta vanhemmat ja terveydenhuollon ammattilaiset oppivat paremmin tunnistamaan varhaisia SEK-kehityksen ongelmia Suomessa.

The purpose of this study was to use first-year test results to develop an early warning system for the identification of freshmen at risk of failing. All students registered between 1989 and 1997 for the six-year programmes chiropractic and homoeopathy were included in this ex post facto study. A descriptive study firstly indicated a serious problem of attrition with on average only 66% of chiropractic and 55% homoeopathy freshmen successfully completing the first year. A relationship was demonstrated between both first and second test results and outcome at the end of the first year of studies. A logistic regression model estimated retrospectively from first test results in physiology, anatomy, biology and chemistry was able to discriminate between successful and non-successful freshmen with an overall predictive accuracy of 80.82%. When this model was validated on a different set of data it was shown to have a very high sensitivity and was thus able to correctly identify >93 % of the potentially at risk freshmen. It also had a low Type II error ( <7%) and thus missed very few of the freshmen at risk of failing. A logistic regression model estimated retrospectively from second test results in physiology, anatomy, biology and chemistry had an overall predictive accuracy of 85.94% . The validated model had a sensitivity of 67% which was too low for the model to be of much use as a management tool for the identification of the freshmen at risk of failing. However, the model was shown to have a high specificity and was able to correctly identify >93% of the potentially successful freshmen. It also had a low Type I error (14.29%). Discriminant analysis models estimated from both first and second test results in physiology, anatomy, biology and chemistry produced strong support for the use of test results for the early identification of those freshmen who would need support in order to be successful. It is suggested that the objective models developed in this research could identify the freshman in need of support at an early enough stage for support measures to still have a positive effect on attrition. / Educational Studies / D. Ed. (Educational management)

Made available in DSpace on 2016-06-02T19:44:02Z (GMT). No. of bitstreams: 1 1615.pdf: 2019572 bytes, checksum: 6255d6f489ad11448457b2441c3dfab5 (MD5) Previous issue date: 2007-05-31 / Studies have shown that developmental surveillance is an important task to be performed by the pediatrician and its objective is to precociously identify children who may need more complex evaluation as well as provide information about their development and not only their physical health. It also makes possible a definite diagnosis and the elaboration of an interdisciplinary plan of care for children in order to undergo early intervention. Other studies indicate that the pediatricians´ knowledge regarding developmental surveillance and their use of instruments to accomplish this practice is defective. Despite the fact that just a few perform developmental surveillance, they consider this issue important and demonstrate interest in updating themselves. According to these studies, the pediatricians should update their knowledge concerning development aspects and risk factors, use sorting techniques and lead the child presenting development delay to early stimulation programs. The general objective of this work is to analyze the knowledge related to health promotion, developmental surveillance and pediatric residents´ perception of babies´ delays in the state of São Paulo by analyzing the curriculum description and the performance in questionnaires. The curriculum guidelines from MEC (Brazilian Education Ministry) for pediatric residence teaching, the relation of vacancies for this specialty and the curriculum of seven medical pediatric residence courses in the state of São Paulo were analyzed, with the objective of identify elements concerning developmental surveillance in pediatric teaching (first stage). In the second stage of this study, the data regarding developmental surveillance practices and the knowledge about children s development were collected and correlated. It was carried out by the replication of two questionnaires, which were answered by 65 first and second-year pediatric residents of five specialization courses in the state of São Paulo. According to the analysis of MEC´s curriculum guidelines in relation to the subjects to be studied about developmental surveillance, it is possible to assert that they are general and non-specific, and the curriculums are superficial and not clear enough to make the identification of the practices related to developmental surveillance possible. Only one course of this research has the necessary requirements that allow the identification of elements related to this topic. The results of the second stage has shown that the majority of pediatric residents has different attitudes compared to the ones performed by doctors who are dealing with children s health for longer time. These different attitudes may reduce the efficacy of the developmental surveillance carried out by pediatricians. The correlation between the pediatric teaching and the residents´ knowledge about developmental surveillance has shown that the courses which have higher average in the questionnaires also have better developmental surveillance s contents described in their curriculums. The residents who justified why they ask or not the mothers about development and the ones who confirmed the use of evaluation scales had higher scores in the questionnaire. This study proposes further investigation related to the continuous professional development for pediatric residents, distance learning, the use of Moodle tools and topics such as: Promotion of health concept and developmental surveillance, non-identified precocious delays consequences, protocols about developmental surveillance, guidelines for normal infant development to the pediatricians, identification of development delays, and quick and easy measures to be used during practice and inserted in institutional dynamics. Using these results as a basis, a contribution to the pediatrician s mobilization regarding the importance of developmental surveillance and precocious identification of children with development delay is expected. / Estudos têm mostrado que a vigilância do desenvolvimento é uma importante tarefa do pediatra e tem a função de identificar precocemente crianças que podem necessitar de avaliação mais complexa; fornecer informações sobre o seu desenvolvimento e não somente sobre sua saúde física; possibilitar o diagnóstico definitivo e a elaboração de um plano de atendimento interdisciplinar para a criança visando a intervenção precoce de deficiências. Outros estudos indicam que o conhecimento dos pediatras sobre vigilância do desenvolvimento e uso de instrumentos para realizá-la é falho. Entretanto, dão importância ao tema e demonstram interesse em atualizar-se, mas poucos praticam a vigilância do desenvolvimento. Para desempenhar essa tarefa o pediatra deveria, segundo tais estudos, atualizar seus conhecimentos sobre os aspectos do desenvolvimento e fatores de risco, utilizar técnicas de triagem e encaminhar a criança que apresenta atraso de desenvolvimento a programas de estimulação precoce. O objetivo geral deste trabalho consiste em analisar alguns conhecimentos relacionados à promoção de saúde, vigilância do desenvolvimento e a percepção de atrasos em bebês junto a residentes em pediatria do estado de São Paulo, considerando a descrição da grade curricular e o seu desempenho em questionários. Foi realizada análise documental das diretrizes curriculares do MEC para o ensino da residência médica em pediatria, da relação de vagas para a especialidade e das grades curriculares de sete cursos de residência em pediatria no estado de São Paulo, com o objetivo de identificar elementos sobre a vigilância do desenvolvimento no ensino da pediatria (primeira etapa). A segunda etapa do estudo levantou e correlacionou dados sobre as práticas em vigilância do desenvolvimento e o conhecimento sobre áreas do desenvolvimento infantil junto a 65 residentes de pediatria de primeiro e segundo ano de cinco cursos de especialização do estado de São Paulo, por meio da replicação de dois questionários. Os dados gerais da análise do ensino de pediatria mostraram que os referenciais curriculares do MEC quanto às disciplinas que deveriam abordar o tema vigilância do desenvolvimento na residência em pediatria são gerais e inespecíficos; as grades apresentam conteúdo superficial quanto à abordagem da vigilância do desenvolvimento e não estão claras suficientemente para permitir a visualização de ações relacionadas a esta temática e apenas um curso participante da pesquisa reúne os requisitos necessários que permitem identificar elementos relacionados ao tema. Os resultados da segunda etapa mostraram que a maioria dos residentes em pediatria apresenta atitudes diferenciadas dos médicos que atuam já há mais tempo em atenção à saúde da criança, mas também apresentam alguns problemas que podem comprometer a eficácia da vigilância do desenvolvimento realizada por pediatras. As correlações entre o ensino de pediatria e o conhecimento dos residentes sobre a vigilância do desenvolvimento mostraram que os cursos que apresentam o desempenho médio mais alto nos questionários têm também a melhor descrição do conteúdo de vigilância do desenvolvimento em suas grades curriculares; os residentes que justificaram porque perguntam ou não sobre desenvolvimento às mães e os que afirmaram utilizar escalas de avaliação em sua prática acertaram maior número de questões do questionário. A partir de tais resultados, apresenta-se como proposta para futuros estudos a elaboração de um programa de formação continuada para residentes em pediatria na forma de ensino à distância, utilizando as ferramentas do ambiente de aprendizagem Moodle, contendo tópicos como: conceito de promoção de saúde e vigilância do desenvolvimento, conseqüências da não identificação precoce de atrasos, protocolos sobre vigilância do desenvolvimento, rota de ações para o pediatra envolvendo o desenvolvimento normal do bebê, a identificação de atrasos do desenvolvimento, uso de instrumentos rápidos e fáceis de serem aplicados na prática clínica e inseridos na dinâmica institucional. Com base nos resultados encontrados, espera-se contribuir para a mobilização do pediatra quanto à importância da vigilância do desenvolvimento e da identificação precoce de crianças com atrasos de desenvolvimento.

School readiness is a stage in a child's development when he learns easily and effectively. A child who is not yet ready for school on school entry is already at a disadvantage in the formal learning situation. This in itself can affect his school performance in the later years. The researcher, being a primary school teacher noticed that the children from the informal settlements that had no pre-school intervention arrived at school unready to learn. This investigation set out to evaluate the school readiness of children from an informal settlement without a pre-school programme. The school readiness of these children were compared against children from an informal settlement with a pre-school programme. Test and questionnaires were used to determine the five year olds' school readiness. The researcher used the idiographic method of research. The findings of the research were based on the interpretations of the tests and questionnaires. / Educational Studies / M. Ed. (with specialisation in Guidance and Counselling)

School readiness is a stage in a child's development when he learns easily and effectively. A child who is not yet ready for school on school entry is already at a disadvantage in the formal learning situation. This in itself can affect his school performance in the later years. The researcher, being a primary school teacher noticed that the children from the informal settlements that had no pre-school intervention arrived at school unready to learn. This investigation set out to evaluate the school readiness of children from an informal settlement without a pre-school programme. The school readiness of these children were compared against children from an informal settlement with a pre-school programme. Test and questionnaires were used to determine the five year olds' school readiness. The researcher used the idiographic method of research. The findings of the research were based on the interpretations of the tests and questionnaires. / Educational Studies / M. Ed. (with specialisation in Guidance and Counselling)