Background: Transition readiness is a critical set of skills that youth must acquire as they prepare for managing their healthcare in adulthood, for both youth with and without special health care needs (SHCN). Currently much of the literature pertaining to transition readiness focuses youth with special health care needs (YSHCN). However, all youth, including those without special healthcare needs, should develop skills for managing their health as they transition into adult healthcare. Additionally, youth from rural areas may face additional barriers to acquiring the skills for transition, yet a paucity of information on transition readiness among this population. Objective: We examined transition readiness among youth in two rural high schools in South Central Appalachia. Specifically, we examined differences in readiness among youth with and without SHCN. Design/Methods: We used data from a 2016 school-based survey of adolescents ages 16-18 at two high schools in rural South Central Appalachia Tennessee (n = 437). Using a validated screener, we identified 23% of youth as YSHCN. Compared to healthy youth, a greater proportion of YSHCN were female (68% vs. 49%) or non-Hispanic white (96% vs. 83%). We assessed differences in transition readiness as measured by four subscales (managing medications, appointment keeping, tracking health, and talking with providers) of the the Transition Readiness Assessment Questionnaire (TRAQ). Responses were collasped into two categories, yes/no, for each item and summed to create scale scores. We conducted MANOVA models predicting transition readiness by YSHCN status and demographics as potential covariates. Results: YSHCN scored significantly higher than youth without SHCN on all four measures of transition readiness (p<.01). In multivariate analyses YSHCN (versus other youth) had significantly greater transition readiness for the four subscales: F(4, 401= 5.36, p<.001), controlling for age. Table 1 displays overall and group means, and p-value for the TRAQ subscales. Conclusion(s): Rural YSHCN scored higher on the scale, perhaps due to their increased exposure to the health care system. Readiness skills for the transition to adult health are necessary for all youth however, findings from this study suggest that many rural youth—particularly those often thought of as “healthy”—may not be fully prepared for this transition. Findings point to the need for the development of interventions to help all youth effectively make transition to adult healthcare

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An increasing number of researchers have begun to identify relationships between dimensions of infants’ and toddlers’ temperament and their language development. Proclivities to engage in joint attention have also been implicated in children’s language development. The purpose of the present investigation was to explore whether aspects of children’s temperament typically associated with linguistic performance could be observed to moderate the joint attentional responsiveness of 11- and 14-month-olds in a controlled laboratory setting. Forty-seven infants (22 females, 25 males) were drawn from a larger study investigating infants’ gaze-following abilities, and included 25 11-month-olds and 22 14-month-olds. In a laboratory setting, two identical objects were placed on opposite sides of the room to the right and left of the infant, respectively. Colorful shower curtains served as background contexts for the objects, and differed in pattern. Experimenters looked at either the right or left object, and infants were scored as to whether they followed the gaze of the experimenter during 1) an initial training phase of 8 trials, and 2) a subsequent testing phase of 8 more trials. Background contexts were switched for half the children during test trials. Temperament played a considerable role in moderating children’s gaze-following at both ages, contributing to 15 significant interactions with factors affecting gaze-following. At 11 months, gaze-following was primarily associated with temperament dimensions reflecting surgency and executive control. For example, perceptual sensitivity, a subcomponent of surgency, entered into a significant 3-way interaction [F(1, 21) = 8.00, p = .010] with training phase (initial versus test) and contextual condition (familiar versus novel). Evaluation of the means vis-à-vis post hoc comparisons indicated that children high in perceptual sensitivity decreased their gaze-following over time in both contexts, whereas children low in perceptual sensitivity exhibited a decrease in gaze-following in only the familiar context. At 14 months, in contrast, negative affectivity was primarily involved. Here, low negative affect children exhibited less gaze-following than high negative affect children during the novel test condition, but the reverse obtained in the familiar test condition [F(1, 18) = 4.56, p = .041]. Our results provide additional evidence of the utility of taking children’s temperament into account when exploring their language development. These findings fit within a model of language development in which children’s temperament influences their language development, at least in part, by virtue of its impact on children’s responsiveness to joint attentional bids.

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5–11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.

An interesting paradox in the developmental literature has emerged in which fast-habituating babies tend to be temperamentally difficult and fast language learners, even though temperamentally difficult babies tend to be slow language learners. The purpose of the present investigation was to examine whether the paradoxical relationships among habituation, temperamental difficulty, and language acquisition could be mediated partly or wholly by infant attentional focus, because the latter also tends to correlate with temperamental difficulty and vocabulary size. Forty mother–infant dyads were followed from child age 5–20-months. Results replicated those of Tamis-LeMonda and Bornstein (Child Develop 1989, 60, 738–751): measures of visual habituation at 5 months were related to 13-month vocabulary. However, relationships between 5-month habituation and 20-month vocabulary were moderated by temperamental attentional focus. For children low in attentional focus, 5-month habituation was related negatively to 20-month productive vocabulary; whereas for children high in attentional focus, early habituation was positively related to later vocabulary. Results are consistent with a model of habituation in which volitional attentional focus overrides basic attentional mechanisms that occur during habituation.

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Researchers have been reporting temperament-language correlations in infants for 10 years. However, in order to identify directions of effects between temperament and language, methodologies besides correlations need to be developed. The “competition attention paradigm” is an effort to sidestep some of the direction-of-effect issues by asking infants to learn novel words in the context of environmental distractions designed to tap into children’s temperaments. The purpose of the present study was to explore whether environmental distracters would differentially impact 15-month-olds’ novel wordlearning as a function of children’s temperamental profiles. Twenty-eight 15-month-olds were asked to learn 4 novel words. Novel word learning consisted of initially familiarizing children with two novel objects, and then mapping a novel label to only one of the novel objects five times. Novel word comprehension was tested by asking children to select the newly-labeled object from the pair of novel objects across 4 test trials. A remotely-controlled mechanical spider competed for children’s attention during object familiarization on two of the words. Half the children were distracted on the first two words, half were distracted on the last two. Temperament was assessed via parental reporting using the Early Child Behavior Questionnaire. The environmental distractions did not impact children’s word-learning directly. However, order of distraction presentation did [F(1, 23) = 7.16, p = .014], such that children who were distracted on the first two words performed higher overall than children who were distracted on the last two. Results involving temperament were complex, yielding many significant interaction effects with factors impacting children’s word-learning. For example, children high in fear demonstrated better word-learning in the absence of the spider than in its presence, whereas the spider had no effect on low-fear children, but only when learning the first word in the pair [F(1, 23) = 5.20, p = .032]. Other temperament factors found to impact novel word-learning included attentional focus, cuddliness, impulsivity, frustration, and high intensity pleasure. The results of the present investigation contribute to a growing body of research linking temperament to word learning. The competition attention paradigm suggest ways through which word learning may be impacted by dimensions of temperament. Although not presentable here due to space limitations, the pattern of results also points to attentional focus as playing a central moderating role over other dimensions of temperament. Finally, the present results are the first to link temperament to language acquisition at 15 months.

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