Sensory Profile-2 in Autism Spectrum Disorder: An Analysis within the International Classification of Functioning, Disability and Health Framework.

Autism spectrum disorder (ASD) is characterized by impairments in many functional areas requiring long-term interventions to promote autonomy. This study aims to map The Sensory Profile™ 2 (SP-2), one of the most widely used assessment tools in children with ASD, with the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), developed by the World Health Organization (WHO). This will allow the identification of the functional dimensions covered by this instrument and the comparison with the ICF shortlist proposed for autism (ICF Core Set [ICF-CS]). The deductive content analysis described in the ICF Linking Rules was followed, along with a systematized process including statistical and reasoning techniques that could contribute to the improvement of ICF linking studies (Cohen's Kappa and percentage of agreement). 218 codes were identified, 71% of them were codes related to the body functions chapters, mainly linked to perceptual functions (b160), emotional functions (b152), and temperament and personality functions (b126). Concerning activities and participation chapters (29%) the most frequently used codes were: focusing attention (d160), carrying out daily routine (d230), and walking (d450). Even though the SP-2 items do not assess most of the functional features regarded as essential in the ASD ICF-CS, SP-2 encompasses a majority of problems concerning body functions. This instrument may be considered as part of a multidimensional assessment approach, to complement other sources that are more likely to assess activity and participation dimensions and guide a functional intervention.

Environment Mediates the Relationship Between Preschoolers Functioning and Involvement in Out-of-School Activities.

This study aims to understand the associations between child functioning and environmental barriers and the involvement of preschool children, with and without disabilities, in out-of-school activities, namely, home and community activities. Particularly, we aimed to investigate if environmental barriers mediate the relationship between child functioning and their involvement in these activities. Parents of 116 preschool-aged children (42 children with disabilities) reported on children's involvement and environmental factors at home and in the community. Preschool teachers assessed child functioning. Multiple linear regressions and mediation analysis were performed. Results indicated significant associations between child functioning, perceived environmental barriers, and involvement at home and in the community. A significant indirect association of child functioning on involvement through the perception of environmental barriers was found in both contexts. Findings support the biopsychosocial model of participation and a focus on environmental features by practitioners designing and implementing intervention strategies.

Contextos Pré-Escolares Inclusivos: Organização do Grupo, Interações e Envolvimento / Inclusive Preschool Contexts: Group Organization, Interactions and Engagement

RESUMO: Este estudo correlacional pretende caracterizar os contextos pré-escolares inclusivos portugueses relativamente aos formatos de atividade, analisar relações entre eles e a qualidade do tom emocional e estimulação cognitiva e da linguagem do educador, e as relações entre formatos de atividade e envolvimento de crianças com incapacidades, em risco e com desenvolvimento típico. Participaram do estudo 198 crianças (47 com incapacidades; 60 em risco; 91 com desenvolvimento típico). O envolvimento das crianças e os formatos de atividade foram observados com o Child Observation in Preschool; tom emocional e estimulação cognitiva com o Teacher Observation in Preschool. Os resultados revelaram que o tom emocional dos educadores nas interações registou valores moderados, sendo mais elevados nas atividades de grande-grupo. O grande-grupo registou níveis de envolvimento mais baixos para todas as crianças. Os três grupos de crianças registam níveis semelhantes de envolvimento em jogo-livre. Concluise que, apesar dos formatos de grande-grupo apresentarem qualidade mais elevada no tom das interações, é nestes que crianças com e sem incapacidades apresentam níveis mais baixos de envolvimento, destacando-se o jogo-livre como um formato onde todas as crianças se envolvem mais. Os resultados salientam a importância da intencionalidade educativa no planeamento das interações e dos formatos das atividades, para assegurar a promoção do envolvimento das crianças.

ABSTRACT: This correlational study aims to characterize the Portuguese inclusive preschool contexts regarding activity-settings, to analyze relationships between them and the quality of the educator's emotional tone and cognitive and language stimulation, and the relationships between activity-settings and involvement of children with disabilities, at-risk and typically developing. A total of 198 children participated in the study (47 with disabilities; 60 at-risk; 91 typically developing). Child engagement and activity-setting were observed with Child Observation in Preschool; emotional tone and cognitive stimulation with Teacher Observation in Preschool. Results revealed that the educators' emotional tone in interactions registered moderate values, being higher in whole-group activities. The whole-group activities registered lower levels of engagement for all children. The three groups of children presented similar levels of engagement in free-play. It was concluded that, although the whole-group activity-settings show higher quality regarding the tone of interactions, it is in these activity-settings that both children with and without disabilities show lower levels of engagement, with free-play emerging as an activity-setting where all children are more engaged. Results highlight the importance of educational intentionality in planning interactions and activity-settings to ensure the promotion of children's engagement.

Consistency between provision, outcomes and functioning needs in statutory documents for young children with developmental disabilities in England.

BACKGROUND: It is widely accepted that early childhood intervention for children with disabilities should address the assessment-intervention cycle holistically. Documenting both assessment and intervention is important to support provision effectively. In England, the official document that describes needs and provision for children with special educational needs and disabilities is the Education Health and Care plan. This document requires inter-professional collaboration and a focus on children's holistic participation, rather than diagnosis. AIM: To examine the consistency between provision, outcomes and needs of young children with disabilities in England, as described in their Education Health and Care plans. METHODS: The plans of 68 young children were examined and the relationships between documented needs, outcomes and provision actions analysed. RESULTS: provision is more related to children's individual needs, than to their diagnoses, when needs are described in sufficient detail; interdisciplinarity leads to higher quality documentation of provision and outcomes. However, more needs to be done to support professionals in developing higher quality needs descriptions and interdisciplinary collaborations. IMPLICATIONS: Training and interdisciplinarity with a common language between professionals have the potential to improve currently observed challenges regarding consistency between provision, needs and outcomes.

Participation of Children between Three and Five Years Old at Home and in the Community Setting / A Participação de Crianças entre os Três e os Cinco Anos em Casa e na Comunidade

Abstract The main goal of the present study was to document the participation of preschool children at home and in the community setting, describing the differences between eligible children with support of Special Education Service and/or of the Early Intervention System and noneligible children, in three main dimensions: child functioning, child participation and perceived environmental barriers. Data about child functioning was collected through preschool teachers and about participation and barriers through parents. Sociodemographic data was also collected. Forty preschool teachers and 116 children (and their parents) participated in this study. Forty-two children were eligible and had support from Special Education Service and/or of the Early Intervention System. The results showed that eligible children have lower levels of functionality, participate less frequently and are less involved in the activities at home and in the community setting and that their parents perceive more environmental barriers in both settings. The results were analysed considering the Biopsychosocial Model.

Resumo O presente estudo tem como objetivo descrever a participação de crianças entre os três e cinco anos de idade em casa e na comunidade, comparando crianças elegíveis e com apoio da Educação Especial e/ou do Sistema Nacional de Intervenção Precoce para a Infância com crianças não elegíveis e sem apoio, em três dimensões: funcionalidade da criança, participação da criança e perceção de barreiras ambientais em ambos os contextos. Os dados acerca da funcionalidade da criança foram recolhidos com recurso às educadoras de infância e da participação e barreiras ambientes com recurso aos pais. Informações sociodemográficas também foram recolhidas. Neste estudo, participaram 40 educadoras de infância e 116 crianças (e os seus pais), das quais 42 eram elegíveis e tinham apoio da Educação Especial e/ou do Sistema Nacional de Intervenção Precoce para a Infância. Os resultados indicaram que as crianças elegíveis e com apoio apresentam níveis mais baixos de funcionalidade, participam menos frequentemente e estão menos envolvidas nas atividades de casa e da comunidade e que os seus pais percebem mais barreiras ambientais nos contextos. Os resultados foram analisados e discutidos à luz do Modelo Biopsicossocial.

Perineal outcomes and its associated variables of water births versus non-water births: a cross-sectional study / Desfechos perineais e as variáveis associadas no parto na água e no parto fora da água: estudo transversal

Abstract Objectives: to describe the perineal outcomes of women who had delivered in water and out of water. Methods: a cross-sectional and quantitative study developed in a public hospital in Setúbal, Portugal. The population was of women who participated in the "Water Birth Project" in the period from 2011 to 2014, which gave birth in water and out of water. 104 women were selected according to established inclusion criteria. The groups were compared according to the following variables: demographics, obstetric information, delivery care and perineal outcomes. The data were analyzed in the Stata(r) software, with descriptive and bivariate statistics (chi-square and Fisher's test). Results: the medical records of 73 women who gave birth in water and 31 women who gave birth out of water were studied. Water deliveries were significantly associated with fewer perineal lacerations, lower rates of episiotomy, and shorter delivery time. Conclusions: the results of the study suggest that childbirth in water has a protective effect against severe third or fourth degree perineal tears, during fetal expulsion in water.

Resumo Objetivos: descrever os resultados perineais de mulheres que tiveram parto na água e fora da água. Métodos: estudo transversal e quantitativo desenvolvido em um hospital público de Setúbal, Portugal. A população foi de mulheres que participaram do "Projeto Parto na Água", no período de 2011 a 2014, que deram à luz na água e fora da água. Foram selecionadas para o estudo 104 mulheres de acordo com os critérios de inclusão estabelecidos. Os grupos foram comparados de acordo com as seguintes variáveis: demografia, informação obstétrica, assistência ao parto e resultados perineais. Os dados foram analisados no software Stata(r), com estatísitica descritiva e bivariada (qui-quadrado e teste de Fisher). Resultados: foram estudados os prontuários de 73 mulheres que deram à luz na água e 31 mulheres que deram à luz fora da água. Os partos na água foram significativamente associados a menos lacerações perineais, menores taxas de episiotomia e menor tempo de parto. Conclusão: os resultados do estudo sugerem que o parto na água tem um efeito protetor contra lacerações perineais severas de terceiro ou de quarto grau durante a expulsão fetal na água.

Evaluating the quality of outcomes defined for children with Education Health and Care plans in England: A local picture with global implications.

Recently, the Children and Families Act 2014 was introduced in England to regulate provision for children with disabilities. According to this policy, statements of special educational needs were replaced with education, health and care plans, which should include high-quality, holistic and participation-focused outcomes to regulate provision; this change aligns with international recommendations regarding provision for children with disabilities. This study aimed to evaluate the outcomes defined for children with education, health and care plans in England. 236 Education Health and Care plans were included in the analysis, providing 2813 outcomes to be examined, which came from 11 local authorities and 42 schools and belong to 69 girls and 167 boys from 4 to 21 years of age. The outcomes were independently rated by two experienced researchers using a Goal Functionality Scale. Inter-rater agreement was calculated for 10% of the outcomes. Most outcomes were considered not to be functional or high-quality; differences in quality were found between local authorities, types of school, type of outcome, and the children's main need. There are important quality concerns regarding the outcomes that have been designed for children with disabilities in England, which should be addressed through standardised training and guidelines on procedures.

Beyond diagnosis: the relevance of social interactions for participation in inclusive preschool settings.

Purpose: This study aims to explore the role of three specific factors within the child-environment interaction process - engagement, independence and social interactions - in influencing development and learning of children with disabilities in inclusive preschool settings. The main question is whether children can be categorised in homogenous groups based on engagement, independence and social interactions (proximal variables within a biopsychosocial framework of human development). The study also examined whether children with the same diagnosis would group together or separately, when trying to identify clusters of engagement, independence and social interactions, and additionally whether such clusters vary as a function of individual child characteristics, and/or as a function of structural and process characteristics of preschool environment. Methods: Data was taken from an intervention study conducted in mainstream preschools in Portugal. A person-centered cluster analysis was conducted to explore group membership of children with various diagnoses, based on their engagement, independence and social interaction profiles. Results: Results show that children clustered based on similarity of engagement, independence and social interaction patterns, rather than on diagnosis. Besides, it was found that quality of peer interaction was the only predictor of cluster membership. Conclusion: These findings support the argument that participation profiles may be more informative for intervention purposes than diagnostic categories, and that preschool process quality, namely peer interaction, is crucial for children's participation.

The role of environment in explaining frequency of participation of pre-school children in home and community activities.

Objectives: The main goal of the present study was to promote an understanding of the role of environment in explaining frequency of participation of pre-school children in home and community activities. Method: Parents of 116 children from completed an adapted version of the Young Children's Participation and Environment Measure (YC-PEM). Pre-school teachers assessed child functioning. Results: Maternal education was significantly related to the child's frequency of participation in home and community activities. Child functioning had an indirect effect on frequency of participation in home activities through perceived environmental barriers by parents. In the community setting, child functioning was a predictor of the parents' perception of environmental barriers and there was no evidence of a mediating effect of perceived environmental barriers. Conclusion: These findings highlight the importance of modifying specific environmental factors to promote child participation and functioning.

A short form of the neonatal intensive care unit family needs inventory / Versão curta do inventário de necessidades da família na unidade de cuidados intensivos neonatais

ABSTRACT OBJECTIVE: The identification of parental needs in Neonatal Intensive Care Units is essential to design and implement family-centered care. This article aims to validate the Neonatal Intensive Care Units Family Needs Inventory for the Portuguese population, and to propose a Short Form. METHODS: A linguistic adaptation of the Neonatal Intensive Care Units Family Needs Inventory, a self-report scale with 56-items, was performed. The instrument was administered to 211 parents of infants hospitalized in all level III Neonatal Intensive Care Units in the North of Portugal, 15-22 days after admission (July of 2013-June of 2014). The number of items needed to achieve reliability close to 0.8 was calculated using by the Spearman-Brown formula. The global goodness of fit of the scale was evaluated using the comparative fit index. Construct validity was assessed through association of each dimension score with socio-demographic and obstetric characteristics. RESULTS: Exploratory factor analysis revealed two dimensions, one focused on parents' needs and another on the infant's needs. To compose the Short Form Inventory, items with ceiling effect were eliminated and 22 items were submitted to confirmatory analysis, which supported the existence of two dimensions (CFI = 0.925). The Short Form showed a high degree of reliability (alpha ≥ 0.76). Less educated and older parents more frequently attributed a significantly higher importance to parent-centered needs, while parents of multiples revealed a tendency to value infant-centered needs. CONCLUSIONS: The Short Form of the Neonatal Intensive Care Units Family Needs Inventory is a brief, simple, and valid instrument with a high degree of reliability. Further studies are needed to explore associations with practices of family-centered care.

RESUMO OBJETIVO: A identificação de necessidades parentais em Unidades de Cuidados Intensivos Neonatais (UCINs) é essencial para planejar e implementar cuidados centrados na família. Este artigo pretende validar o Inventário de Necessidades da Família em UCIN na população portuguesa e propor uma Versão Curta do mesmo. METODOLOGIA: Foi realizada uma adaptação linguística do Inventário de Necessidades da Família na UCIN, uma escala de autorrelato com 56 itens. O instrumento foi aplicado a 211 pais de bebês internados em todas as UCINs de nível III no Norte de Portugal 15 a 22 dias após a internação (julho de 2013-junho de 2014). O número de itens necessários para atingir uma confiabilidade próxima a 0,8 foi calculado pela fórmula de Spearman-Brown. A adequação global da escala foi avaliada pelo índice de ajuste comparativo (CFI). A validade de construto foi avaliada através da associação do escore de cada dimensão com características sociodemográficas e obstétricas. RESULTADOS: A análise fatorial exploratória revelou duas dimensões, uma focada nas necessidades dos pais e outra, nas necessidades do bebê. Para compor a Versão Curta do Inventário, os itens com efeito teto foram eliminados, e 22 itens foram submetidos a análise confirmatória, que sustentou a existência de duas dimensões (CFI = 0,925). A Versão Curta apresentou alto grau de confiabilidade (alfa ≥ 0,76). Pais mais velhos e com menor escolaridade atribuíram, mais frequentemente, maior importância à subescala de necessidades centradas nos pais enquanto os pais de gêmeos revelaram uma tendência de valorizar as necessidades centradas nos bebês. CONCLUSÕES: A Versão Curta do Inventário de Necessidades da Família em UCIN é um instrumento breve, simples e válido com alto grau de confiabilidade. São necessários estudos adicionais para explorar as associações com práticas de cuidados centrados na família.

A short form of the neonatal intensive care unit family needs inventory.

OBJECTIVE: The identification of parental needs in Neonatal Intensive Care Units is essential to design and implement family-centered care. This article aims to validate the Neonatal Intensive Care Units Family Needs Inventory for the Portuguese population, and to propose a Short Form. METHODS: A linguistic adaptation of the Neonatal Intensive Care Units Family Needs Inventory, a self-report scale with 56-items, was performed. The instrument was administered to 211 parents of infants hospitalized in all level III Neonatal Intensive Care Units in the North of Portugal, 15-22 days after admission (July of 2013-June of 2014). The number of items needed to achieve reliability close to 0.8 was calculated using by the Spearman-Brown formula. The global goodness of fit of the scale was evaluated using the comparative fit index. Construct validity was assessed through association of each dimension score with socio-demographic and obstetric characteristics. RESULTS: Exploratory factor analysis revealed two dimensions, one focused on parents' needs and another on the infant's needs. To compose the Short Form Inventory, items with ceiling effect were eliminated and 22 items were submitted to confirmatory analysis, which supported the existence of two dimensions (CFI=0.925). The Short Form showed a high degree of reliability (alpha≥0.76). Less educated and older parents more frequently attributed a significantly higher importance to parent-centered needs, while parents of multiples revealed a tendency to value infant-centered needs. CONCLUSIONS: The Short Form of the Neonatal Intensive Care Units Family Needs Inventory is a brief, simple, and valid instrument with a high degree of reliability. Further studies are needed to explore associations with practices of family-centered care.

Linking the early development instrument with the ICF-CY.

Objective: The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) provides a universal taxonomy to describe functioning. One of the most relevant applications of the ICF has been the development of code-sets for particular contexts/situations, such specific age groups. An important step in research around child assessment and intervention is to identify extant measures that can assess the essential functioning features for each age range. This study aims to map the Early Development Instrument (EDI) with the ICF-CY and to identify the functioning dimensions regarded by experts as essential in the age range 3-5 that are covered by this instrument. Method: A systematic deductive content analysis procedure was used in the mapping process. Results: Most of EDI items were mapped to Activities and Participation and the majority of Activities and Participation regarded as essential from 3 to 5 years are assessed by the EDI; only some essential Environmental Factors and Body Functions are covered. Conclusion: The mapping process between the EDI and the ICF has shown that the EDI should be complemented with other measures with a focus on Body Functions and Environmental Factors, in order to facilitate a holistic description of the child.

Estilos interactivos de educadoras do Ensino Especial em contexto de educação-de-infância / Special Education teachers' interactive styles in early education

Este estudo pretendeu caracterizar os estilos interactivos das educadoras do Ensino Especial ao se relacionarem com crianças com Necessidades Educativas Especiais (NEE) integradas em creches/jardins-de-infância do Porto. Participaram 50 educadoras e 50 crianças. Os comportamentos interactivos foram avaliados utilizando a Escala de Avaliação dos Estilos de Ensino. O envolvimento das crianças foi codificado por meio do EQUAL-III. A análise de clusters identificou dois sub-grupos: (i) educadoras que utilizam mais frequentemente comportamentos directivos; (ii) educadoras nas quais predominam comportamentos elaborativos e responsivos. Os subgrupos distinguiram-se em características de qualidade estrutural da sala, da educadora e do envolvimento da criança. As crianças com NEE parecem se beneficiar de interacções baixas em directividade. Interacções elaborativas-responsivas tendem a promover níveis mais sofisticados de envolvimento, pelo que são recomendadas.(AU)

This study intended to characterize special education teachers' interactive styles while interacting with children with disabilities, in day care/preschool contexts in Porto. Fifty special education teachers and 50 children with disabilities participated in the study. Interactive behaviours were rated based on the Teaching Styles Rating Scale. Child engagement was coded by means of the E-QUAL III. Using cluster analysis, two subgroups of teachers were identified: (i) teachers using more frequently directive behaviours; (ii) teachers with predominance of elaborative and responsive behaviours. Subgroups differences were found for classroom structural quality, teachers' characteristics and children's observed engagement. Children with disabilities seem to benefit from low directive interactions. Elaborative-responsive teacher's interactions tend to promote more sophisticated levels of children's engagement, and are thus recommended.(AU)

Estilos interactivos de educadoras do Ensino Especial em contexto de educação-de-infância / Special Education teachers' interactive styles in early education

Este estudo pretendeu caracterizar os estilos interactivos das educadoras do Ensino Especial ao se relacionarem com crianças com Necessidades Educativas Especiais (NEE) integradas em creches/jardins-de-infância do Porto. Participaram 50 educadoras e 50 crianças. Os comportamentos interactivos foram avaliados utilizando a Escala de Avaliação dos Estilos de Ensino. O envolvimento das crianças foi codificado por meio do EQUAL-III. A análise de clusters identificou dois sub-grupos: (i) educadoras que utilizam mais frequentemente comportamentos directivos; (ii) educadoras nas quais predominam comportamentos elaborativos e responsivos. Os subgrupos distinguiram-se em características de qualidade estrutural da sala, da educadora e do envolvimento da criança. As crianças com NEE parecem se beneficiar de interacções baixas em directividade. Interacções elaborativas-responsivas tendem a promover níveis mais sofisticados de envolvimento, pelo que são recomendadas.

This study intended to characterize special education teachers' interactive styles while interacting with children with disabilities, in day care/preschool contexts in Porto. Fifty special education teachers and 50 children with disabilities participated in the study. Interactive behaviours were rated based on the Teaching Styles Rating Scale. Child engagement was coded by means of the E-QUAL III. Using cluster analysis, two subgroups of teachers were identified: (i) teachers using more frequently directive behaviours; (ii) teachers with predominance of elaborative and responsive behaviours. Subgroups differences were found for classroom structural quality, teachers' characteristics and children's observed engagement. Children with disabilities seem to benefit from low directive interactions. Elaborative-responsive teacher's interactions tend to promote more sophisticated levels of children's engagement, and are thus recommended.