An independent assessment of reliability of the Melbourne Cerebral Palsy Hip Classification System.

PURPOSE: Neuromuscular (NM) hip dysplasia is common in patients with cerebral palsy (CP). Traditionally, migration percentage (MP) has been used to measure the severity of NM hip dysplasia; however, the MP has some limitations. The purpose of this study is to determine the intra- and inter-reliability of the Melbourne Cerebral Palsy Hip Classification System in the typical paediatric population of patients with CP. METHODS: A total of 65 anteroposterior pelvis radiographs in patients (age range 12 years to 21 years) with CP spanning all grades (I to VI) of the classification system were identified and collected for analysis in this institutional review board approved study. Four paediatric orthopaedic surgeons and one orthopaedic surgical resident classified each radiograph according to the Melbourne system. Then, at least four weeks later, the raters repeated the process with a re-randomised order of radiographs. Statistical analysis was performed using the intraclass correlation coefficient (ICC) where < 0 denotes poor agreement and > 0.8 indicates almost perfect agreement. RESULTS: The interobserver reliability was found to be excellent with the ICC of 0.853 (0.813 to 0.887) and 0.839 (0.795 to 0.877). The intraobserver reliability was also found to be excellent with the ICC in the range of 0.838 to 0.933 among the raters. Subgroup analysis indicated no differences in the reliability of observers based on clinical experience. CONCLUSION: This study independently demonstrates that the Melbourne Cerebral Palsy Hip Classification System for NM hip dysplasia in patients with CP can be reliably used for communication among various healthcare providers and research and epidemiological purposes.

Child compliance/noncompliance and maternal contributors to internalization in maltreating and nonmaltreating dyads.

Moral development in maltreated and nonmaltreated children was examined by coding child compliance and noncompliance behaviors in a mother-child interaction during a cleanup situation that followed a semistructured free play. Features of child compliance/noncompliance involve a shift from reliance on external controls to internal mechanisms, thereby reflecting child internalization of the maternal agenda. Differences in maltreating versus comparison mothers' use of control strategies (power-assertive and inductive techniques) and their relations to child internalization were examined. Eighty-nine mother-child dyads participated; approximately half of the children (n = 46) had documented histories of maltreatment and the remaining children (n = 43) were nonmaltreated, demographically similar comparison children. Maltreated children were divided into two subgroups: physically abused and neglected. Compared with nonmaltreated children, abused children were found to exhibit less internalization, whereas neglected children displayed significantly more negative affect. No differences were found between groups for the maternal control strategies. However, maltreated and nonmaltreated groups differed in the maternal variables that predicted child internalization. A lower level of maternal negative affect was linked to child internalization in maltreated children, whereas a lower level of maternal joy predicted internalization for the comparison children. The findings suggest that maltreated children exhibit both behavioral and affective differences in their moral development, with differential effects based on the type of maltreatment. The clinical implications for maltreated children's self and moral development are discussed.

Children's narratives about hypothetical moral dilemmas and objective measures of their conscience: mutual relations and socialization antecedents.

We explored children's conscience using narrative measures that utilized responses to hypothetical moral dilemmas and objective measures (observed moral conduct and mothers' reports). Children and mothers were studied at Time 1 (N = 103, 26-41 months) and at Time 2 (N = 99, 43-56 months). The first goal was to examine correspondence between both sets of measures. There were meaningful links between the narratives, administered at Time 2, and children's observed and mother-reported conscience at Times 1 and 2. Children who produced many antisocial narrative themes were less internalized, whereas children who produced many themes of commitment to and concern about good behavior were more internalized on the objective measures. The second goal was to test the prediction that maternal power assertion is detrimental to conscience. Children who experienced more power-assertive maternal discipline produced fewer themes of commitment to and concern about good behavior in their narratives and were more poorly internalized on observed and mother-reported measures at Time 1 and Time 2. Girls were more internalized on the narrative and objective conscience measures.

Inhibitory control in young children and its role in emerging internalization.

We examined inhibitory control as a quality of temperament that contributes to internalization. Children were assessed twice, at 26-41 months (N = 103) and at 43-56 months (N = 99), on repeated occasions, in multiple observational contexts and using parental reports. Comprehensive behavioral batteries incorporating multiple tasks were designed to measure inhibitory control at toddler and preschool age. They had good internal consistencies, corresponded with maternal ratings, and were developmentally sensitive. Individual children's performance was significantly correlated across both assessments, indicating stable individual differences. Girls surpassed boys at both ages. Children's internalization was observed while they were alone with prohibited objects, with a mundane chore, playing games that occasioned cheating, being induced to violate standards of conduct, and assessed using maternal reports. Inhibitory control was significantly associated with internalization, both contemporaneously and as a predictor in the longitudinal sense. The implications for considering children's temperament as a significant, yet often neglected contributor to developing internalization are discussed.

A longitudinal study of the roots of preschoolers' conscience: committed compliance and emerging internalization.

The focus of this study is the complex relation between compliance and internalization in childhood. It is a replication and a longitudinal extension of earlier work, where we distinguished between 2 forms of compliance: committed, when the child eagerly embraced and endorsed the mother's agenda, and situational, when the child was cooperative, but lacked the sincere commitment and feeling of internal obligation. 99 children, seen previously at 26-41 months, were studied again at 43-56 months. Compliance and internalization were assessed in multiple observational contexts and using maternal reports. As at toddler age, the 2 forms of compliance had distinctly different developmental trajectories, and again, only committed compliance was significantly associated with measures of internalization. Moreover, committed but not situational compliance at toddler age predicted internalization at preschool age. Shared positive affect within the mother-child dyad at toddler age predicted some measures of internalization at preschool age. Further evidence of significant differences in children's compliance to maternal "dos" versus "don'ts" is reported.