搜索结果：Journal of communication disorders

Low language proficiency (LLP) affects up to 10% of children, depending on how it is defined, and is a known risk factor for academic and social difficulties. Despite growing awareness, there is limited consensus on the long-term consequences of LLP across quality of life domains. This review synthesises evidence from longitudinal cohort studies to evaluate long-term risks associated with LLP identified between ages four and eight, with follow-up from age 12 onwards. To examine the long-term outcomes of children aged four to eight years with low language proficiency (LLP), in terms of language, literacy, and quality of life across five WHO domains (physical, psychological, independence, social relationships, and environment). CENTRAL, MEDLINE, Embase, PsycINFO, ERIC, and 17 other databases were searched without language or date restrictions. In addition, reference lists were checked, citation searching was conducted, and study authors were contacted to identify additional studies. The most recent search was completed in March 2025. We included prospective or retrospective longitudinal cohort studies that identified children with LLP between ages four and eight years and assessed outcomes at age 12 or older. Studies could include comparison groups or single-cohort designs. LLP was defined either using standardised diagnostic criteria (≤ -1 SD on normed language measures, encompassing ~10-15% of the population) or clinical judgement by qualified professionals. We extracted data on language, literacy, and World Health Organization (WHO) quality of life domains and used robust variance estimation (RVE) meta-analysis models, including hierarchical and correlated effects models. Effect sizes were reported as Hedges' g or risk ratios (RR), with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) applied to each outcome domain. We conducted sensitivity and moderator analyses and assessed small-study effects. We included 80 studies; 72 contributed to meta-analyses across 15 independent cohorts (≈ 28,828 participants). Studies were published between 1982 and 2024 and conducted in Europe and North America. Risk of bias, assessed across study participation, attrition, and outcome measurement, varied; only three studies were at low risk across all assessed domains, with study attrition most frequently rated as moderate or high. Language outcomes showed large adverse associations in long-term follow-up (145 effect sizes; 11 cohorts; Hedges' g = -1.36, 95% Confidence Interval (CI) -1.80 to -0.92; moderate certainty). Literacy outcomes were similarly affected (86 effect sizes; 7 cohorts; g = -1.12, 95% CI -1.28 to -0.96; high certainty). Physical outcomes were reported in only one study and could not be meta-analysed; evidence was insufficient to draw conclusions. Psychological outcomes showed moderate adverse associations (91 effect sizes; 7 cohorts; g = -0.50, 95% CI -0.80 to -0.19; moderate certainty), with risk ratio analyses indicating lower probability of favourable psychological outcomes (RR = 0.53, 95% CI 0.42 to 0.67). Independence outcomes showed smaller and more uncertain associations (17 effect sizes; 2 cohorts; g = -0.59, 95% CI -1.35 to 0.18; low certainty). Social relationship outcomes showed moderate adverse associations (35 effect sizes; 6 cohorts; g = -0.64, 95% CI -1.35 to 0.07; moderate certainty). Environmental outcomes showed large but imprecise adverse associations (23 effect sizes; 5 cohorts; g = -1.10, 95% CI -1.47 to -0.73; moderate certainty). Across domains, sensitivity analyses supported the robustness of findings, although degrees of freedom were often low due to the limited number of independent cohorts. Where binary outcome data were available, risk ratio estimates were directionally consistent with continuous outcomes but frequently imprecise. Early low language proficiency (LLP) is consistently associated with substantial long-term language and literacy difficulties. LLP is also associated with poorer psychological well-being and social relationship outcomes later in life, with moderate certainty of evidence. Associations with independence outcomes are smaller and more uncertain, reflecting limited data and low certainty. Environmental outcomes, including education, employment, and societal participation, show large adverse associations, although estimates are imprecise due to the small number of contributing cohorts. Physical health outcomes remain under-researched. Taken together, these findings indicate that childhood LLP is not a transient delay but a marker of enduring developmental vulnerability, underscoring the need for sustained identification and support across developmental stages. Further high-quality longitudinal studies are needed, particularly in under-represented outcome domains. Internal sources Department of Special Needs Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for ÅMH, KR, and MM-L. Department of Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for AL. External sources The Research Council of Norway, Norway This review is part of the project, Better Equipped, which is funded by the Research Council of Norway, Grant 324207. Lervåg and Melby-Lervågs participation was founded by The Research Council of Norway, Centres of Excellence, Grant 331640. The funder had no role in the study design, conduct, methods, data analysis, reporting, or publication of this protocol for the review. https://discovery.ucl.ac.uk/id/eprint/10165057/1/Hagen_et_al-2023-Cochrane_Database_of_Systematic_Reviews.pdf.

Cognitive-communication disorder (CCD) is common after acquired brain injury (ABI), reported in about two-thirds of people who sustain an injury. Quantitative studies have found that the disorder can negatively impact a person's ability to socially re-integrate into the community, return to work or education and achieve a good quality of life. However, little is known about how the disorder impacts people with ABI and the family. Therefore, the aim of this qualitative evidence synthesis was to provide a detailed exploration of the lived experience of CCD for people with ABI and their family members. A systematic literature search was conducted across eight databases (CINAHL Ultimate, PsycINFO, PsycARTICLES, Medline, EMBASE, AMED, Scopus, PubMed) to August 2025. Studies were included if they reported on people with ABI who present with CCD (or similar term) and/or familiar communication partners whereby the impact of the disorder was described. Relevant data were extracted, and studies were critically appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and the confidence of the findings was assessed using GRADE-CERQual tool. The final included studies were synthesised using thematic analysis. 13 articles met the eligibility criteria and reported on 103 people with ABI with CCD and 66 familiar communication partners including spouses, parents, friends, carers, siblings and children. Methodologies comprised interviews (n = 10), focus groups (n = 1), spoken discourse samples (n = 1) and online survey (n = 1). Eight main analytic themes were identified centred around the experiences of both people with ABI: (1) communicating is not easy; (2) lack of awareness and feeling tired; (3) anxiety, embarrassment and isolation; (4) connecting with others; and (5) participation and identity; and their familiar communication partner: (6) adjusting to giving increased support; (7) emotional toll of supporting; (8) relationship and life role changes. This review highlights the broad and unique impacts of CCD for both people with ABI and their familiar communication partners. People with ABI require tolerance to manage their communication difficulties; and communication partners require education, support and training to manage the change in relationship. These findings underpin the need for interventions to include partners in rehabilitation and for therapists to consider the diverse needs of people with ABI including emotions, relationships, social participation and changes to identity.

Self-efficacy (SE), a concept from health promotion, is known to be associated with numerous positive health outcomes but has not been formally described for the management of individuals with inducible laryngeal obstruction (ILO). The purpose of this article is to describe how a SE framework can be used to promote optimal outcomes for individuals with ILO. The SE framework uses a variety of methods to enhance self-management and achieve therapeutic goals. Key elements include mastery experiences, vicarious experience, verbal persuasion, and an understanding of physiological and affective states, all of which are relevant to the optimal treatment of ILO. Data from our clinic support the use of a SE approach and two case scenarios are presented which illustrate its use in clinical practice. In a study of adults with ILO treated at our institution, there were significant associations between feelings of control of symptoms, activity limitations, and psychological symptoms. These findings highlight the utility of using the concept of control as a way of goal-setting at diagnosis, tracking progress in therapy, and as a metric of treatment success. At our institution, simple numeric rating scales provide a useful means of assessing control and are used for the management of ILO at every visit. SE is a powerful predictor of behavior change and has been widely used to successfully treat a wide variety of medical conditions. Further investigation of the application of this framework to the treatment of ILO is recommended. As a result of this activity, readers will: 1. Describe the findings from previous research and the measures that have been used to document improvement after ILO treatment. 2. Define the concept of self-efficacy and its component parts and summarize its previous use in the literature. 3. Apply that model to the field of rehabilitation, with particular reference to a comprehensive treatment model for ILO as a way of promoting optimal outcomes.

Communicating effectively in everyday life is a key outcome for children with speech, language and communication difficulties. However, we lack a clear way to describe children's everyday communication functioning-their communicative participation. Communicative participation is defined for adults, as 'taking part in life situations where knowledge, information, ideas, or feelings are exchanged', and included how communicative participation is achieved, with whom and for what purposes. This study aimed to consider communicative participation for children and young people, by using an existing definition regarding adults' communicative participation to elicit meaning from children and young people with speech, language and communication needs, and that of their parents and clinicians. Three focus groups with young people with speech, language, and communication needs (n = 6, ages 14-16 year old), parent carers (n = 5), and speech and language therapists (n = 19) and two semi-structured interviews, one with a parent of a young child with complex communication needs and one with a parent and their daughter with developmental language disorder, were conducted online, audio recorded and transcribed verbatim. Participants were shown an existing definition of communicative participation (originally intended to be applied to adults) and discussed the appropriateness of each section of the definition for children and young people. Transcripts were analysed following the Framework Analysis Approach. Participants broadly agreed with the existing definition but highlighted the changing nature of communicative participation throughout childhood. They thought that a definition of communicative participation should include interaction for joy, where closeness rather than meaning is shared, and reference to play and education as key communicative participation situations. Participants highlighted the importance of skilled partners in meaning making for children with developmental communication difficulties, and the fundamental role of technology in communicative participation. They also discussed the impacts of successful communicative participation on children's social and emotional development, seeing communicative participation as a driver to protect mental health and wellbeing, build independence, develop trusting relationships and stay safe. Communicative participation develops across childhood and differs to that in adulthood in some important respects. The broad boundaries of the construct provided in this study can inform further development of the construct with potential impact for developing assessments and interventions related to communicative participation for children. What is already known on this subject Communicative participation has been defined as 'taking part in life situations where knowledge, information, ideas, or feelings are exchanged' (Eadie et al. 2006, 311) and 'understanding and being understood in a social context, by applying verbal and nonverbal communication skills' (Singer et al. 2020, 1801) What this paper adds to the existing knowledge Communicative participation changes across childhood. It includes interaction for closeness, without a message being conveyed; play; education; and social and emotional development. Skilled interaction partners are vital for the development of communicative participation for children and young people with speech, language and communication needs (SLCN). The extended boundaries for communicative participation developed in this study can inform the development of new measurement tools. What are the potential or actual clinical implications of this work? Communicative participation is a prized outcome for children and young people with SLCN and their parents. Speech and language therapists should investigate children's communicative participation and intervention should be directed toward participation goals.

Deep brain stimulation (DBS) is an emerging intervention for treatment-resistant psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Despite strong evidence of efficacy, its acceptability remains limited among psychiatrists, especially in France. Understanding professional attitudes is essential for its clinical integration. We conducted a mixed-method study using the script method, combining qualitative item development with quantitative analysis through a self-administered online questionnaire. The survey, based on a multidimensional model of acceptability, assessed French psychiatrists' perceptions of DBS across dimensions such as utility, usability, reliability, risk, and professional culture. Data were analyzed using network clustering analysis, centrality metrics, and community detection, allowing exploration of structural relationships among acceptability factors. Subgroup analyses were conducted by gender, professional seniority, practice type, and theoretical orientation. Among 418 respondents, the most central determinant of DBS acceptability was adherence to professional guidelines. Other influential factors included perceived utility, self-acceptability, and the classification of DBS as part of psychiatry's therapeutic arsenal. Peripheral concerns, such as cost or multidisciplinary logistics, were weakly connected to the core network. Gender and seniority influenced network structure: male psychiatrists showed stronger associations between adherence to professional guidelines and viewing DBS as a legitimate psychiatric treatment, while senior psychiatrists exhibited denser patterns of associations between acceptability-related factors. No significant differences were found by practice type or theoretical orientation. DBS acceptability among French psychiatrists hinges on institutional validation and perceived alignment with psychiatric norms. These findings highlight the need for guideline-based dissemination strategies and tailored communication to support the ethical and effective adoption of DBS in psychiatric care.

BACKGROUND: Despite the widespread use of telehealth, particularly throughout the COVID-19 pandemic, there has been little published evidence about the effect of telehealth on the therapeutic relationship and clinician and patient interaction. This study sought to identify the divergence in this mode of communication compared with in-person interaction for both clinicians and patients. METHODS: An exploratory qualitative interview study of 22 mental health practitioners (registered psychologists or psychiatrists) in Australia who have treated patients using psychotherapy in-person and using telehealth, followed by a qualitative interview study of 20 patients in Australia who have undergone psychotherapy in-person and using telehealth. Using an interpretative phenomenological analysis, this paper examines participants’ perspectives on, communication with, and reactions to telehealth when providing or receiving psychotherapy treatment. RESULTS: Both clinicians and patients described the benefits and detriments of clinical interactions using telehealth versus face-to-face. Both groups drew attention to the evident “convenience” inherent in the use of telephone or video contact, while also noting how the absence of a shared physical space fundamentally changed the conduct of private conversations with affective content. Many clinicians expressed the view that telehealth induced an underlying and intrinsic shift in the connection with the patient. Patients, likewise, reported a corresponding change in interpersonal interaction, although many experienced difficulties articulating a description of this change in relational connection. CONCLUSION: Patients and doctors identify both benefits and limitations of telehealth in comparison with face-to-face communication. This study has found that various factors inherent in telehealth contact affect the curative value and quality of the healthcare interaction which impacts both patient and clinician. The structure and content of the therapeutic relationship varied according to whether it occurred in a telehealth setting or in-person. These results suggest that the use of telemedicine should be tailored to the specific needs, preferences and circumstances of individual patients. The results also demonstrate that the themes identified have different implications and effects depending on the clinician, patient, and clinical situation. There are indications that telehealth overall limits or constrains the exchange of meanings in the clinic, and further research is required to explore the process by which this change occurs and its meaning.

Friedreich ataxia (FA) causes progressive impairment of communication due to gradual deterioration of speech, associated with impaired hearing, socio-cognitive and language skills. There is an urgent need to investigate the impact of this multiparametric alteration on patients' lives. Therefore, the COMunication and ATAXia measure (COMATAX) was developed and validated in French and German. In the PROFA study (NCT05943002), we conducted focus groups and cognitive interviews with patients with FA, professionals and caregivers to elaborate relevant items of communication disabilities. Subsequently, the measure was validated in 93 patients with FA via a mobile health app. For validation, distribution properties, reliability (Cronbach's alpha) and validity (correlations with VHI-30, SSQ-12, SARA total score, SARA speech item, Speech rate and GAA repeats; known-groups validity by age, sex, and self-rated health/wellbeing, disease-severity, hearing function, daily activities, and exploratory factor analysis) were calculated. An IRT analysis was performed to assess item characteristics. COMATAX consists of 17 items (five response options each) and an 18th question asking about the most bothersome symptom. We observed high internal consistency for the total COMATAX scale (α = 0.897), strong correlations with VHI-30 (r=.894), SSQ-12 (r = -.531), moderate with SARA score (r=.498), SARA speech item (r=.416), Speech rate (r=-.354), weak with GAA repeat length (rGAA1=-0.207) and the ability to distinguish between different subgroups (disease severity, self-rated health, wellbeing, hearing function, and daily activities). Most items showed good discrimination of communication ability. The COMATAX is a valid and reliable patient-reported communication disability measure, useful in future therapeutic trials in FA.

ABSTRACTBackground: Mental disorders often emerge in childhood, affecting individual development and family functioning. Parents are often responsible for seeking mental health care for their child and thereby encounter structural, emotional, and knowledge-related barriers. For parents of children exposed to traumatic events, additional challenges may arise.Objective: This study aims to investigate parental perceptions of barriers to psychotherapy for their child and to compare perceptions between parents of children with and without traumatic experiences.Methods: Perceived barriers were measured with a self-developed 10-item scale. Online survey was conducted with N&#x2009;=&#x2009;271 parents who had at some point been seeking or receiving psychotherapy for their child. Non-parametric Mann-Whitney-U-tests were performed for several group comparisons: search only (n&#x2009;=&#x2009;63) vs. treatment (n&#x2009;=&#x2009;208); child with (n&#x2009;=&#x2009;71) vs. without traumatic experience (n&#x2009;=&#x2009;200); trauma- (n&#x2009;=&#x2009;54) vs. non-trauma-related reasons for treatment (n&#x2009;=&#x2009;154).Results: Parents reported a moderate level of barriers. The highest agreements were found for waiting time and time investment (Md&#x2009;=&#x2009;4.00; IQR&#x2009;=&#x2009;2.00). Parents of children who had only sought but not received psychotherapy reported greater difficulties in finding adequate treatment (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;-0.18). Both if children had experienced a traumatic event and if the reason for therapy was trauma-related, parents reported a significantly higher degree of time investment (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;-0.16), the concern that their child might be too burdened (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;-0.20) and lack of confidence in professional competence (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;-0.19).Conclusions: Structural barriers were reported as most prominent. Trauma exposure of the child may further increase perceived barriers. These findings highlight the need for parental support and trauma-informed guidance. Parents encounter multiple barriers when seeking or engaging in psychotherapy for their child, with structural barriers being most prominent.Children&#x2019;s exposure to traumatic events may further increase the perception of barriers.Trauma-informed training and guidance for parents, improved access to support, improved trauma-focused training for professionals and transparent communication between professionals and parents are needed. Antecedentes: Los trastornos mentales con frecuencia emergen en la ni&#xf1;ez, afectando el desarrollo individual y el funcionamiento familiar. Los padres son con frecuencia los responsables de la b&#xfa;squeda de atenci&#xf3;n en salud mental para sus ni&#xf1;os y por lo tanto se enfrentan a barreras estructurales, emocionales y de conocimiento. Para los padres de ni&#xf1;os expuestos a eventos traum&#xe1;ticos, pueden aparecer otros desaf&#xed;os. Objetivo: Este estudio tiene como objetivo investigar las percepciones parentales de las barreras a la psicoterapia para sus hijos y comparar las percepciones entre los padres de ni&#xf1;os con y sin experiencias traum&#xe1;ticas. M&#xe9;todos: Las barreras percibidas se midieron con una escala de 10 &#xed;tems desarrollada para este estudio. Se realiz&#xf3; una encuesta en l&#xed;nea a N&#x2009;=&#x2009;271 padres que en alg&#xfa;n momento hab&#xed;an buscado o recibido psicoterapia para sus hijos. Se realizaron pruebas U de Mann&#x2013;Whitney no param&#xe9;tricas para varias comparaciones de grupos: solo b&#xfa;squeda (n&#x2009;=&#x2009;63) vs. Tratamiento (n&#x2009;=&#x2009;208); ni&#xf1;os con experiencias traum&#xe1;ticas (n&#x2009;=&#x2009;71) vs sin experiencias traum&#xe1;ticas (n&#x2009;=&#x2009;200): razones para el tratamiento relacionada con el trauma (n&#x2009;=&#x2009;54) vs no relacionas con trauma (n&#x2009;=&#x2009;154). Resultados: Los padres reportaron un nivel moderado de barreras. Los mayores acuerdos se encontraron en el tiempo de espera y la inversi&#xf3;n de tiempo (Md&#x2009;=&#x2009;4.00; IQR&#x2009;=&#x2009;2.00). Los padres de ni&#xf1;os que solo buscaron psicoterapia, pero no la recibieron reportaron mayores dificultades en encontrar un tratamiento adecuado (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;&#x2212;0.18). Tanto si los ni&#xf1;os tuvieron experiencias traum&#xe1;ticas como si el motivo de la terapia estaba relacionado con el trauma, los padres reportaron un grado significativamente mayor de inversi&#xf3;n de tiempo, (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;&#x2212;0.16), la preocupaci&#xf3;n que su hijo pudiera estar demasiado sobrecargado (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;&#x2212;0.20) y la falta de confianza en la competencia profesional (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;&#x2212;0.19). Conclusiones: Se reportaron las barreras estructurales como m&#xe1;s prominentes. La exposici&#xf3;n a trauma del ni&#xf1;o podr&#xed;a incrementar aun mas las barreras percibidas. Estos hallazgos destacan la necesidad del apoyo parental y orientaci&#xf3;n especializada en trauma.

Paediatric feeding disorders (PFDs) are common but often underrecognised in primary care. Families frequently face long diagnostic delays and fragmented management. Therapeutic patient education (TPE) programmes exist in hospital settings but remain rare in community care. To design and implement a structured, multidisciplinary TPE programme for children with PFD and their parents, adapted to a primary care context. The pilot programme was launched in February 2025 within the Maison de Sant&#xe9; Pluriprofessionnelle Universitaire Corneille (MSPU; Hauts-de-France). It was developed by a primary care team in partnership with the regional CPTS (Communaut&#xe9; Professionnelle Territoriale de Sant&#xe9;), which will provide ongoing financial support to extend the initiative. This programme consists of five 2-hour workshops involving one child (aged 3-8 years) and at least one parent per session. Each group includes six children and 14 parents, supervised by three health professionals - always including a speech therapist - trained in TPE and non-violent communication. Sessions cover eating mechanisms, posture, nutrition, sensory exploration, and emotional regulation. The first cycle involved six children and their families. Early feedback indicates high engagement, improved parental confidence, and observed progress in children's mealtime comfort. Twenty-four additional families are already registered and awaiting the next series of workshops planned for late 2025. This first TPE programme for PFD implemented in primary care demonstrates feasibility, strong acceptability, and interprofessional collaboration. It offers a promising model for community-based management of complex paediatric feeding issues.

Cardiometabolic conditions-including cardiovascular disease, type 2 diabetes, and obesity-are highly prevalent among individuals with psychotic disorders. These conditions contribute substantially to reduced life expectancy, diminished quality of life, and increased societal and economic burdens. Thus, effective, individualized interventions are urgently needed. Outpatient psychiatric clinics offer an ideal setting for such efforts owing to regular patient contact and access to multidisciplinary care. We have developed a comprehensive, clinically integrated trial aimed at improving cardiometabolic health, promoting healthier lifestyles, and enhancing quality of life for individuals with psychotic disorders receiving care in the Greater Gothenburg region. LAGOM is a multicenter, naturalistic, quasi-experimental case&#x2012;control trial conducted across six geographically separate outpatient psychosis clinics within the Department of Psychotic Disorders at Sahlgrenska University Hospital, a multi-site university hospital in the Greater Gothenburg region. A total of 650 adults with psychotic disorders will be recruited from these clinics. Two clinics will implement the LAGOM intervention, whereas four will serve as control sites delivering usual care. The intervention is embedded within routine psychiatric care and grounded in behavioral science. It includes comprehensive cardiometabolic risk assessments, two visual motivational tools (QRISK3 and a body composition analyzer), personalized follow-up plans, risk-oriented referrals to primary care, and structured education for patients, relatives, and staff. The intervention is designed to be scalable, sustainable, and tailored to individual patient needs. If proven superior to usual care, this pragmatic, multicomponent intervention-delivered within routine psychiatric care-could improve cardiometabolic health and quality of life for individuals with psychotic disorders. Embedding the intervention within existing clinical structures enhances its scalability and feasibility and, if effective, could serve as a model for wider implementation. ClinicalTrials.gov (NCT06781801; date registered: 16 January 2025). Recruitment started on 27 February 2025 and will be completed on 31 December 2026. The current clinical investigation plan version is 3.1, dated 21 October 2025.

Atypical antipsychotics (AAPs) are increasingly prescribed for bipolar spectrum disorders in children and adolescents. This study aimed to investigate the prevalence and trends of AAP prescriptions among Korean children and adolescents with bipolar spectrum disorders. We analyzed data from the Korean National Health Insurance Review and Assessment Service to assess AAP use among Koreans aged 0-18&#x2009;years with bipolar spectrum disorders between 2010 and 2022. This population-based study used an annual cross-sectional assessment to evaluate trends in AAP prescription. The prevalence of AAP prescriptions for children and adolescents with bipolar spectrum disorders increased over the 13-year study period, rising from 0.14 in 2010 up to 1.23 per 1000 persons in 2022. During this time, the dominant AAP shifted from risperidone to aripiprazole. Data from 2022 revealed that the most prescribed AAP for children was aripiprazole, followed by risperidone, quetiapine, and olanzapine. Children and adolescents with bipolar spectrum disorders and psychiatric comorbidities, particularly ADHD, were prescribed AAPs more frequently (p&#x2009;<&#x2009;0.001). The prescription of AAPs in Korean children and adolescents with bipolar spectrum disorders has increased over the last decade. This trend was particularly pronounced among individuals with psychiatric comorbidities, especially ADHD. Future research is needed to develop more evidence-based AAP treatments for bipolar spectrum disorders in this population.

There is growing evidence that dynamic assessment shows high discriminant validity in classifying children with and without language disorders. The Dynamic Assessment of Narrative in Cantonese (DANIC) is a new tool adapted from the language subtest of the Predictive Early Assessment of Reading and Language. This study aimed to explore the acceptability of the prototype DANIC tool to inform further development and implementation. A mixed-methods approach was used. A postseminar survey and a focus group meeting were conducted to collect opinions from practicing speech-language pathologists (SLPs) of the prospective and retrospective acceptability of the DANIC, respectively. Correlation and regression analyses were used to analyze the quantitative survey data. Thematic analysis was applied to the qualitative data using Sekhon's theoretical framework of acceptability. Fifty survey responses were analyzed. A high acceptability rating (3.24/4) reflected high prospective acceptability. Correlation analysis revealed that overall acceptability was linked to various factors, some of which were interconnected. Ten SLPs who had used the DANIC prototype with at least two children participated in the focus group. Thematic analysis identified eight themes and 30 subthemes. A mind map was derived to depict the interconnections of main themes and subthemes. Focus group participants were positive about the ease of administration and short duration of the DANIC. At the same time, they expressed concerns regarding scoring, interpretation of the scores, adapting to clients' characteristics, keeping clients motivated, and the cultural appropriateness of the test materials. This study found high clinical acceptability of the DANIC through quantitative data, with qualitative feedback indicating moderate acceptability due to varied expectations and experiences. The results highlight the multifaceted interplay of factors influencing acceptability. Broader implications on social validity were discussed. https://doi.org/10.23641/asha.32137597.

Trauma to the spinal cord initiates an inflammatory response causing secondary damage, which collectively can result in loss of function below the level of the injury. The unbalanced risk-benefit ratio of methylprednisolone led to development of therapeutic nanoparticles (NPs) that associate with circulating monocytes and neutrophils to reduce inflammation and secondary damage and improve functional recovery in a female mouse model of cervical hemisection spinal cord injury. Herein, we investigate the mechanisms occurring during the acute phase of injury by which NPs directly and indirectly modulate the phenotype and trafficking of monocytes and neutrophils and computationally catalog the communication network among cell types within the injury microenvironment. Using adoptive transfer to monitor trafficking, NP treatment reduced the extent of myeloid cell recruitment to the injury yet did not impact the composition of adoptively transferred monocytes or neutrophils. The proportion of inflammatory monocytes was reduced with NP treatment, and single-cell sequencing analysis indicated increased polarization toward pro-regenerative phenotypes. Sequencing analysis also demonstrated that outgoing signals from monocytes and neutrophils influenced the phenotype of numerous cell types, including endothelial cells, fibroblasts, oligodendrocyte progenitor cells, and Schwann cells. Signaling between cell compartments involves a combination of soluble and matrix signals, with NP treatment enhancing expression of genes associated with anti-inflammatory phenotypes, angiogenesis, neuroprotection, and promotion of axon outgrowth or decreasing expression of inhibitors to regeneration. Collectively, NP delivery leads to direct and indirect effects on monocytes and neutrophils, which subsequently influence gene expression and intercellular signaling networks that promote a pro-regenerative environment.

Temporomandibular disorders (TMD) are common conditions that may substantially impair quality of life, yet the quality of health information available on short-video platforms remains unclear. This study evaluated the coverage of TMD-related content, the educational quality, and the reliability of TMD-related Chinese videos on TikTok and Bilibili. On October 5, 2025, TikTok and Bilibili were searched using the Chinese keyword "." After screening, 200 eligible videos were included, comprising 100 from TikTok and 100 from Bilibili. Video characteristics, uploader categories, engagement indicators, and content coverage were recorded. Video quality and reliability were assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) benchmark criteria. The median video duration was 136.50 seconds (Q1, 66.00; Q3, 235.25). The median GQS, mDISCERN, and JAMA scores were 3.00 (Q1, 2.00; Q3, 3.00), 3.00 (Q1, 2.00; Q3, 4.00), and 2.00 (Q1, 2.00; Q3, 3.00), respectively, indicating overall moderate quality and reliability. Diagnosis, symptoms, and treatment were the most frequently covered domains, whereas epidemiology was the least well covered; only 9.0% of videos provided a complete explanation of epidemiology, and 70.0% did not mention it at all. Bilibili videos were significantly longer than TikTok videos (median, 164.00 vs 81.50 seconds, P&#x2005;<&#x2005;.001), whereas TikTok videos showed significantly higher engagement in likes, comments, shares, and saves (all P&#x2005;<&#x2005;.001). No significant differences were observed between the 2 platforms in GQS, mDISCERN, or JAMA scores. Videos uploaded by specialized healthcare professionals had significantly higher GQS, mDISCERN, and JAMA scores than videos uploaded by other sources (all P&#x2005;<&#x2005;.001). Engagement indicators were strongly correlated with one another but did not reflect better informational quality. TMD-related videos on TikTok and Bilibili attracted substantial public attention; however, their overall educational quality and reliability were only moderate. Greater involvement of specialized healthcare professionals, clearer source disclosure, and more balanced topic coverage may help improve the quality of TMD-related health communication on short-video platforms.

While maternal congenital heart disease (CHD) is associated with increased risks of adverse pregnancy outcomes, its impact on long-term child development remains unknown. This study aimed to investigate if in-utero exposure to maternal CHD is associated with child developmental vulnerability at school entry. This population-based cohort study included 256,629 singleton offspring born in British Columbia, Canada between January 1, 1995 and December 31, 2016, with follow up through linkage to teacher-rated Early Development Instrument (EDI) surveys administered in kindergarten around 5-6 years of age. Over 90% children enrolled in participating schools completed the questionnaire. Developmental vulnerability was defined as a score <10th percentile in any two of the five EDI domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive development, and communication and general knowledge. The association between maternal CHD and child developmental vulnerability was examined using modified Poisson regression models, adjusted for maternal age at delivery, parity, country of birth, marital status, neighborhood income quintiles, preexisting psychiatric disorders, and pre-gestational diabetes. A counterfactual four-way decomposition method was used to quantify potential mediation and moderation by preterm birth. Of the 256,629 children (51.4% female) included in the analysis, 456 (0.2%) were exposed to maternal CHD. Developmental vulnerability was identified among 25.2% children exposed to maternal CHD compared with 16.6% among the unexposed. In the adjusted model, maternal CHD was associated with 28% higher risk of developmental vulnerability (aRR 1.28; 95% CI [1.11, 1.48]) compared with no maternal CHD. The increased risk was observed across multiple developmental domains related to physical health and wellbeing (aRR 1.31; 95% CI [1.11, 1.54]), social competence (aRR 1.22; 95% CI [1.02, 1.45]), language and cognitive development (aRR 1.39; 95% CI [1.13, 1.70]), and communication and general knowledge (aRR 1.33; 95% CI [1.09, 1.63]). Preterm birth mediated only about 8% of the overall association. Severe CHD was more strongly associated with developmental vulnerability (aRR 1.98; 95% CI [1.31, 3.00]) compared to mild CHD (aRR 1.19; 95% CI [1.00, 1.42]). However, the study had limited capacity to separate intrauterine effects from potential genetic and postnatal familial influences. Some degree of CHD misclassification is possible, which would likely bias the association toward the null. In this population-based study, maternal CHD was associated with child developmental vulnerability at school entry. While further research is required to elucidate the mechanisms, enhanced clinical monitoring and tailored support to reproductive age women with CHD may help reduce the risk of developmental vulnerability in their children.

Temporomandibular disorders are among the most common causes of orofacial pain, often leading patients to seek information online. The increasing use of large language models such as chat generative pre-trained transformer in healthcare communication has raised questions about the reliability and readability of artificial intelligence-generated patient information. The aim of this study was to evaluate the accuracy, comprehensiveness, readability, and inter-rater reliability of chat generative pre-trained transformer-generated responses to common patient questions regarding temporomandibular disorders. ChatGPT (version 4.0) was prompted to generate 50 potential patient questions about temporomandibular disorders. Ten representative questions were selected and independently evaluated by five experts (two oral and maxillofacial surgeons, two physiotherapists, and one physical medicine specialist). Responses were rated using a four-point quality scale assessing accuracy and completeness. Readability was calculated using the Flesch-Kincaid method, and inter-rater reliability was assessed using the Intraclass Correlation Coefficient. The responses demonstrated variable but generally acceptable quality. The overall Intraclass Correlation Coefficient value was 0.862, indicating good inter-rater agreement. Readability levels ranged from grade 6.2-10.7 (mean 8.0), corresponding to middle-to-high school comprehension. While most responses were rated satisfactory, several lacked sufficient clinical detail, particularly in differentiating professional consultation pathways. chat generative pre-trained transformer provides moderately reliable and readable information about temporomandibular disorders, supporting its potential role in patient education. However, reliance on artificial intelligence-generated frequently asked questions introduces methodological limitations and authority bias. Future studies should incorporate real patient data and external fact-checking to enhance clinical relevance.

The purpose of this study was to translate and validate the Voice Activity and Participation Profile (VAPP), a comprehensive tool for assessing the impact of voice disorders on daily life activities and social participation, into Arabic and to test its reliability among voice disorders patients in Riyadh, Saudi Arabia. A descriptive, questionnaire-based validation study was conducted at two university hospitals from December 2023 to September 2024. The VAPP was translated using forward and backward translation methods from English into Arabic. The questionnaire's reliability and internal consistency were assessed using Cronbach's alpha and test-retest reliability. To measure the construct validity, exploratory factor analysis (EFA) was conducted. Discriminant validity was assessed using the Mann-Whitney U test, and reproducibility was evaluated using the intraclass correlation coefficient (ICC). The study included 120 participants, of which 60 had voice complaints (VCG) and 60 were healthy HCG (HCG). The Arabic-VAPP (A-VAPP) demonstrated excellent reliability, with a Cronbach's alpha of 0.967 and ICC exceeding 0.979 (p < 0.001). Significantly higher scores were observed in the VCG compared to the HCG across job (p = 0.03), daily communication (p < 0.001), social communication (p = 0.01), and emotional impact (p < 0.001) domains. Receiver operating characteristic analysis further confirmed strong discriminative validity with an area under the curve of 0.960, sensitivity of 84%, and specificity of 100%. A-VAPP is a reliable and valid tool for assessing voice disorders in Arabic-speaking patients, making it suitable for both clinical practice and research.

The role of social media in in shaping the public perception of health crises is growing, yet we know little about the contribution of platforms such as YouTube in shaping knowledge regarding child undernutrition. We aimed to explore the digital discussion of and sentiment around YouTube content on child undernutrition in Pakistan, where at least 38% of children are stunted (as per global rankings). We compiled a dataset of 1847 videos and 42&#x2009;963 comments YouTube users that were uploaded between January 2010 and March 2024. We used Latent Dirichlet Allocation (LDA) topic modelling to analyse this data and identify narrative frames present in the content. We also used the Valence Aware Dictionary for sEntiment Reasoning (VADER) to analyses sentiment in the comments. The analysis reveals six dominant narrative frames, where 'policy failure' made up 32% of the discourse, while just 5% addressed 'solution-focused actions'. The VADER sentiment analysis supports this with a compound score of -0.72, suggesting an overall negative and highlighting considerable public concern about institutional responses. The data further suggests specific engagement patterns that point to a clear break between crisis-oriented and solution-oriented information. Algorithms on digital platforms amplify the narratives that serve as digital determinants of health, shaping public perceptions and reinforcing public distrust in institutional policy responses. It will not be enough to simply 'get the message right' if we seek to create effective health communication - we must, instead, be prepared to actively challenge harmful discourses, champion fair and locally relevant narratives, and engage for algorithmic transparency and public health-centred content curation from these platforms. These results provide an important evidence base for the reframing of nutrition communication initiatives in Pakistan and beyond.

Procedural therapies, including chemodenervation and nerve-targeted surgery, are increasingly used for refractory migraine. However, nonclinical factors associated with escalation to procedural care remain incompletely understood. A retrospective cohort study was conducted using data from the National Institutes of Health All of Us (NIH AoU) Research Program Registered Tier dataset (version 8). Adults with a documented diagnosis of migraine were identified and classified based on receipt of procedural migraine treatment within 1 year of diagnosis. Patient-reported measures were derived from NIH AoU The Basics and Social Determinants of Health (SDOH) surveys, focusing on psychosocial stress, emotional well-being, and patient-provider interactions. Multivariable logistic regression was performed to estimate the adjusted odds ratios (ORs) for receipt of procedural migraine treatment, controlling for age, sex, and race. Among 23,163 adult patients, 458 (2.0%) received procedural migraine treatment within 1 year of diagnosis. In adjusted analyses, higher perceived psychosocial stress (OR, 1.48; 95% confidence interval [95% CI], 1.21-1.82), frequent emotional withdrawal (OR, 1.47; 95% CI, 1.10-1.95), and patient-reported negative patient-provider interactions (OR, 1.35; 95% CI, 1.09-1.69) were significantly associated with receipt of procedural migraine treatment. Demographic factors, including age, sex, and race, were not significantly associated with treatment utilization after adjustment. Psychosocial distress and patient-provider interactions are associated with receipt of procedural migraine treatment, likely reflecting disease burden and care complexity rather than differential access. Leveraging the granularity of patient-reported survey data within the NIH AoU Research Program highlights the potential of next-generation datasets to advance patient-centered research in plastic and reconstructive surgery.