AutInsight is an innovative, consumer-informed parent support program for parents of autistic children grounded in perspectives from qualitative research with autistic adults. The current study outlines the development and evaluation of AutInsight through a pilot randomised controlled trial. Parents ( N = 41) of autistic children (10 years and younger) were randomly allocated to AutInsight ( n = 20) or care-as-usual ( n = 21) and completed online questionnaires across three timepoints (baseline, post-program and 3-month follow-up). Measures include parental sensitivity, parental acceptance and understanding, psychological flexibility, mindful parenting, parental mental health, overall family experience, quality of life, and child behaviours. Intent-to-treat analyses indicated greater rates of improvement for parents allocated to the AutInsight program, with small- to medium-sized effects for parent-reported parental sensitivity (EA-SR mutual attunement d = 0.84, EA-SR child involvement d = 0.50), as well as overall autism family experience (AFEQ total d = 0.38, AFEQ family life d = 0.29). Greater rates of improvement were also found in parent-reported child conduct problems (SDQ d = 0.62) and prosocial behaviours (SDQ d = 0.48). No significant results were found in observed parental sensitivity or any other measure. Results suggest preliminary evidence of effectiveness, feasibility and acceptability of the AutInsight program. A larger, fully powered trial is warranted. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12623000806662).

This systematic review aimed to examine whether parental insightfulness is associated with parental sensitivity, parent and child mental health, and attachment in autistic children. Eligible articles used a quantitative research design and included participants who were parents or caregivers of a child diagnosed with autism and who completed a measure of parental insightfulness. Eight papers (six studies) met inclusion criteria. Parental insightfulness was associated with higher parental sensitivity and attachment security. No studies investigated associations between parental insightfulness and parent mental health. Although research is limited, parental insightfulness appears to be associated with parental sensitivity and child attachment in families of autistic children. More research is required to confirm whether these relationships exist cross-culturally, and with different caregivers.

Background: Prior to 2018, sapropterin hydrochloride (BH4, Kuvan (R)) had not been used in Queensland, Australia, to treat sapropterin-responsive phenylketonuria (PKU). This gave our centre at the Queensland Children's Hospital the opportunity to assess the difference a new treatment makes to the quality of life of the child and family. Study design and methods: A qualitative study design was used. Forty parents of children with a sapropterin-responsive form of PKU (one parent per family) were invited to take part in a semi-structured one-on-one interview exploring their experiences and perspectives on commencing sapropterin therapy with their child. Thirty-eight parents met the eligibility criteria, 23 consented to participate, and 21 were able to be contacted for an interview. Data collected included family background and their experiences pre and post commencement of sapropterin therapy and its impact on their child(ren), diet, and physical and psychosocial wellbeing. Results: Four key themes emerged from thematic analysis: a) psychosocial wellbeing, b) child health and nutrition, c) family economic benefits, and d) parent-child interactions. Overall, parents reported positive experiences and reduced impact of PKU on child, parent, and family quality of life following initiation of sapropterin therapy. The majority reported a sense of relief and optimism and expressed that they were able to manage their child's PKU more effectively than before. Conclusions: Sapropterin therapy is associated with physical and psychosocial benefits for children and families, including improved psychosocial wellbeing, parent-child relationship quality, and child health and nutrition. Implications for research, policy, and practice: Commencement of sapropterin therapy can result in physical and psychosocial benefits for children with phenylketonuria and their families. Longer-term follow-up studies are warranted.

BACKGROUND:Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children. METHODS:A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492). RESULTS:The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%). CONCLUSIONS:Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children. SYSTEMATIC REVIEW PROTOCOL:PROSPERO (CRD42022351492).

Children born very preterm (VP) are at increased risk for challenges in the school environment. This study aimed to understand the needs of parents of VP children for intervention and support in relation to their child's transition to school, and to capture parent preferences for content and delivery of a transition to school intervention. Two hundred and twenty parents of 3-7-year-old children who were born VP (<32 weeks), living in Australia completed a cross-sectional survey. Results showed that over half of parents identified a need for assistance in supporting their child to be ready to start school. Intervention content aimed at improving parent-skills, child-skills and school factors were identified. Parents also identified key considerations and preferences for the format of a transition to school support programme. Parents of VP children have specific needs for support around their child's transition to school, with key factors at the parent-, child - and school-levels.

Currently there are no instruments designed to assess parents’ acceptance and understanding of their autistic child. We aimed to develop and evaluate the reliability and validity of a parent-report scale assessing parents’ acceptance and understanding of their autistic child – the Parental Acceptance and Understanding of Autistic Children Scale (PAUACS). A total of 158 parents (74 non-autistic, 42 autistic, 42 questioning; mean age 42.69 years) of autistic children (mean age 10.80 years) completed an online survey comprising the prototype PAUACS as well as validated measures of parental sensitivity, neurodiversity affirming attitudes, autistic traits, mental health, and child adjustment and family experience. A subsample of participants (n = 97; 61.4

Background Resilience and passion for work are associated with better psychosocial wellbeing and professional quality of life for healthcare workers. Objective To evaluate the characteristics and efficacy of interventions to promote resilience and passion for work in health settings. Methods A comprehensive search was conducted across six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO) for articles published between January 2003 and February 2023. Studies utilizing both quantitative and qualitative methodologies were included. Methodological quality assessment was performed using the Mixed Methods Appraisal Tool. Data from the included studies were analyzed using a convergent mixed methods design. Results A total of 33 studies met the inclusion criteria. All reported on interventions designed to enhance resilience for healthcare workers. None reported on interventions to enhance passion for work. Interventions included mindfulness-based programs, psychoeducation workshops, stress management techniques, and professional coaching. Interventions varied widely in terms of delivery modality, format, content, intensity, duration, and outcomes. Of the studies reporting quantitative data, most (21/29) reported statistically significant improvements in resilience. Of the studies reporting qualitative data, all reported a positive impact of the intervention on resilience and psychological well-being. Conclusions Overall, interventions designed to enhance resilience in health care settings appear to be effective across a variety of healthcare settings. The diversity of effective intervention approaches, delivery formats, intensity and duration suggest that brief, light-touch or self-directed online interventions may be equally as effective as more intensive, lengthy, in-person or group-based interventions. This provides health care organisations with the opportunity to select and flexibly implement interventions that align with organisational, and staff needs and preferences. Future research needs to explore effective approaches to building passion for work.

Objective To evaluate the efficacy and costs of a brief, group-delivered parenting intervention for families of children with eczema.Methods A randomized controlled trial design was used. Families attending the Queensland Children's Hospital and from the community (n = 257) were assessed for eligibility (child 2-10 years, diagnosed with eczema, prescribed topical corticosteroids). Families who consented to participate (N = 59) were assessed at baseline for clinician-rated eczema severity, parent-reported eczema symptom severity, and electronically-monitored topical corticosteroid adherence (primary outcomes); and parenting behavior, parents' self-efficacy and task performance when managing eczema, eczema-related child behavior problems, and child and parent quality of life (secondary outcomes). Families were randomized (1:1, unblinded) to intervention (n = 31) or care-as-usual (n = 28). The intervention comprised two, 2-hr Healthy Living Triple P group sessions (face-to-face/online) and 28 intervention families attended one/both sessions. All families were offered standardized eczema education. Families were reassessed at 4-weeks post-intervention and 6-month follow-up, with clinician-raters blinded to condition. Costs of intervention delivery were estimated.Results Multilevel modeling across assessment timepoints showed significant intervention effects for ineffective parenting (d = .60), self-efficacy (d = .74), task performance (d = .81), and confidence with managing eczema-related child behavior (d = .63), but not disease/symptom severity, treatment adherence or quality of life. Mean cost per participating family with parenting behavior (clinically) improved was $159.Conclusions Healthy Living Triple P is effective in reducing ineffective parenting practices and improving parents' self-efficacy and task performance when managing children's eczema and eczema-related behavior difficulties. There was no effect on disease/symptom severity, treatment adherence, or quality of life.Clinical Trial Registration ACTRN12618001332213

The transition to school is an important developmental milestone for children and their families and sets the foundation for further educational experiences. There is a paucity of evidence-based interventions to support families during their child’s transition to school. To meet the needs of families during their child’s transition to school, better understanding of parents’ experiences is necessary. This systematic review identified 61 studies which reported on parent experiences of their child’s transition to school, although only a minority of studies explicitly focused on this outcome. Most studies were cross sectional, qualitative and focused on typically developing children. Six themes were identified in a narrative synthesis of the included studies: (1) Parent emotions about the transition to school; (2) Child’s school readiness and adjustment; (3) Parent factors; (4) Positive aspects of transition to school; (5) Practical transition issues; and (6) School partnership and communication. Overarching parent experiences focused on the ecological system within which the transition to school takes place, and we consider the implications for practice based on this framework.

Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes.

De invloed van buitensporig schermgebruik op de gezondheid en ontwikkeling van kinderen is een zorg voor de volksgezondheid, en veel landen hebben aanbevelingen gepubliceerd om het schermgebruik in de kindertijd te beperken en in goede banen te leiden. Toch melden internationale studies dat de meerderheid van de ouders en kinderen zich niet aan de aanbevelingen voor schermgebruik houdt. Bestaand onderzoek om inzicht in het schermgebruik van kinderen te krijgen heeft zich hoofdzakelijk op oudere kinderen gericht, en op demografische en structurele aspecten van de omgeving van het kind. Ouders bepalen in belangrijke mate het schermgebruik van jonge kinderen en benoemen talloze obstakels om bij hun kinderen gezonde praktijken in schermgebruik te ontwikkelen. Er bestaan echter geen duidelijke modellen die belangrijke opvoedingsfactoren opnemen om inzicht in het schermgebruik van kinderen te krijgen, wat de ontwikkeling van interventies belemmert. Er bestaat wel wat bewijs voor interventies om het schermgedrag van kinderen te verbeteren, maar de meeste daarvan richten zich op oudere kinderen en ouderlijke betrokkenheid is doorgaans beperkt. In dit artikel kijken we naar belangrijke factoren die verband houden met schermgebruik bij jonge kinderen (< 5 jaar) en geven we een overzicht van de bestaande bewijsbasis voor interventies die zijn ontwikkeld om gezond schermgebruik te ontwikkelen. In dit artikel wordt verder een conceptueel model voorgesteld dat opvoedkundige aspecten en de sociaalecologische omgeving met het schermgebruik van jonge kinderen verbindt. Ons voorgestelde model zou kunnen worden gebruikt om longitudinale studies naar voorspellers en uitkomsten voor schermgebruik te ontwerpen, en zou richting kunnen geven aan de ontwikkeling van interventies. Als laatste worden er in het artikel belangrijke aanbevelingen gedaan voor toekomstig onderzoek en voor de ontwikkeling en het testen van interventies.

The transition to school is a sensitive developmental period for young children. Although children born very/extremely preterm have increased risk of health and developmental concerns, predictors of their school readiness and adjustment remain largely unexamined. Parents of very/extremely preterm-born children (aged 3-7 years; pre-transition n = 114, post-transition n = 112) completed an online survey assessing their perceptions of children's school readiness (pre-transition) or adjustment (post-transition), support needs, child behaviour, parent distress, and parent confidence. Poorer school readiness and adjustment and greater needs for support correlated with child health/developmental condition/s; hyperactivity, peer problems, conduct problems, emotional symptoms, and less prosocial behaviour; and lower parent confidence. Using hierarchical linear regression, parent confidence emerged as the strongest common predictor of school readiness (pre-transition) and school adjustment (post-transition), followed by low hyperactivity, high parent education (tertiary), and no diagnosed child health/developmental condition/s. Results will be used to identify families needing support and develop tailored support strategies.

Objective: This study aimed to examine factors associated with maternal post-traumatic stress (PTS) and shame, including adverse childbirth and breastfeeding events, subjective childbirth and breastfeeding experiences, psychological flexibility, and self-compassion.Methods: A convenience sample of 405 community-recruited mothers of infants (<2 years) from Australia and New Zealand completed an online cross-sectional survey. A series of hierarchical multiple regressions tested potential predictors of PTS and shame. Results: Birth experiences (low autonomy/support and high fear) predicted PTS symptoms. Negative subjective birth experiences (low autonomy/support), negative breastfeeding experiences, younger maternal age and financial stress predicted shame. Addition of psychological flexibility and self-compassion improved both regression models. Psychological flexibility predicted both PTS and shame, and moderated relationships between both fear and low autonomy/support and PTS. Self-compassion predicted shame and moderated the relationship between low autonomy/support and shame.Conclusion: Subjective experiences of birth and breastfeeding are important. Psychological flexibility buffers the impact of a difficult birth experience on PTS, and self-compassion on shame.

OBJECTIVE:To determine the prevalence of compassion satisfaction, related factors, and predictors among healthcare professionals in Thai intensive care units. METHODS:A cross-sectional study was conducted in 12 intensive care units at a university hospital in Thailand from August to November 2022. All nurses and doctors were invited to complete an anonymous online survey which included: the Professional Quality of Life Scale version 5, Connor-Davidson Resilience Scale, Passion Scale, Flourishing Scale, and Acceptance and Action Questionnaire. Descriptive statistics, Pearson's correlation coefficients, and hierarchical multiple regressions were used for data analysis in SPSS 28.0. RESULTS:A total of 178 nurses and doctors participated (92.13% nurses, 89.89% female, mean 32.10 years). Average compassion satisfaction (assessed using the Professional Quality of Life Scale) was moderate, with a mean score of 37.94 (SD = 5.58). The final regression model predicting compassion satisfaction was significant and explained 65% of the variance in compassion satisfaction, F (11, 154) = 26.00, p < 0.001. Four out of 11 predictor variables made unique statistically significant contributions to the final model: resilience (β = 0.48, p < 0.001), harmonious passion (β = 0.24, p < 0.001), being a nurse (not a doctor; β = 0.17, p < 0.05), and holding a postgraduate qualification (β = 0.10, p < 0.05). CONCLUSION:Most healthcare professionals in critical care units have a moderate level of compassion satisfaction, which is correlated with resilience, flourishing, and harmonious passion. Resilience and harmonious passion predict compassion satisfaction. These factors are modifiable through intervention. IMPLICATION FOR CLINICAL PRACTICE:Assessment of staff psychological well-being can identify those at risk for stress and impaired professional quality of life. Resilience and harmonious passion predict compassion satisfaction and can be modified through psychological interventions to promote psychological well-being and professional quality of life in healthcare workers in intensive care units.

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Chronic health conditions such as asthma and eczema are common and are associated with significant psychosocial sequelae for children and their families. A number of parenting variables have been implicated in child health outcomes; however, there are gaps in understanding of the relationships between parenting and child adjustment in the context of chronic illness. This study examined the role that modifiable parenting factors including parenting style, self-efficacy, and adjustment play in explaining general and illness-related child behaviour and emotional problems. Parents (N = 107) of children diagnosed with asthma only (n = 22), eczema only (n = 59), or both conditions (n = 26) completed a range of parenting and child adjustment measures. The majority of the modifiable parenting factors (parents' self-efficacy with managing their child's internalising, asthma-related, and eczema-related behaviours; parent adjustment; and use of ineffective parenting strategies) made significant contributions to explaining variance child behaviour. Parenting variables consistently explained greater proportions of variance in general and illness-related child behaviour difficulties compared to demographic and illness factors and represent important intervention targets.

Purpose Parenting has implications for psychosocial adjustment well into adulthood. While much is known about the parenting behaviors that influence adjustment in autistic children, little is known about how the effects of parenting persist in autistic adults. Further, autistic adults’ perspectives on how they were parented have not been investigated to date. This study aimed to examine autistic adults’ perspectives on their experiences of being parented in childhood and the advice they would like to offer to parents of autistic children in the context of their lived experience. Methods Ninety-six Australian autistic adults responded to open-ended questions in a larger survey assessing childhood experiences of being parented, adult attachment, psychological flexibility, and adult adjustment. Results A total of 10 themes were identified. Autistic adults emphasized the importance of embracing early diagnosis and that the goal of parents should be their child’s happiness rather than “neurotypical” success. They highlighted the importance of unconditional love and understanding of their autistic child, recognizing that autistic children have similar fundamental needs as other children. Participants discussed the importance of structure and predictability in the home to feelings of safety. Parents were encouraged to meet them halfway. Finally, autistic adults reflected on the role of parents in advocacy and parental well-being. Parental neurodivergence was discussed as a possible bane or boon. Conclusions Autistic adults emphasized the importance of unconditional acceptance from their parents, with the goal being their child’s happiness. Findings from this study will inform future programs for families of autistic children.

Introduction: Obesity and overweight are significant health problems among Australian children. Parents play a vital role in establishing healthy eating behaviors in their children. However, parents often experience difficulties in implementing effective parenting practices and lack confidence in their ability to help children adopt these behaviors. This trial will evaluate the efficacy of an online program, Healthy Habits Triple P, in improving children’s snacking and mealtime behaviors and related parenting practices. Methods and analysis: This is a single-blinded, randomized controlled trial for parents of young Australian children aged 2–6 years. Participants will be recruited through childcare centers, social media, online parent forums and existing networks. The participants in the intervention arm will receive access to a web-based parenting intervention in addition to nutrition-related information for parents published by the National Health and Medical Research Council of Australia; those in the control arm will receive nutrition-related information only. After the completion of the study, the parenting intervention will be offered to the control arm. The primary outcome will be improvement in children’s eating habits. The secondary outcomes include parents’ self-efficacy, confidence, children’s mealtime behaviors and mealtime parenting strategies. Both primary and secondary outcomes will be evaluated through online-administered, validated parent-reported questionnaires. We will also undertake a quantitative and qualitative evaluation of the practicality and acceptability of the intervention.