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Childhood obesity levels continue to rise, with significant impact on individuals and the NHS. The ‘Complications of Excess Weight’ (CEW) clinics provide support to young people with complications of their weight. Our objective was to co-develop, with young people, a new intervention; AIM2Change, to enable young people to develop their intrinsic motivation to manage weight, using Acceptance and Commitment Therapy (ACT), with a person-centred approach. Young people from the Care of Childhood Obesity (CoCO) clinic in Bristol, UK, were recruited to co-develop this intervention. The study was registered on ISRCTN (ISRCTN16607863). The seven-session, ACT-based intervention was delivered one-to-one, securely online. Qualitative interviews were conducted after each intervention session was delivered. Qualitative data were coded and reviewed regularly to make iterative changes to individual sessions and the overall programme. Fourteen co-developers were recruited, of whom nine completed the co-development process (female = 4; median age (IQR)=15(1.5); 4 with a parent; Indices of Multiple Deprivation (IMD) median = 3.5, range = 1–10). Iterative changes made during co-development included introducing an earlier focus on eating behaviour and body image, with more practical activities to increase engagement. Thematic analysis of co-developer feedback identified four themes: theoretical understanding; delivery and receipt of therapy; view of strategies and engagement; real world benefits of co-development process. Framework analysis was conducted to map data pertaining to these themes into matrices according to each participant and session. Insights from the co-development process have shaped AIM2Change to optimise the intervention’s value, relevance and acceptability. Findings suggest that AIM2Change meets an unmet need in delivery of current childhood weight management services.

IntroductionSurvivors of childhood brain tumours have the poorest health-related quality of life of all cancer survivors due to the multiple physical and psychological sequelae of brain tumours and their treatment. Remotely delivered acceptance and commitment therapy (ACT) may be a suitable and accessible psychological intervention to support young people who have survived brain tumours. This study aims to assess the feasibility and acceptability of remotely delivered ACT to improve quality of life among these young survivors.Methods and analysisThis study is a two-arm, parallel group, randomised controlled trial comparing ACT with waitlist control at 12-week follow-up as the primary endpoint. Seventy-two participants will be recruited, who are aged 11–24 and have completed brain tumour treatment. Participants will be randomised to receive 12 weeks of ACT either immediately or after a 12-week wait. The DNA-v model of ACT will be employed, which is a developmentally appropriate model for young people. Feasibility will be assessed using the proportion of those showing interest who consent to the trial and complete the intervention. Acceptability will be assessed using participant evaluations of the intervention, alongside qualitative interviews and treatment diaries analysed thematically. A range of clinical outcome measures will also assess physical and mental health, everyday functioning, quality of life and service usage at 12-week follow-up. The durability of treatment effects will be assessed by further follow-up assessments at 24 weeks, 36 weeks and 48 weeks.Ethics and disseminationEthical approval was given by East Midlands, Nottingham 1 Research Ethics Committee (Reference: 20/EM/0237). Study results will be disseminated in peer-reviewed journals, through public events and relevant third sector organisations.Trial registrationISRCTN10903290; NCT04722237.

ObjectivesTo identify predictors of persisting symptoms after concussion (PSaC) in children, following any medically attended traumatic brain injury (TBI).DesignRetrospective cohort study.SettingLinked primary and secondary care data from UK Clinical Practice Research Datalink and Hospital Episode Statistics.ParticipantsChildren aged 1–17 years with a medically attended TBI between 2013 and 2017.Main outcome measureA binary indicator of PSaC or suspected PSaC, measured using either a clinical code for PSaC or medical attendances for one or more PSaC symptoms 3–12 months after TBI.ResultsWe identified 137 873 children with a TBI; 4620 (3.4%) had PSaC or suspected PSaC. More females (3.8%) had PSaC than males (3.1%). Those with PSaC were older at the time of TBI compared with those without PSaC (8 vs 5.5 years). In a multivariable logistic regression model, older age (OR =1.02 per year increase in age, 95% CI 1.01 to 1.03), female sex (OR=1.20, 95% CI 1.13 to 1.28), being Asian (OR=1.37, 95% CI 1.22 to 1.54) or mixed ethnicity (OR=1.18, 95% CI 1.01 to 1.37) (compared with white ethnicity), having a history of headaches (OR=3.52, 95% CI 3.13 to 3.95), learning disabilities (OR=2.06, 95% CI 1.69 to 2.52), ADHD (OR=2.41, 95% CI 1.91 to 3.04), anxiety (OR=2.58, 95% CI 2.18 to 3.05), depression (OR=4.00, 95% CI 3.28 to 4.89) or sleep disorders (OR=2.35, 95% CI 1.99 to 2.78) were associated with increased odds of PSaC.ConclusionsThese results may be used to identify children more likely to develop PSaC following a TBI and those who may benefit from targeted healthcare for PSaC symptoms. Identifying cases of PSaC in primary care data was challenging as perhaps many children do not attend services for suspected PSaC or, if they did, are not diagnosed with PSaC. Furthermore, the clinical predictors are a measure of healthcare access for these symptoms; thus, results could be influenced by patient or carer’s health-seeking behaviour.

Objective:The CCoSI is a brief screening instrument that is designed to detect cognitive impairment in children aged 5y0m-16y11m shortly after acquired brain injury (ABI) by evaluating language, fluency, attention, memory, and visuospatial domains. Each domain translates to a CCoSI index and is composed of a series of brief subtests. This study assessed the feasibility of modifying the Children’s Cognitive Screening Instrument (CCoSI) into an electronic version (eCCoSI) and administering it using video teleconferencing (VTC).Participants and Methods:Tasks and stimuli were modified for online administration. Typically developing children aged 5y0m-16y11 m were tested using the modified eCCoSI via VTC. The eCCoSI was administered using Skype for Business and Microsoft Teams. Participants attended one 25-minute video assessment session over either platform. Results of VTC-assessed healthy controls were compared to age-matched peers ([25] Female: [19] Male; mean age = [11.54], SD = [3.01], age range =5.00-15.75) who had been previously tested face-to-face (FTF) with the original CCoSI at the Bristol Royal Hospital for Children (BRHC).Age-related trends in performance were also examined across FTF and VTC for comparability.Results:44 typically developing children were virtually assessed ([25] Female: [19] Male; mean age = [11.79], SD = [3.03], age range =5.05-16.92). Results from a 2x2 ANOVA with age-group and modality as independent factors showed no significant difference in performance between participants tested FTF and VTC over the CCoSI Attention, Fluency, Language, Memory, and Visuospatial indices. No significant result of interaction between age and modality was found; however, there was a significant result of age-group.Conclusions:VTC assessment is a feasible alternative to FTF administration of the CCoSI within healthy controls. Results from the present study are promising for the use of the eCCoSI in clinical practice. Further research should attempt to replicate these results within clinical populations.

Objective:The COVID-19 pandemic has been a catalyst for a shift towards virtual forms of working, and specific support for the provision of virtual therapy (BPS, 2020). Remotely delivered therapy has known potential benefits, such as improving access to people living in underserved areas and for those who struggle to attend face-to-face appointments due to psychosocial, physical or geographical constraints. Those with neurological conditions frequently fall in these groups.Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention which aims to improve the physical and mental health of people living with neurological conditions. However, there are several considerations to translating this into a virtual therapy for this clinical group that have not yet been thoroughly empirically evaluated. Such considerations include: fatigue, cognitive difficulties in the context of virtual communication, adaptations within the therapeutic alliance, and translation of dynamic and interactive therapeutic exercises within a virtual medium.This study aimed to describe the experiences of Clinical Psychologists delivering ACT remotely in the context of two randomised controlled feasibility and acceptability clinical trials for young people (aged 11 to 24) who have experienced a brain tumour or Tuberous Sclerosis Complex. Exploring therapist perceptions and experiences provides valuable insights into potential barriers and facilitators to engagement with remote ACT delivery.Participants and Methods:Clinical Psychologists who were trained to deliver ACT via videoconferencing were invited to take part in virtual interviews. The semi-structured interview guide aimed to draw on their experience of ACT training, supervision, remote delivery, and perceived impact of ACT. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.Results:Five Clinical Psychologists were interviewed. Interview data were coded into broad themes around the experience of delivering ACT, engaging with remote systems, the wider perceived impact of ACT and the adaptability of ACT. ACT training was reported to be an effective, positive experience and the opportunity for regular peer and group supervision worked to solidify the training and support fidelity to the ACT processes. It was largely acknowledged that while remote delivery of the intervention did create some initial challenges to the therapeutic process, this approach created opportunity for the young people to access psychological support that they might not have been able to engage with due to logistical considerations. Clinical Psychologists also shared that training in and experience of delivering ACT had a positive and meaningful impact on their clinical practice and personal conduct. They also reported that ACT was adaptable to the needs of the young people in the clinical trials and felt appropriate to deliver in this context.Conclusions:This in-depth, qualitative study demonstrated the clinical promise of remotely delivered ACT. Clinical Psychologists viewed remotely delivered ACT as an appropriate, acceptable and feasible intervention for young people with experience of brain tumour and Tuberous Sclerosis Complex within the context of research, that would be generalisable to everyday clinical practice.

ObjectiveTo identify demographic, premorbid and injury-related factors, or biomarkers associated with long-term (≥3 months) adverse outcomes in children after mild traumatic brain injury (mTBI).DesignScoping review of literature.PatientsChildren and adolescents with mTBI.Risk factorsAny demographic, premorbid and injury-related factors, or biomarkers were included. We excluded genetic and treatment-related factors.Main outcome measuresPostconcussion syndrome (PCS), recovery.ResultsSeventy-three publications were included, reporting 12 long-term adverse outcomes, including PCS in 12 studies and recovery in 29 studies. Additional outcomes studied were symptom scores/severity (n=22), quality of life (n=9) and cognitive function (n=9). Forty-nine risk factors were identified across studies. Risk factors most often assessed were sex (n=28), followed by age (n=23), injury mechanism = (n=22) and prior mTBI (n=18). The influence of these and other risk factors on outcomes of mTBI were inconsistent across the reviewed literature.ConclusionsThe most researched risk factors are sex, age and mechanism of injury, but their effects have been estimated inconsistently and did not show a clear pattern. The most studied outcomes are recovery patterns and symptom severity. However, these may not be the most important outcomes for clinicians and patients. Future primary studies in this area should focus on patient-important outcomes. Population-based prospective studies are needed that address prespecified hypotheses on the relationship of risk factors with given outcomes to enable reliable prediction of long-term adverse outcomes for childhood mTBI.

Childhood obesity levels continue to rise, with significant impact on individuals and the NHS. The 'Complications of Excess Weight' (CEW) clinics provide support to young people with complications of their weight. Our objective was to co-develop, with young people, a new intervention; AIM2Change, to enable young people to develop their intrinsic motivation to manage weight, using Acceptance and Commitment Therapy (ACT), with a person-centred approach. Young people from the Care of Childhood Obesity (CoCO) clinic in Bristol, UK, were recruited to co-develop this intervention. The study was registered on ISRCTN (ISRCTN16607863). The seven-session, ACT-based intervention was delivered one-to-one, securely online. Qualitative interviews were conducted after each intervention session was delivered. Qualitative data were coded and reviewed regularly to make iterative changes to individual sessions and the overall programme. Fourteen co-developers were recruited, of whom nine completed the co-development process (female = 4; median age (IQR)=15(1.5); 4 with a parent; Indices of Multiple Deprivation (IMD) median = 3.5, range = 1-10). Iterative changes made during co-development included introducing an earlier focus on eating behaviour and body image, with more practical activities to increase engagement. Thematic analysis of co-developer feedback identified four themes: theoretical understanding; delivery and receipt of therapy; view of strategies and engagement; real world benefits of co-development process. Framework analysis was conducted to map data pertaining to these themes into matrices according to each participant and session. Insights from the co-development process have shaped AIM2Change to optimise the intervention's value, relevance and acceptability. Findings suggest that AIM2Change meets an unmet need in delivery of current childhood weight management services.

Childbirth for some women can be experienced as a traumatic event whereby it is appraised as threatening to life and associated with feelings of fear, helplessness or horror. These women may develop symptoms consistent with post-traumatic stress disorder or its sub-clinical symptoms (post-traumatic stress, PTS). Cognitive processes such as attentional biases have been identified in individuals with PTS exposed to other traumatic events. This study used an experimental design (the modified Stroop task) to investigate the relationship between attentional biases and PTS symptoms in 50 women who experienced their labour and delivery as stressful and responded with fear, helplessness and horror. Attentional biases away from childbirth words were significantly associated with both symptoms of post-traumatic stress and more negative experiences of childbirth. A negative experience was also associated with more severe symptoms of PTS. Positive experiences were unassociated with attentional biases or symptoms. Post-traumatic stress responses, in this population, may be associated with avoidance, and through influencing cognitive processing, acting as a maintaining factor of distress.

Competence in object search and pretend play are argued to reflect young children's representational abilities and appear delayed in children with Down syndrome relative to social and imitative skills. This paper explores the effects on object search and play of this social strength in children with Down syndrome. Three experiments compared performance on traditional tasks with modified tasks designed to assess the role of imitation in object search and pretend play. Children with Down syndrome, relative to typically‐developing children, were able and willing to imitate hiding actions when no object was hidden (Experiment 1). When imitation was prevented in object search, children with Down syndrome searched less effectively than typically‐developing children (Experiment 2). In play, children with Down syndrome expressed more willingness to imitate a counter‐functional action, modelled by the experimenter, despite apparent competence in spontaneous functional play (Experiment 3). These findings indicate that object search and play behaviours of children with Down syndrome rely more heavily on imitation than is the case for typically‐developing children. The implications for the development of children with Down syndrome and models of representational development are discussed.