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(2020)Aims and objectives. The field of speech and language therapy nowadays emphasizes the participation of client’s environments, such as the family. The importance of close environments is highlighted by e.g. the ecological systems theory, the ICF classification and the concept of zone of proximal development. To learn to communicate using a communication aid, a child needs modeling from a more competent interaction partner. Parents are usually essential interaction partners for their children, yet they need guidance and support to be able to model the use of the communication aid for their child. Previous research on parents’ experiences of guidance and support received for aided communication has been scarce. However, it has been noticed that inadequate support for parents can lead to abandonment of the communication aid. The objective of this study was to explore parents’ experiences of guidance and support on using their child’s communication aid. In addition, parents’ experiences of the challenges in the communication aid service delivery were studied, as well as experiences of their own role in the process. The study also examined parents’ views on how the support and guidance practices could be developed. Methods. The data of this study were gathered through semi-structured interviews. From seven different families, nine parents of children who were using a communication aid with an extensive vocabulary participated in the interviews. Data were analyzed using data driven content analysis. Results and conclusions. The results of this study indicated that parents receive guidance and support on using their child’s communication aid from several actors. The guidance and support were mainly considered insufficient in quantity but their content was mostly perceived adequate. Parents had positive experiences of e.g. guidance and support received from their child’s speech therapist, communication instruction, peer support, and technical support provided by the manufacturers and importers of communication aids. One of the main challenges parents had experienced in the process was that the communication aid was not always actively used in the daycare or school settings. Most of the parents had had an active, self-imposed role in the service delivery process, for example in finding services and information. Parents would develop the services provided to families e.g. by offering more guidance and support at the beginning of the process, by training professionals more comprehensively on augmentative and alternative communication, and by informing families more effectively of the services and support that are available. Based on the results of this study, the guidance and support on using a communication aid do not seem to be completely equally available for families, and parent’s own activeness appears to affect the access to services. Practices on providing guidance and support, informing parents of services and training professionals on aided communication may need to be improved and clarified. Parents’ experiences of the guidance and support vary individually, but the results of this study can help professionals develop their practices to support families.
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(2023)Objectives – Pediatric chronic pain can result in mental health problems and functional disability. One of the important considerations in pediatric chronic pain is the influence of parental factors which are known to affect adolescents’ pain experience. However, there is still little research on this topic. The aim of the present study is to investigate whether parents’ self-efficacy (about their adolescent’s pain) changes after Acceptance and Commitment Therapy (ACT) based intervention aimed at adolescents suffering from idiopathic musculoskeletal pain and their parents. Additionally, study examines whether parents’ self-efficacy is associated with adolescents’ pain. Methods – The study data (n = 49) were gathered at a pediatric rheumatological clinic in the Päijät-Häme Central Hospital between 2010 and 2015. Patients were adolescents aged between 13 and 17 (mean age 15,4, boys 15 %) and suffered from chronic idiopathic musculoskeletal pain. Adolescents participated in six month ACT based group intervention with one of their parents. Adolescents’ pain intensity and parents’ self-efficacy were assessed using self-reported questionnaires before and after the program and at a 6-month follow-up. The changes in parents’ self-efficacy and the associations between parents’ self-efficacy and adolescents’ pain were examined using linear mixed models. Results – There were neither significant changes in parents’ self-efficacy nor significant associations between parents’ self-efficacy and adolescents’ pain when self-efficacy was considered as a whole. However, parents’ confidence in their ability to influence adolescents’ pain and their perceptions of how well the adolescent was coping with the illness increased. Also, parents rated adolescent’s illness as less severe after the intervention. Adolescents’ pain was associated with parents’ confidence in their ability to influence on the adolescent’s pain, experienced support from partner and estimated severity of the adolescent’s illness. Additionally, there were associations between pain and interactions of both time and confidence in their ability to influence on the adolescent’s pain time and estimated severity of the adolescent’s illness. Conclusions – The study supports the view that parental factors should be considered when treating adolescents’ pain. By influencing parents’ pain beliefs, it is possible to diminish parents’ distress and pain promoting behaviors, which is associated with adolescent’s pain and functional disability.
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(2023)Objective: Coparenting refers to co-operation and division of labour between parents in child rearing. The importance of coparenting for the well-being of whole family has been recognized in earlier studies, and interventions focusing on coparenting have been developed. However, the research on the effects of usual parenting interventions on coparenting is insufficient. The aim of the current study is to examine whether it is possible to support coparenting relationship between parents through usual parenting intervention that are municipally provided in Finland. In addition, the study focuses on the association between parents’ adverse childhood experiences (ACE), coparenting relationship and its possible change during interventions. There is widely demonstrated association between ACEs and worse overall well-being in adulthood. However, the research on the association between ACEs and coparenting is limited, and therefore that is investigated in this study. Methods: The current study is a part of a larger effectiveness study of Finnish community-based parenting interventions conducted by Tampere University in co-operation with University of Helsinki, and University of Turku. The study sample consisted of 245 mothers (having a baby younger than 1 year or expecting a baby) that participated in community-based parenting interventions in capital area of Finland (Helsinki, Espoo, Vantaa). 41 of the participants received practical support, 37 received short-term psychological services, and 83 intensive therapeutic support. Control group comprised 84 mothers recruited during routine visits to the child health clinics in the capital area of Finland. Coparenting difficulties were measured with Parenting Alliance Inventory in three measurement points: pre- and post-intervention and six months after the second measurement (control group was measured at the beginning of the study and six and twelve months after the first measurement). ACEs were measured by applying A Revised Inventory of Adverse Childhood Experiences at the beginning of the intervention (for control group at the beginning of the study). Changes in coparenting difficulties during the interventions and follow-up as well as the effect of ACEs on this change were evaluated using generalised linear mixed models and Gamma link function. The association between ACEs and coparenting difficulties at baseline was analysed using generalized linear model with Gamma link function. Results and conclusions: According to this study, coparenting difficulties declined during intervention and follow-up in all other groups except practical intervention group. Additionally, cumulative ACEs were associated with more coparenting difficulties at baseline. This is an important new finding that supports the previously observed association between ACEs and wide negative outcomes in adulthood. Furthermore, the effect of ACEs on the change of coparenting difficulties in control group was unlike that in therapeutic intervention group. In control group ACEs constituted a risk factor for coparenting difficulties, while therapeutic intervention seemed to protect from that risk. This result supports the above-mentioned association between ACEs and coparenting difficulties and suggests that ACEs also constitute a risk factor for the development of coparenting relationship. According to this study, especially therapeutic intervention seems to have potential supporting a coparenting relationship, which may be explained by the therapeutic elements. However, more research with larger sample sizes is needed to investigate different parenting interventions and their possibilities on supporting coparenting relationship, especially in risk groups like ACEs group.
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(2022)The restrictions due the COVID-19 -pandemic had a significant influence on everyday life throughout the society. Especially the elderly, who have a higher risk for severe coronavirus disease, were affected by strict restrictions. The elderly aged over 70 years were obligated to avoid all social contacts outside home. As a result, also in the services for older people, visits of relatives were forbidden and free time activities were ceased. The wellbeing of the elderly during these restrictions has received increasing interest in the academic field. This thesis focuses on the customers of Finnish services for older people. The thesis aims to describe life satisfaction and everyday activity of the elderly during the pandemic. Furthermore, in the context of the pandemic, the relationship of everyday activity and life satisfaction is examined. The thesis first examines the existing literature about life satisfaction and everyday activity of the elderly. Also, the effects of the coronavirus pandemic are discussed. The primary database of references used in the review was Google Scholar. The empirical study was conducted on survey data collected by Finnish Institute of Health and Welfare via VANKO-project. The participants were both the customers of the elderly services (n=7440), and providers of elderly services (n=2950). Everyday activity and life satisfaction were examined through descriptive statistics, and linear regression analysis was used to examine the relationship of everyday activity and life satisfaction. The analyses were conducted with IBM SPSS Statistics. The study found that life satisfaction of the customers of Finnish elderly services was moderately high despite the pandemic. Moreover, majority of the participants were satisfied with the possibilities of physical activity during the pandemic. Also, experiences of insufficient amounts of physical activity did not correlate with lower life satisfaction. The results are aligned with previous studies that have also reported only minor effects between the pandemic and the wellbeing of the elderly. The strength of the study is an extensive sample of the customers of elderly services in Finland. However, the results of this thesis are not applicable outside the specific examined population. As a result, further studies on the subject are needed.
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(2017)Vanhuspalvelulaki astui voimaan vuonna 2013. Lain tehtävänä on ohjata kuntien toimintakäytänteitä turvaamaan tervettä ja toimintakykyistä ikääntymistä sekä parantamaan palveluiden laatua ja vaikuttavuutta iäkkäille. Suun terveydenhuollon osalta vanhuspalvelulaki edellyttää tarpeenmukaisten suun terveydenhuollon palvelujen järjestämistä iäkkäille. Aikuisväestön suun terveydentilan positiivisesta kehityssuunnasta huolimatta iäkkäät tarvitsisivat tutkimusten mukaan apua suun puhdistukseen sekä ammattilaisen suorittamaa hoitoa ja ennaltaehkäisyä suun terveyden parantamiseksi. Vanhuspalvelulain tärkeys perustuukin pitkälti iäkkäiden tarpeenmukaisen hoivan turvaamiseen, mutta sen toimeenpano asettaa kunnille haasteita niin resurssien kuin asenteidenkin puolesta. Tämän tutkimuksen tavoitteena oli selvittää ikääntyvien suun terveydenhuollon järjestämiseen liittyviä keskeisiä haasteita sekä kartoittaa kuntien käyttämiä keinoja vanhuspalvelulain huomioimiseksi palveluita järjestettäessä. Tutkimusaineisto kerättiin lähettämällä vuosina 2015 ja 2017 kuntien ylihammaslääkäreille sähköpostitse linkki e- lomakkeella toteutettuun kyselyyn. Tutkimusaineisto muodostuu siis kahdesta erillisestä poikkileikkaustutkimuksesta, joiden vastaajat vaihtelevat. Vuosien 2015 ja 2017 tuloksia verrattiin keskenään tilanteen sekä toimintakäytäntöjen kehittymisen arvioimiseksi pohtien, onko vanhuspalvelulaki ollut olennaisena syynä mahdollisiin muutoksiin. Tutkimuksessamme tarkastelemme kotona ja palveluasumisen piirissä asuvien, pitkäaikaispäätöksen laitoshoidosta saaneiden ja ympärivuorokautisessa hoivayksikössä asuvien vanhusten suun terveydenhuollon palveluita ja niiden järjestämistä. Tutkimustulostemme mukaan vanhuspalvelulaki on vaikuttanut eniten kotihoidon piirissä olevien ikääntyvien suun terveydenhuollon järjestämiseen. Suurin lain tuomia muutos on terveydenhuollon eri tahojen yhteistyön lisääntyminen. Yleisimpiä ongelmia vanhusten suun terveydenhuollon järjestämisessä ovat resurssipula, hoitohenkilöstön riittämättömyys sekä vanhusten vaikea hoidettavuus muiden sairauksien vuoksi. Sosiaali- ja terveydenhuollon uudistuksen (sote-uudistuksen) uudistaessa koko julkista sosiaali- ja terveydenhuoltoa, tullaan uusia toiminta- ja ratkaisumalleja varmasti pohtimaan aktiivisesti tulevina vuosina laajemmassakin mittakaavassa. Iäkkään väestön terveyden, hyvinvoinnin ja toimintakyvyn ylläpito, parantaminen sekä ennaltaehkäisy oikeaan aikaan ovat tärkeitä tekoja kunnille eettisesti, sosiaalisesti kuin taloudellisestikin kestävän palvelujärjestelmän rakentamista ajatellen. Tutkimustuloksiamme voidaan huomioida tavoitellessa parempia ja tehokkaampia ratkaisuja vanhusten suun terveydenhuollon järjestämisessä aiheen ollessa sosiaali- ja terveydenhuollon uudistuksen vuoksi hyvin ajankohtainen.
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(2022)Laki ikääntyneen väestön toimintakyvyn tukemisesta sekä iäkkäiden sosiaali- ja terveyspalveluista eli niin kutsuttu vanhuspalvelulaki astui voimaan vuonna 2013. Lain tarkoituksena on taata ikääntyneelle väestölle oikea-aikaiset ja laadukkaat sosiaali- ja terveyspalvelut sekä tukea heidän hyvinvointiaan, terveyttään, toimintakykyään ja itsenäistä suoriutumistaan. Tutkimuksen tavoitteena oli selvittää vanhuspalveluiden tilaa suun terveydenhuollossa sekä selvittää mahdollisia vanhuspalveluiden järjestämiseen liittyviä haasteita. Tutkimustulokset ovat apuna myös vanhuspalveluiden järjestämisen ongelmakohtien havainnoinnissa ja tätä kautta vanhuspalveluiden kehittämisessä. Tutkimushypoteesi oli, että ikääntyneen väestön suunterveyden ylläpitäminen ja hoidon järjestäminen on parantunut vanhuspalvelulain voimaan tultua. Tutkimusta varten kuntien johtaville hammaslääkäreille lähetettiin vuonna 2019 sähköinen kysely e-lomakkeella. Kysymyslomake sisälsi kysymyksiä kunnan taustatiedoista sekä kunnan kotona, palveluasumisessa ja laitoksessa asuvien ikäihmisten suunhoidon ja suun terveydenhuollon toteuttamisesta kyseisessä kunnassa. Lisäksi kysyttiin muun muassa kuinka ikäihmisten suun terveydenhuolto on pyritty kunnassa kehittämään ja ovatko suun terveydenhuollon ammattihenkilöt saaneet aiheeseen liittyvää koulutusta. Suurimmassa osassa kyselyyn vastanneista kunnista vanhuspalvelulain voimaantulo ei ollut vaikuttanut iäkkään väestön suun terveydenhuoltoon. Vanhusten suun terveydenhuoltoa pidettiin tärkeänä, mutta samalla vaativana ja ongelmallisena. Suurimpina haasteina koettiin resurssipula, vanhuksia hoitavan henkilökunnan osaamisen puute sekä suun terveyden asiakasmaksut. Suurimmassa osassa kunnista vanhuspalvelulain voimaantulo ei ole vaikuttanut ikääntyneen väestön suun terveydenhuoltoon eikä vanhuspalvelulaki toteudu kaikissa kunnissa. Vanhusten suun hoito koettiin haastavaksi eikä vanhuspalvelulain tavoitteet ole toteutuneet suunnitellusti.
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(2024)Vangeilla on monia terveysongelmia, mukaan lukien suun terveyteen liittyvät ongelmat. Tästä huolimatta vankien suun terveydentilaa on tutkittu varsin vähän. Vangeilla on todettu huonompi suun terveys ja suuremmat tyydyttämättömät hammashoitotarpeet kuin muulla väestöllä. Yleisesti vankien sosiaalinen asema ja koulutustausta ovat huonommat kuin muulla väestöllä. Tämän kirjallisuuskatsauksen tarkoituksena oli tutkia vankien suun terveyden yhteyttä elämänlaatuun ja toimintakykyyn. Aineiston mukaan vankien suun terveys on selvästi huonompi globaalisti kuin muulla väestöllä. Vangeilla esiintyi enemmän kariesta ja iensairauksia sekä puuttuvia hampaita. Myös eroosio ja purentaelimen toimintahäiriöt ovat yleisiä vangeilla. Erityisesti karies ja hammaskivut vaikuttivat negatiivisesti vankien elämänlaatuun sekä toimintakykyyn. Vankiloiden ja vankiterveydenhuollon tulisi kiinnittää huomiota tehokkaampaan vankien hammashoitoon sekä ennaltaehkäisyyn. Vankien tulisi päästä hammaslääkärin vastaanotolle myös muulloin kuin vain akuutissa tilanteessa. Olisi hyvä kehittää enemmän järjestelmällistä hoitoa, jolloin vankien suun terveyteen voitaisiin vaikuttaa positiivisesti tarpeeksi ajoissa ja näin elämänlaatu ja toimintakyky pystyttäisiin pitämään paremmalla tasolla. Omahoidon kehittämistä olisi hyvä opettaa konkreettisesti vangeille ja korostaa suunterveyden vaikutusta muuhun terveyteen. Tupakoinnin ja päihteiden lopettaminen sekä väkivallan vähentäminen ovat myös tärkeitä kehityksen kohteita vankipopulaatiolla, mikäli halutaan parantaa vankien suun terveyttä sekä elämänlaatua ja toimintakykyä. Tärkeää olisi selvittää vankipopulaatiolta, miten heitä voitaisiin auttaa suun terveyteen liittyvissä asioissa paremmin.
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(2024)Inledning: Opioider är kliniskt viktiga läkemedel som erbjuder en oerhört viktig analgetisk effekt, men också har ett antal biverkningar. Bieffekten sedation har påvisats, men tidigare forskning har inte hittat en klar förklaring till den. Studien använde sig av möss som saknar transkriptionsfaktorn Tal1 i embryonala rombomer 1. De uppvisar symptom på hyperaktivitet, ökad lokomotorisk effekt, jämfört med kontrollmöss. Men efter injektion av morfin blir de betydligt mer sederade än kontrollmössen som fått samma injektion. Detta är en explorativ studie med målet att hitta skillnader och med hjälp av litteraturen analyserade avvikelserna bland hjärnorna för att försöka förklara verkningsmekanismen bakom opioidernas sedativa effekt. Material: Studien utfördes på 20 möss, med fem per grupp av varje kombination av genotyp (Tal1cko, wild type) och injektionstyp (morfin, salin). Mössen injicerades antingen med salin eller morfin (30 mg/kg, intraperitonealt) med en volym på 10 ml/kg. Metoder: 13 koronala genomskärningar som representerar hela hjärnan valdes utifrån hjärnområden med stor expression av opioidreceptorer. Totalt 69 områden valdes inom dessa, därmed med 20 möss blev det 1380 områden att analysera. Skivorna skars med en kryostat och proteinet c-Fos färgades immunhistokemiskt. Antalet aktiverade celler kvantifierades manuellt. Data testades med tvåvägs-ANOVA. Resultat: Vid dataanalysen hittades en genomsyrande trend. Kontrollmössen uppvisade mera c-Fos-aktivering efter morfininjektion, medan Tal1cko-mössens aktiveringsnivå sjönk efter injektion. Vid analys av specifika områden hittades ett huvudområde med bilateral statistisk signifikans var trenden syns, det preoptiska området. Diskussion: Målet med denna studie var att explorativt undersöka c-Fos-expressionen hos mössen för att försöka ta reda på varför Tal1-knockoutmössens lokomotoriska aktivitet sjunker efter morfininjektion. En mekanism för detta har studien hittat. Kontrollmössen uttryckte mer c-Fos efter morfininjektion, medan Tal1cko-mössens aktiveringsnivå sjönk. Det funderades omkring flera teorier för att förklara detta, men på grund av projicerande axoner och ospecifiteten av c-Fos kan inte forskningsfrågan med säkerhet besvaras.
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(2023)Syömishäiriöt usein nuorella iällä alkavia, vakavia ja pitkäkestoisia sairauksia. Suomessa joka kymmenes nuori tai nuori aikuinen on sairastanut syömishäiriön. Varhaisella puuttumisella voidaan lyhentää hoitamattoman syömishäiriön kestoa, parantaa taudin ennustetta ja välttää monet pitkäaikaiskomplikaatiot. Varhaisen puuttumisen esteenä on viive sekä hoitoon hakeutumisessa että hoitoon pääsyssä. Eri maissa on kehitetty erilaisia ratkaisuja. Britanniassa kehitetty varhaisen puuttumisen malli (FREED, First episode rapid early intervention for eating disorders) painottaa nopeaa hoitoonpääsyä ja aikaista psykoedukaation aloitusta. Hoitoon voi hakeutua myös ilman lähetettä, mikä osaltaan nopeuttaa hoitoonpääsyä. Psykoedukaatiossa sairastuneelle kerrotaan syömishäiriön vaikutuksista aivoihin sekä kehoitetaan pohtimaan sosiaalisen median ja suurten elämänmuutosten vaikutusta oireisiin. FREED-mallilla hoidetuista potilaista 60% saavutti normaalipainon vuoden seurannassa, kun taas tavanomaisesti hoidetuista potilaista normaalipainoon pääsi vain 17% potilaista. Suomessakin on kehitetty alueellisia hoitomalleja syömishäiriöiden hoidon tehostamiseksi. Pietarsaaren Fredrika-klinikka on syömishäiriöihin erikoistunut yksikkö, jossa painotetaan kokonaisvaltaista hoitoa, perheen aktiivista osallistumista sekä nopeaa hoitoonpääsyä. Hoitotulokset vastaavat FREED-mallin tuloksia.
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(2024)Objectives. According to previous research higher level of early attachment security is associated with lower level of externalizing symptoms later in childhood and adolescence. The aim of this Master´s Thesis was to study whether the early attachment between the mother and the child as well as the father and the child is associated with externalizing symptoms in children in middle childhood. In addition, the aim was to study whether there is a difference in the association between the child´s externalizing symptoms and maternal versus paternal attachment security. Methods. The data used is a part of the PREDO cohort study (Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction). Two samples of data were selected: maternal sample (n=1662) and paternal sample (n = 1027). Each parent filled in a questionnaire assessing the security of the parent´s attachment to their child during the first year of the child´s life. The child´s level of externalizing symptoms in middle childhood was assessed with the CBCL questionnaire filled in by the mother. The association between early attachment security and externalizing symptoms was studied using linear and gamma regression models. Results and Conclusions. According to the results higher level of early mother-child attachment security was associated with lower level of externalizing symptoms in children in middle childhood. However, early paternal attachment security was not associated with the level of externalizing symptoms in children. Externalizing symptoms are common and can lead to harmful consequences for the individual over the life course. Thus, the finding that the level of externalizing symptoms can possibly be reduced through supporting the mothers’ attachment to their child in the first year is important.
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(2017)Developmental dyslexia is a heritable learning disorder which according to the predominant theories has its core problems in the processing of speech sounds. Auditory processing deficits have been found in dyslexics and in infants with a genetic risk for dyslexia. It has been shown that infants with a genetic risk for dyslexia have attenuated or more right-hemispheric lateralized auditory event-related potentials (ERPs) to changes in speech stimuli compared to infants with no genetic risk. It has been shown that interventions can ameliorate the reading and writing skills of dyslexics and concurrently influence their ERPs. The aim of the present study was to find out if an early musical intervention can ameliorate the auditory processing skills in infants. Altogether 58 infants with a genetic risk for dyslexia were assigned to three groups where one group listened to vocal music, second group listened to instrumental versions of the same music and the third one was a control group with no intervention. After six months of intervention, auditory ERPs of the infants were recorded while the infants were presented with a repetitive pseudoword /tata/ with random infrequent duration, frequency, or vowel changes in the latter syllable. It was also studied if the ERPs were correlated with the amount of music played during the intervention or with the parents' evaluations of their infant's degree of prelinguistic development. The groups differed from each other in the auditory processing of the repetitive standard sound so that in the control group the ERPs had a different hemispheric pattern compared to the intervention groups and the repetitive sound was processed faster in the control group than in the instrumental group. It was also found that the hemispheric pattern of the ERPs for the vowel changes was different in the instrumental intervention group compared to the other groups. The parents' evaluations of the prelinguistic development of their infant were correlated with the ERPs so that the ERPs to the repetitive standard stimuli were enhanced and reached their peak earlier in the infants who were evaluated to be more mature in their prelinguistic development. According to the results, the ERPs for the repetitive sounds are correlated with children's linguistic development and an early musical intervention can modify the neural network processing speech sounds in infants with a genetic risk for dyslexia. In the future, it should be followed if these intervention effects on brain functions also enhance the linguistic development of the children and it should be also explored how other parts of the auditory environment of the children besides the intervention have possibly affected their auditory skills.
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(2022)Aim of the study. Compared to typically developing children, a child with a familial risk for dyslexia is four times more likely to develop major difficulties in reading. Difficulties in early language development, such as a narrow vocabulary, may precede later difficulties in reading, especially when the child is at risk for dyslexia. Because reading builds partly upon prereading skills, such recognizing letters and knowing how they sound like, weak early language skills such as a small vocabulary size, may be an early sign for later deficits in prereading skills. The interest of this current study was to investigate whether a child’s vocabulary size at 28 months can predict prereading skills at the age of five. Methods. The research data were based on Lukivauva longitudinal study, which follows the development of children who have a familial risk for dyslexia. 220 families were recruited in the study before the baby was born, between 2015 and 2017. The sample of this current study consists of 93 children, of which 80.6 % had a familial dyslexia risk and 19.4 % were controls. To evaluate early vocabulary size, parents filled out the MCDI questionnaire (MacArthur Communicative Developmental Inventories) when the child was 28 months old. Prereading skills were measured at the age of five as a part of Reading and writing questionnaire. Results. Early vocabulary size predicted later prereading skills only for the at-risk group. In the whole sample, predictors for prereading skills were early vocabulary size, familial dyslexia risk and gender combined. Maternal education didn’t predict prereading skills in either of the groups. Conclusions. Small early vocabulary size can predict weaker prereading skills when the child is at familial risk for dyslexia. Prereading skills form the basis for effortless reading and therefore the signs that predict prereading skills ought to be noticed early. In families with dyslexia, the parents could evaluate their child’s early vocabulary size by filling out the MCDI questionnaire as a part of the check-ups at maternity and child health clinics, for example. This would allow the children at the highest risk for weak prereading skills to be noticed.
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(2019)Objectives: Late-life depression is underdiagnosed and undertreated, and more information about its specific risk factors and mechanisms is needed. Early life stress has been shown to predict depressive symptoms in adults as well as a poor course of depression; it is unclear, however, whether this association is still present in older adults. The present study investigated how emotional and physical stress in childhood predicted depressive symptoms in Finns who were older than 60 years. Depressive symptoms were selfrated at two separate measurement points. The effect of neuroticism as a mediator was also examined. Methods: The study sample was a subsample of Helsinki Birth Cohort Study, which consists of 13,345 subjects born in Helsinki in 1934–1944. The sample included those subjects who completed the Traumatic Experiences Checklist (TEC) and either Neuroticism-Extraversion-Openness Personality Inventory (NEO-PI) or Beck Depression Inventory II (BDI-II) in either 2004 or 2010. Sample size varied between 764–1332, depending on the analysis. Linear and logistic regression as well as mediation analyses were used to analyze the data. Results and conclusions: Both types of early life stress were shown to predict more depressive symptoms and higher risk of clinically significant depressive symptoms at both measurement points. High neuroticism mediated the relationship between early life stress and depressive symptoms. Contrary to hypothesis, early life stress did not predict the duration of depressive symptoms. The results indicate that early life stress plays a role in late-life depression, and this effect is mediated by neuroticism.
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(2022)Objectives. Prelinguistic development is a part of the continuum of linguistic development and refers to a period when speech is not yet the child's primary means of communication. Prelinguistic skills include several non-linguistic modes of interaction such as pronunciation, gestures, facial expressions, and the use of gaze. Although temperament and developmental dyslexia have been found to affect later linguistic development, it is still poorly understood how temperament and dyslexia together and separately influence prelinguistic development. The purpose of this study is to investigate whether early temperament is associated to prelinguistic development and whether the association is different in children with familial risk of dyslexia and in typically developing children. For the first research question, it was hypothesized that the temperament dimensions of surgency and regulation capacity are related to prelinguistic skills. For the second research question, no hypothesis was set, as the phenomenon has not been previously studied. Methods. The research data comes from the DyslexiaBaby project, which studies the linguistic development of children, especially in families with dyslexia. 148 children were selected for the sample of this study. Exclusion criteria included learning disabilities, ADHD and language disorders other than dyslexia in parents. Data from six- and 12-month follow-up points were used as data. At six months of age, parents assessed their children’s temperament using the IBQ-R-VSF questionnaire based on Rothbart’s temperament theory, and at 12 months of age, they assessed their children’s prelinguistic skills using the ESIKKO questionnaire. The association of temperament and familial risk of dyslexia with prelinguistic skills was examined by several linear regression analyzes. Results. Of the three temperament dimensions, regulation capacity was related to communication composite and surgency was related to prelinguistic skills as a whole. None of the temperament dimensions were related to expressive speech or symbolic composite. Mild, moderate or severe risk of dyslexia was found to be associated with communication composite but not with other aspects of prelinguistic development. Conclusions. For temperament the results were in line with the hypothesis, although the study controlled the effect of child sex, duration of maternal education and duration of pregnancy. Since temperament is formed by several traits, it would be good to consider the possible interactions of temperament dimensions in further research. Regarding the risk of dyslexia, the results are new and partly contrary to the underlying assumptions, so it would be important to examine whether the result can be replicated in other studies.
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(2023)Objective. Maternal self-efficacy refers to a mother’s beliefs regarding her ability to perform competently in parenting, and its low level has been associated with challenges in parenting. Infant regulatory difficulties, including excessive crying, sleep problems, and inflexibility with changes, may form a risk for both infant socio-emotional development as well as maternal self-efficacy. In this study, we focus on early naturalistic parenting interventions. We further examine whether maternal self-efficacy and problems with infant crying, sleep and inflexibility are linked with each other, and do these change in the intervention and control groups. Methods. The intervention groups comprised 171 families (expectant or having a baby younger than 1 year) receiving parenting interventions (practical support n=49, short-term psychological services n=38, intensive therapeutic support n=85) in community-based clinics in Southern Finland. Control group comprised 86 families from the same area. Parenting efficacy was measured with Maternal Self-Efficacy Scale and infant regulation with Baby Pediatric Symptom Checklist. During this longitudinal study, there were three measurement points: pre- and post-intervention (for control group six months after first measurement) and after six months. Results and conclusions. According to the correlation analysis, lower baseline maternal self-efficacy was associated with more excessive infant crying and severe sleep problems but not with infant inflexibility. The therapeutic group showed lower baseline of self-efficacy than control group and practical help group higher baseline of sleep problems than control group and psychological services. Analyses conducted with linear mixed models showed that in the therapeutic group, maternal self-efficacy increased, and infant sleep problems decreased more from pre-intervention than in the control or psychological services groups. Both also improved significantly in the practical help-group, but the change did not differ from controls. Infant crying decreased and infant inflexibility increased over time, but the change was similar in all groups. This study suggests that the different areas of infant regulation problems should be analysed separately also in the future since their associations with self-efficacy and change during the interventions may differ from each other. The study results indicate that real-life naturalistic interventions may be effective in improving parenting and infant sleep problems, and especially more intensive therapeutic support focusing on family interactions may be helpful for both mothers’ and infants’ well-being. The practical support and psychological groups seem important for early support and directing to further services when needed. The focus on maternal self-efficacy and infant regulation problems may help in recognizing families in potential need of help and in preparing effective interventions.
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(2019)Tavoitteet. Neuvolajärjestelmällä on Suomessa vahva ja vakiintunut asema, ja terveydenhoitajaa pidetään neuvolan keskeisimpänä voimavarana. Neuvoloissa on panostettu 2000-luvun alkupuolella paljon varhaisen vuorovaikutuksen tukemiseen etenkin suotuisan mielenterveyden edistämisen näkökulmasta, ja aihetta on myös tutkittu paljon. Koska neuvolaterveydenhoitaja on ammattihenkilö, jonka luota lapset useimmiten ohjautuvat puheterapeutin tutkimuksiin, on tärkeää tietää, miten neuvolaterveydenhoitajat arvioivat, havainnoivat ja tukevat varhaista vuorovaikutusta myös lapsen esisanallisen kielenkehityksen näkökulmasta. Tämän pro gradu -tutkielman tarkoituksena oli selvittää, millaisia sisältöjä lastenneuvolassa työskentelevät terveydenhoitajat antavat varhaiselle vuorovaikutukselle ja miten he havainnoivat, arvioivat ja tukevat yhtäältä lapsen ja vanhemman välistä varhaista vuorovaikutusta ja toisaalta lapsen esisanallisia vuorovaikutuskeinoja ja -taitoja. Menetelmät. Tutkimuksessa käytettiin laadullista tutkimusotetta. Tutkimusaineisto koostui puolistrukturoiduista teemahaastatteluista, jotka kerättiin haastattelemalla touko–marraskuussa 2018 viittä Vantaan kaupungin palveluksessa työskentelevää neuvolaterveydenhoitajaa. Haastattelut nauhoitettiin ja litteroitiin sekä analysoitiin induktiiviseen päättelyyn perustuvan sisällönanalyysin avulla. Tulokset ja johtopäätökset. Varhainen vuorovaikutus määriteltiin laajasti. Sen perustan nähtiin rakentuvan jo raskausaikana, ja sen merkitystä pidettiin tärkeänä koko elämän kannalta. Terveydenhoitajien keskeisimpiä varhaisen vuorovaikutuksen arviointikeinoja olivat havainnointi ja vanhemmille esitetyt kysymykset. Neuvolassa käytettiin myös varhaista vuorovaikutusta arvioivia lomakkeita, mutta ei lapsen esisanallisen kielenkehityksen arvioimisen ja seuraamisen yhteydessä. Niin varhaisen vuorovaikutuksen havainnointi kuin tukeminenkin vaikutti suuntautuvan etupäässä vanhemman toiminta- ja käyttäytymistapoihin, ja terveydenhoitajat havainnoivat niitä keskenään yhdenmukaisemmin kuin lapsen esisanallisia vuorovaikutuskeinoja. Varhaista vuorovaikutusta tuettiin vahvistamalla vanhemman toimijuutta, neuvomalla ja ohjaamalla vanhempaa, ohjaamalla tämä tarvittaessa erilaisten neuvolapalveluiden ja vertaistukiryhmien pariin sekä lähettämällä asiakas neuvolan erityistyöntekijöiden, erityisesti psykologin, arvioitavaksi. Varhaista vuorovaikutusta arvioidaan ja tuetaan neuvolassa etupäässä lapsen ja vanhemman psyykkisen hyvinvoinnin näkökulmasta. Lapsen esisanallisen kielenkehityksen arvioimisessa esiintyy yksilöllistä vaihtelua, eikä se välttämättä ole yhtä monipuolista ja yhdenmukaista kuin lapsen ja vanhemman välisen vuorovaikutuksen arviointi. Puheterapeuttien ammatillista osaamista ei tämän tutkimuksen perusteella tunneta ja osata hyödyntää varhaisen vuorovaikutuksen arvioimisessa ja tukemisessa. Varhaiseen vuorovaikutukseen liittyvän ammatillisen yhteistyön lisääminen olisi tärkeää ja hyödyttäisi paitsi eri ammattiryhmien työtä myös asiakasta ja hänen perhettään.
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(2023)Tavoitteet: Raskaus ja vanhemmuus voivat kuormittaa vanhemman hyvinvointia ja pahimmillaan heikentää mielenterveyttä. Vanhemman heikentynyt mielenterveys puolestaan voi vaikuttaa kielteisesti lapsen kehitykseen. Vanhempien mielenterveyden tukemiseen voidaan käyttää esimerkiksi varhaisen vuorovaikutuksen psykoterapiaa, joka edistää sekä vanhempien mielenterveyttä että vuorovaikutussuhdetta lapsen kanssa. Suomessa tämän hoitomuodon vaikuttavuutta ei ole kuitenkaan vielä tutkittu. Tämän tutkimuksen tarkoituksena on selvittää, lievenevätkö vanhempien ahdistus- ja masennusoireet hoitojakson jälkeen. Koska varhaisen vuorovaikutuksen psykoterapian vaikutus voi riippua mielenterveyden hankaluuden tyypistä, tarkastellaan diagnoosin merkitystä oireiden muutokselle. Menetelmät: Tutkimuksessa hyödynnettiin HUSin psykoterapian aineistoa. Aineisto koostui kaikista varhaisen vuorovaikutuksen lyhytpsykoterapioista ajanjaksolla 2018- 2022 (N = 46). Tutkimuksessa tarkasteltiin eroja henkilöiden ahdistuneisuus- (OASIS) ja masennusoireiden (PHQ-9) välillä ennen ja jälkeen varhaisen vuorovaikutuksen psykoterapian, kun diagnoosi oli selittävänä tekijänä. Yhteyttä tutkittiin lineaarisilla sekamalleilla. Tulokset: Potilaiden ahdistuneisuus- ja masennusoireet lievenivät varhaisen vuorovaikutuksen psykoterapian aikana. Masennusoireet vähenivät enemmän ahdistuneisuushäiriödiagnoosin kuin masennusdiagnoosin saaneilla potilailla. Masennusdiagnoosin saaneilla potilailla ahdistuneisuus oli terapiajakson lopussa korkeampi kuin ahdistuneisuushäiriödiagnoosin saaneilla potilailla. Johtopäätökset: Varhaisen vuorovaikutuksen psykoterapia näyttää vähentävän tuoreiden vanhempien ahdistus- ja masennusoireita. Hoitomuoto vaikuttaa erityisen tehokkaalta ahdistuneisuushäiriödiagnoosin omaavan henkilön masennus- ja ahdistusoireiden hoitoon. Varhaisen vuorovaikutuksen psykoterapian yhteys ahdistus- ja masennusoireiden muutokseen oli myös itsessään voimakas ja hoitoa olisi hyödyllistä tarjota vanhemmille, jotka kärsivät mielenterveyden haasteista. Tulevaisuudessa tämän tutkimuksen tulokset tulisi varmistaa laajemmalla aineistolla ja ahdistuneisuus- ja masennusoireiden lieventymisen voimakkuutta varhaisen vuorovaikutuksen psykoterapian jälkeen tulisi tarkastella.
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(2019)Objectives. Selective mutism is a condition that develops during childhood. Selective mutism means a person’s inability to communicate in certain social situations, such as attending kindergarten. However, there are no extensive studies of people who deal with children with selective mutism on a daily basis. This thesis concentrated on early childhood educators’ experiences in interacting with children who have selective mutism. Furthermore, this thesis examined the participants’ perceptions on how selective mutism manifests in the early stages of a person’s development and in the environment of early childhood education. As well as their perceptions on diagnosing selective mutism and multi-professional cooperation. Methods. Eleven participants with a professional background in early childhood education participated in a semi-structured interview. The participants shared their own experiences and perceptions of the subject at hand guided by the frame of the interview. The recorded conversations where transcribed into academic material which was then processed with inductive analysis. Results and Conclusions. The participants experienced that the long-term nature of selective mutism, paucity of communication, and developing a relationship with the child caused challenges when working with selectively mute children. They felt that a broad professional and general knowledge of selective mutism helped them overcome these challenges. The interviewees agreed that selective mutism had a negative impact on the child’s opportunities to influence the matters that concerned them. Childhood educator professionals have a key role in identifying the symptoms of selective mutism in its early stages and intervening before it becomes a chronic issue for the child; therefore, childhood educators need systematic training and information about the disorder. The results of this thesis can be utilized when designing a more cohesive path to rehabilitation for children with selective mutism, planning education paths and implementing clinical cooperation with early childhood education professionals. Furthermore, the results indicate that the most effective way to prevent long term negative effects of selective mutism is to identify and deal with the problem early on in a child’s development. In addition, the results of this thesis indicate that rehabilitation measures during early childhood combined with a confidential relationship between the educator and the child are essential in overcoming selective mutism, so the child will be able to rehabilitate and communicate in kindergarten.
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(2017)Tavoitteet. Monikielisyys on lisääntynyt merkittävästi Suomessa viimeisen kahdenkymmenen vuoden aikana. Monikielisyyden lisääntyminen näkyy myös puheterapian asiakaskunnassa. Esimerkiksi Helsingissä puheterapiassa vuonna 2015 käyneistä lapsista 40 – 50 % oli monikielisiä. Monikielisillä ei tutkimuksissa ole todettu olevan suurempaa riskiä kielelliseen erityisvaikeuteen kuin yksikielisillä. Heitä kuitenkin ohjautuu puheterapeutin tutkimuksiin suhteellisesti enemmän ja heitä myös herkemmin ylidiagnosoidaan. Toisaalta monikielisten on todettu ohjautuvan puheterapeutin tutkimuksiin yksikielisiä myöhemmin ja aloitteen tulevan useammin päivähoidon kuin neuvolan taholta. Tämän tutkielman tavoitteena on selvittää, millaisia kielellisten vaikeuksien merkkejä suomi toisena kielenä (S2) -lastentarhanopettajat ovat havainneet työssään monikielisillä lapsilla sekä pohtia, kuinka puheterapeutit voisivat auttaa näiden vaikeuksien tunnistamisessa. Menetelmät. Tutkimus toteutettiin puolistrukturoituna teemahaastatteluna. Tutkimuksessa haastateltiin yhdeksää S2-lastentarhanopettajaa tai vastaavaa työtä tekevää varhaiskasvatuksen ammattilaista Helsingistä, Vantaalta, Kotkasta, Turusta ja Jyväskylästä. Tutkittavat hankittiin ottamalla yhteyttä edellä mainittujen kuntien varhaiskasvatuksen monikielisyys- ja kulttuuriasioista vastaaviin henkilöihin. Tutkittavilla oli kokemusta monikielisten kanssa työskentelystä yhdestä kahteenkymmeneen vuoteen. Aineisto kerättiin keväällä 2017. Haastattelut litteroitiin, ja ne analysoitiin Atlas.ti -analyysiohjelman avulla. Analyysin avulla aineistosta muodostui kuusi teemaa. Tulokset ja johtopäätökset. Haasteltavilla oli selkeä näkemys siitä, millaisia piirteitä he pitivät huolestuttavina ja puheterapeutin arviota vaativina. Tällaisia olivat muun muassa sanojen hidas omaksuminen, jo opittujen sanojen jääminen pois käytöstä, puheen huomattava epäselvyys, puheen ymmärtämiseen liittyvät vaikeudet sekä käyttäytymisen ongelmat. Haasteita kielellisten vaikeuksien olemassaolon määrittelylle muodostivat erityisesti riittävän toiselle kielelle altistumisajan määritteleminen ja lasten äidinkielen taitotason arvioiminen. Haastateltavat kokivat puheterapeuttien kanssa tehtävän yhteistyön pääasiassa hyvänä, mutta toivoivat erityisesti lisää mahdollisuuksia konsultoida suoraan puheterapeuttia sekä keinoja arvioida ja tukea monikielisten lasten kielellisiä taitoja.
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(2018)Goals: Eating disorder symptoms are relatively common in adolescence. Recognizing and early clinical intervention of partial and subthreshold symptoms is important, because they are associated with functional impairment and distress and may progress to fully fledged eating disorders. Body dissatisfaction is one of the main symptoms of and also a significant risk factor for eating disorders. Extensive research has been done to examine how body dissatisfaction predicts eating disorders in adults, but knowledge of these associations in childhood and adolescence is scarce. More advanced stage of puberty has been associated with higher risk for eating pathology, but little is known about how pubertal stage affects the association between body dissatisfaction and eating disorder symptoms. The goal of this study is to explore if body dissatisfaction early in adolescence predicts eating disorder symptoms (drive for thinness, body dissatisfaction, bulimic symptoms) later in adolescence and how pubertal stage moderates this association. Methods: The data this study used was from Finnish birth cohort Glycyrrhizin in Licorice Study (Glaku). Altogether 145 adolescents estimated their body dissatisfaction (Kids´ Eating disorders survey, KEDS) at the age of 12 and completed eating disorder symptoms related questionnaire (Eating Disorder Inventory 2, EDI-2) at the age of 17. Stage of puberty was assessed at 12 years of age using Tanner pictures. The associations between body dissatisfaction and eating disorder symptoms were analyzed with linear and logistic regression. Results and conclusions: High body dissatisfaction in early adolescence was associated with more drive for thinness and body dissatisfaction in late adolescence. Although gender did not moderate the association between body dissatisfaction and eating disorder symptoms, in accordance with the results of previous studies, associations were explicit only in girls. Furthermore, even moderate body dissatisfaction in early adolescence predicted clinically significant drive for thinness in late adolescence. More advanced stage of puberty strengthened the association between body dissatisfaction in early adolescence and bulimic symptoms in late adolescence. However, future research is needed to assess the effect of puberty on associations between body dissatisfaction and eating disorder symptoms in separate models for boys and girls. The results of this study indicated that, to prevent eating disorders, support should targeted to girls, to adolescents with even moderate body dissatisfaction and, as for bulimic symptoms, to those in advanced pubertal development.
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