Conference Agenda

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Session Overview
Morning poster session
Wednesday, 24/Nov/2021:
10:30am - 11:15am

Location: Foyer 1 & 2


Geospatial Analysis of Access to Healthcare: Child Development Needs and Available Care in the Canton of Zurich

Etienne Grueebler1,3, Oliver Gruebner1,2, Michael von Rhein3,4

1University of Zurich, Department of Geography; 2University of Zurich, Epidemiology, Biostatistics, and Prevention Institute; 3University Children`s Hospital, Child Development Center; 4University of Zurich, Children's Research Center

<p>Developmental delay (DD) is one of the most frequent disorders in early childhood affecting 10-15% of all preschool children. Early identification of children with DD is critical to ensure appropriate therapeutic interventions, to support the families, and finally to prevent chronic, life-long health, educational, and social consequences. It is widely acknowledged that early intervention (EI) programs are both ethically mandatory and cost-effective for a society on a long-term perspective. However, data shows that many cases are missed in early childhood. Although research has identified potential risk factors for under-utilization of EI, the spatial distribution of children in need, referring doctors, and therapeutic places have been neglected in many research studies so far. Consequently, we do not know much about the spatial variation in EI, and knowledge on potential influencing factors for spatial variation in referral and utilization is lacking. Therefore, we aimed to quantify accessibility of care in the Canton of Zurich, Switzerland.</p>

<p>To do so, a comprehensive data set from all children (age 0-4) admitted to the two Units of Special Needs Education (USNE) in the Canton of Zurich in 2017 (n=1971) was used and analyzed with the Floating Catchment Area (FCA) set of methods. Our results show major differences between rural and urban regions and better accessibility closer to greater therapy institutions. Our findings highlight spatial inequalities between healthcare needs and services. Our research contributes to a better understanding of spatial access to healthcare and informs healthcare policy to help increase accessibility to EI for children with DD.</p>

Children with an autism spectrum disorder in the canton of Zurich – Evaluation of daily life, early interventions, and need of support by professionals

Nadja Katharina Schneider, Michael von Rhein, Oskar Jenni, Christina Schaefer

Universitäts-Kinderspital Zürich, Switzerland

<p>In recent years, the topic of Autism Spectrum Disorder (ASD) received increasing attention in Switzerland and gained additional political relevance through the report on measures to improve the support of people with ASD published by the Federal Council (1). In Switzerland, the prevalence of ASD is estimated to be between 0.6 and 0.8 percent (with an increasing tendency) (2). Parents of children with ASD are often greatly burdened by the intensive and challenging care of their child. Therefore, an early diagnosis associated and initiation of early therapeutic measures is crucial for the development and the quality of life of children with ASD and their families.<br />However, little is known on the families&rsquo; perspective regarding early interventions, so far: what specifically are the needs of affected families? Do early special education measures such as special education and speech therapy meet their needs, and how much experience with autistic children do therapists in these two disciplines have, considering the increased need for autism-specific interventions?<br />Based on a central register of all children registered for special needs education before kindergarten entry, we conducted a survey of 57 affected families to investigate everyday life, early intervention and the need for further support.<br />In addition to the question of a possible imbalance between supply and demand for these therapies, the need and experiences of the parents are being assessed in a sequential-explanative mixed method design, and compared to the perspective of special education teachers working with affected children.<br />Data collection and interviews have been completed already. The presentation will provide an overview over the most important findings of this comprehensive study.</p>

<p>1. Bundesrat. Bericht Autismus-Spektrum-St&ouml;rungen. Massnahmen f&uuml;r die Verbesserung der Diagnostik, Behandlung und Begleitung von Menschen mit ASS in der Schweiz. 2018</p>

<p>2. Gundelfinger R. Autismus in der Schweiz. P&auml;diatrie; 2013</p>

Dyadic coping and coparenting among couples after their child’s recent autism diagnosis

Naomi Downes, Emilie Cappe

Université de Paris, LPPS, F-92100 Boulogne-Billancourt, France.

<p><strong>Background:</strong> After a diagnosis of autism, parents' stress levels can be heightened while they adapt their co-parenting relationship to meet the specific needs of their child. To date, no studies have explored dyadic coping: how couples cope together to face the stress experienced at this time. Yet, research has recognized the couples&rsquo; relationship as being a primary source of support for parents. A better understanding of how parents adapt together is needed to provide better support for families from the earliest age of their child.</p>

<p><strong>Objectives:</strong> The aim of this research project was to explore how parents use their relationship as a support system, to face any stress generated by having a child on the autism spectrum and to work as a team to raise their child.</p>

<p><strong>Methods:</strong> Overall, 70 couples were recruited 1 to 36 months after their child's autism diagnosis via four specialized autism screening centers in France. Couples were eligible if they were cohabiting and if their child was aged between 24 months to 6 years 11 months old at the time of diagnosis. Each partner completed the same questionnaires to assess stress appraisals (ALES-vf), parenting sense of competence (QAECEP), dyadic coping (DCI), their co-parenting relationship (PAI), as well as socio-demographic information.</p>

<p><strong>Results:</strong> Questionnaire data was analyzed using the Actor-Partner Interdependence Model (APIM): a model for conducting dyadic statistical analyzes. Results showed dyadic coping and parents' sense of competence were related to parents&rsquo; own level of co-parenting. Partner effects were also observed: mothers&rsquo; positive dyadic coping increased fathers&rsquo; perceptions of a high-quality co-parenting relationship. While a better sense of parenting competence among fathers was associated to a higher level of co-parenting relationship quality among mothers.</p>

<p><strong>Conclusion:</strong> This research emphasizes the need to further understand how parents function and adapt after their child has been diagnosed with autism.</p>

The mediating role of early regulatory problems in infancy on the relation of early life stress with preschoolers’ behavioral problems

Nadine Messerli-Bürgy1, Jan-Philip Knirsch1, Andrea H. Meyer2,3, Tanja H. Kakebeeke4,5, Kerstin Stülb2, Amar Arhab6, Annina E. Zysset4, Claudia S. Leeger-Aschmann7, Einat A. Schmutz7, Silvia Schneider8, Susi Kriemler7, Oskar G. Jenni4,5, Jardena J. Puder6, Simone Munsch2

1Department of Psychology, University of Fribourg, Switzerland; 2Department of Clinical Psychology and Psychotherapy, University of Fribourg, Switzerland; 3Department for Psychology, University of Basel, Switzerland; 4Child Development Center, University Children’s Hospital Zurich, Switzerland; 5Children’s Research Center, University Children’s Hospital Zurich, Switzerland; 6Obstetric Service, Department Women-Mother-Child, Lausanne University Hospital, Switzerland; 7Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland; 8Faculty of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Germany

Early regulatory problems (ERP) include crying, feeding and sleeping problems during infancy and are thought to be related to early life stress (ELS) and the later development of behavioral problems at preschool age. The aim of the study was to assess the mediating role of ERP in preschoolers. Parents of 555 healthy children (aged 2–6 yrs) of the Swiss Preschooler’s Health Study (registrated as ISRCTN41045021; date 21.03.2014) were asked to retrospectively complete questions on their child’s ERP during infancy, on ELS of their child, and on current behavioral problems of their child. A structural equation model revealed that ELS on the hyperactivity-inattention was mediated through ERP (b=0.022, C.I.=0.006/0.050, beta=0.093), and accounted for a large proportion (76%) of the total effect (b=0.029, C.I.=–0.025/0.103, beta=0.126), while the direct effect was comparably small (b=0.008, C.I.=–0.058/.073, beta=0.033). ELS has a short–term impact on psychopathology in infancy, but these psychopathologic patterns may persist over several years.

Association between child self-regulation and parental factors in preschoolers with special education needs

Lotta Balters1, Simone Keßel1, Laurence Nawab1, Helen Hegerath1, Christa Grüber-Stankowski2, Charlotte Hanisch1

1Universität zu Köln, Germany; 2Zentrum für Frühbehandlung und Frühförderung e.V. Köln, Germany

The multidimensional construct of school readiness is considered to be an important indicator for early and later academic success. In addition to early academic ability (e.g. early knowledge of letters and numbers or oral speech), research has focused on self-regulation as the key element linked to school readiness (Blair & Raver, 2015; Roebers & Hasselhorn, 2018).

The impact of parental factors such as parenting behavior, socioeconomic status, stress or mental health on the development of children´s self-regulation has been highlighted in numerous studies (Blair & Raver, 2015; OECD, 2020; Rademacher & Koglin, 2020). However, for the group of children with early intervention needs, who are at particular risk for academic failure, little is known about the influence of these variables.

The aim of this study is to show correlations between parental factors and self-regulation abilities of children with early intervention needs.

For this purpose, parents of 274 pre-school children with early intervention needs (M=5.97, SD=0.38, 193 boys) reported on their children’s self-regulation abilities as well as on their parenting behavior, stress, mental health, sense of coherence and parental attributions.

Preliminary analysis in a subsample showed significant correlations between negative parenting behavior (r = .399; β = .295, p = .002), as the strongest predictor, as well as parental sense of coherence (r = -.360; β = -.227; p = .015) and child self-regulation. In addition, correlations with migratory background and first language became identifiable. The presentation will report the results of the complete sample.

Findings highlight the importance of parental influence on the development of self-regulation of children with early intervention needs. The involvement of the parents in early intervention approaches should therefore aim to provide a better understanding of the child's developmental prerequisites and to align parenting strategies accordingly.

Testing a single-session behavioral intervention to reduce intrusive traumatic memories and PTSD symptoms after childbirth: a proof-of-principle study

Camille Deforges1, Deborah Fort1, Suzannah Stuijfzand1, Emily Holmes2, Antje Horsch1,3

1Institute of Higher Education and Research in Healthcare, University of Lausanne, Switzerland; 2Department of Psychology, Uppsala University, Sweden; 3Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland

<p><strong>Background and aim:</strong> Childbirth-related intrusive traumatic memories (CB-ITM) are involuntary and distressing sensory impressions of the birth, and a key symptom of childbirth-related posttraumatic stress disorder (CB-PTSD). Laboratory studies suggest that ITM and PTSD symptoms could be reduced via exposure to trauma-related reminder cues combined with a task hypothesized to interfere with trauma memory reconsolidation. However, this has never been tested for old and real-life single-event trauma, nor in the perinatal context. This translational proof-of-principle study aimed at testing the efficacy of a single-session behavioural intervention, based on memory reconsolidation processes, to reduce CB-PTSD symptoms, particularly ITM.</p>

<p><strong>Methods: </strong>In this single case experimental study, 18 mothers suffering from CB-ITM received a behavioural intervention consisting of a combination of the traumatic childbirth evocation with a visuospatial task assumed to interfere with childbirth memory reconsolidation. Mothers daily reported their CB-ITM during the two weeks before the intervention (diary 1), the two weeks after (diary 2), and the 5<sup>th</sup> and 6<sup>th</sup> weeks post-intervention (diary 3). CB-PTSD symptoms were assessed with the PCL-5 just before and one month after the intervention. <strong></strong></p>

<p><strong>Results</strong>: There were fewer CB-ITM in diary 2 (post-intervention), compared to diary 1 (pre-intervention). The changes were durable, given that the number of CB-ITM did not differ between diary 2 and 3. CB-PTSD symptoms were also significantly reduced at one month post-intervention. All effect sizes were large. Participants rated the intervention as highly acceptable.</p>

<p><strong>Discussion: </strong>This innovative single-session behavioural intervention seems promising, thus justifying the launch of a large randomized controlled trial.</p>

If I could build... Empowering the voices of children with disabilities in playground planning

Ines Wenger1,2,3, Thomas Morgenthaler2,3,4, Christina Schulze2

1Luleå University of Technology; 2Zurich University of Applied Sciences; 3University College Cork; 4Queen Margaret University

<p><strong>Background:</strong> Children with and without disabilities consider playgrounds as significant places in their life, which offer opportunities for play and social interactions. Playgrounds are especially important in times when opportunities to meet are restricted, for example, due to the Covid-19 pandemic. Even though the primary purpose of playgrounds is to be a place for children to play, playground design is mainly determined by adults. Children`s voices regarding their use of playgrounds, and their wishes and needs to enhance participation on playgrounds are seldom addressed. In particularly perspectives of children with disabilities are often absent. The aim of this presentation is to give insight into how the perspectives of children with disabilities may contribute to playground design.</p>

<p><strong>Method:</strong> The presentation draws on an international project that explores children's perspectives through literature reviews and semi-structured interviews.</p>

<p><strong>Results:</strong> Children make important contributions to playground design. For example, children with disabilities show a unique understanding of their own situation and propose inclusive playground adjustments. Their unique perspectives on play could help playground providers to adapt playgrounds to their needs and wishes to ensure participation in play including opportunities for social interactions and challenges according to their abilities.</p>

<p><strong>Discussion:</strong> Children are the main user group of playgrounds. Child-focused participatory methods that include children with different abilities and a variety of needs and backgrounds should be included in processes of playground planning, evaluating, and monitoring to enhance playground design.</p>

<p>This project has received funding from the European Union&rsquo;s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 861257.</p>

Early childhood care and education professionals’ views on the inclusion of children with disability: A mixed-method study on attitudes and self-efficacy

Matthias Lütolf, Simone Schaub

University of Teacher Education in Special Needs

In Switzerland, the UN Conventions on the Rights of the Child (ratified in 1997) and on the Rights of Persons with Disabilities (ratified in 2014) grant children with disability equal access to education and social integration. Accordingly, efforts to include children with disability in early childhood education and care (ECEC) have increased in recent years. For inclusion to succeed, ECEC professionals’ views on inclusive care and education are critical. This study used a mixed-method design to assess the views on inclusion of ECEC professionals in Zurich day-care centers. 119 participants completed a questionnaire on their attitudes towards inclusion and their self-efficacy towards inclusive practices. Based on the quantitative findings, six problem-centered interviews with ECEC professionals were conducted. Taken together, results show that ECEC professionals held positive views on inclusion, which were strongly associated with current professional experiences with inclusion. Compared to attitudes, self-efficacy was experienced as lower. Especially regarding the inclusion of children with complex and high needs, ECEC professionals were less confident in their own abilities.

Developmental and mental health care involved in early childhood placement in Switzerland: Facts and considerations to promote fragile infant mental health

Maria Mögel Wessely, Oskar G. Jenni, Ruth Etter

Child Development Center (Abteilung Entwicklungspädiatrie) University Children’s Hospital Zürich

<p>In Switzerland, there are currently no figures on the extent or outcome of early placement or adoption. Research documents very well, however, that infants and toddlers receive less regular pediatric well-child visits and necessary remedial education than children in traditional families, even though these children are removed from their parents and placed specifically because their development was at considerable risk<sup>, </sup>often already during pregnancy. Before the effects of a stable and responsive new environment can act, placement processes may cause great stress on the still-developing psychological organization of such young children. However, early signs of stress or trauma in this vulnerable group receive still little attention; although they often quickly strain the relationship between the children and their new caregivers and jeopardize sometimes the stability of the placement. Thus these children should receive early developmental pediatric follow-up and screening for mental health problems at the beginning of placements and close follow-up examinations thereafter, as recommended, for example, by the American Academy of Pediatrice. Based on case series from a Swiss study as well as on the current practice of developmental pediatrics and psychotherapists, reflections will be made on the content-related elements of such practice and its interdisciplinary anchoring in placement procedures.</p>

Neonatal care delivery for low birth weight infants in the context of continuum of care in Ghana

Christina Schuler1, George Edward Ntow2, Faith Agbozo3, Veronika Waldboth1

1Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute of Nursing, Winterthur, Switzerland; 2Dodowa Health Research Centre, Dodowa, Ghana; 3University of Health and Allied Sciences (UHAS), School of Public Health, Department of Family & Community Health, Ho, Ghana

<p><strong>Introduction and Aims</strong></p>

<p>Effectively coordinated care linkages have high tendency of minimising adverse events associated with low birth weight (LBW) infants. In Ghana, however, linkages across health settings and family support structures are not clearly laid-out. This study elicited the continuum of care for LBW infants to understand how linkages can be strengthened to optimise quality of care.</p>


<p>This study adopted a constructivist grounded theory design. Data collection took place in a municipality in Ghana between 2020 - 2021 with families, health professionals and managers providing care in clinical and community-based facilities. Audio recorded in-depth interviews were analysed using initial and focused coding, constant comparative analysis, theoretical memos, and diagramming until theoretical sufficiency was determined.</p>


<p>Analysis of 25 interviews generated an interpretive theory showing that referral, discharge, and review processes were not systematically planned and documented. Neonatal care knowledge was lacking due to insufficient investments in coordination and trainings with awareness creation on newborn health thought to reduce misconceptions. Motivated staff, implementation of care guidelines and staff supervision were identified as enabling factors. Mothers lacked financial and practical support and needed assistance in balancing their hope and confidence and empowerment to care for their LBW infants. To overcome these challenges, early bonding and family involvement were helpful.</p>


<p>A coordinated care process, family, and community involvement through adoption of a family system approach is necessary. Implementing guidelines, providing training opportunities, involving stakeholders, and promoting committed leadership can improve quality in the care continuum.</p>

Validation of the French version of the City Birth Trauma Scale and its psychometric properties

Vania Sandoz1, Coraline Hingray2, Suzannah Stuijfzand1, Alain Lacroix1, Wissam El Hage3,4, Antje Horsch1,5

1Institute of Higher Education and Research in Healthcare, University of Lausanne, Switzerland; 2Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; 3CHRU de Tours, Centre Régional de Psychotraumatologie CVL, Tours, France; 4UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; 5Department Woman-Mother-Child, Lausanne University Hospital, Switzerland

<p>Aims: This study first aimed to validate the French version of the City Birth Trauma Scale (City BiTS-F), recently developed to assess childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms, and secondly to determine CB-PTSD latent factor structure.</p>

<p>Methods: French-speaking mothers of a 1-to-12-month old (<em>n</em> = 541) participated in this online cross-sectional survey, with the following standardised self-report questionnaires: the City BiTS-F, the PTSD Checklist, the Edinburgh Postnatal Depression Scale, and the anxiety subscale of the Hospital Anxiety and Depression Scale. Medical and sociodemographic data were also collected.</p>

<p>Results: The bifactor model, with a general factor and the birth-related symptoms (BRS) and general symptoms (GS) subscales, fitted best the data. This confirms that using the total score in addition to the BRS and GS scores is warranted. Good convergent and divergent validity and high reliability (&alpha; = .88 to .90) were observed. Moreover, weeks of gestation, gravidity, history of traumatic childbirth and event, and mode of delivery were used to calculate discriminant validity.</p>

<p>Discussion: CB-PTSD can be measured by both the total score and the BRS and GS subscales scores. Women having a history of traumatic event or childbirth scored higher on the total and subscale scores compared to mothers without such trauma exposure. Emergency caesarian section resulted in higher total or subscale scores compared to other modes of delivery. Associations between gravidity and total and GS scores were obtained. The City BiTS-F is a reliable and valid CB-PTSD symptoms assessment for French-speaking mothers for clinical and research purposes.</p>

Motor developmental profile as a predictor of social deficit in ASD preschoolers

Vincent Junod, Joana Osorio Almeida, Borja Rodriguez-Herreros, David Romascano, Sonia Richtin, Nadia Chabane, Anne M. Maillard, Marine Jequier Gygax

Service des Troubles du Spectre de l’Autisme, Lausanne University Hospital, Lausanne, Switzerland

<p>Aims : We aimed at identifying motor atypical development in an ASD preschoolers population (&lt; 5yo), compared it to a control cohort, and decipher whether the motor profile might be a predictor for social functioning.</p>

<p>Method : Participants recruited were between 1 years 9 months and 4 years 11 months old, divided into two groups: 32 children with a diagnosed autism spectrum disorder (ASD) (<em>Mean age=3.33</em>), 3 girls/29 boys, and 24 children with typical development (TD) (<em>Mean age=3.25</em>)<em>, </em>8 girls/16 boys. We used the Peabody Developmental Motor Scale (PDMS-2) to assess the motor level for each group, Autism Diagnostic Observation Schedule (ADOS-2) to assess the symptoms of autism.</p>

<p>Results: We controlled all analyses for gender as well as nonverbal intelligence quotient (NVIQ). The results show lower scores for the ASD group in all motor components, gross motor (GMQ), fine motor (FMQ) and total motor (TMQ). These findings are consistent with the literature on motor development in children with ASD. Moreover, the NVIQ is a predictor of gross motor skills for both ASD and TD groups. Interestingly, motor skills appear to be a predictor of the ADOS-2 social affect (SA) in ASD.</p>

<p>Discussion : This monocentric study shows that motor development is significantly affected early in life in ASD children, and is correlated to the social skills. These results contribute to refine the sensorimotor profile in ASD, underlying the global developmental burden associated with the social cognition deficits.</p>

Growing up in institutional care: Risk and protective factors for early development

Hannah Sand1, Heidi Simoni1, Oskar G. Jenni2, Patricia Lannen1

1Marie Meierhofer Children’s Institute, University of Zurich, Zurich, Switzerland; 2Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland

For healthy development, young children need responsive caregivers and a stimulating environment. Children growing up in institutional care may not have these supporting conditions. Due to high child-staff-ratios and strict routines one-to-one interaction is often limited; responding in a sensitive manner to children’s emotional needs and exploratory initiatives becomes difficult. Many studies show that institutionalization under such conditions of sensory and emotional deprivation is associated with a significant developmental risk. However, little research exists on which aspects of institutional care cause developmental deficits and which children are particularly vulnerable to negative conditions in the institutions.

To better understand the association of institutionalization and early development, we draw on a historical data set collected in the late 1950s in Switzerland. At that time, Dr. Meierhofer and colleagues assessed the developmental and living conditions of 341 children placed in 12 institutions in Zurich. They showed that the institutionalized children had significant developmental delays compared to family raised children. They also found significant within-group differences depending on which of the 12 institutions a child was placed in. Because no association with child- or family-related variables could be confirmed, they concluded that the extent of developmental delay was related to the care conditions in the institutions.

To validate this result and to draw more differentiated conclusions about risk and protective factors on individual and institutional level, we have reprocessed and reanalyzed the historical data set using new statistical methods. The results will contribute to better understand the developmental risk of institutionalization.

Beyond the technique of calming methods: the role of parental values and parental emotion-regulation in co-regulative processes across the first year of life

Margarete Bolten1, Lukka Popp2, Mitho Müller2, Corinna Reck2

1Universitäre Psychiatrische Kliniken Basel (UPK), Switzerland; 2Ludwig-Maximilians-Universität München (LMU), Germany

<p>During the first year of life, infant crying and sleeping problems are common. In early childhood co-regulation is fundamental for infants&rsquo; adjustment and functioning, especially in babies who cry more and sleep less. Parents use various soothing strategies to calm their baby or to help him to fall asleep. In the present study, we analyse the effectivnes of different calming techniques and asses how parental values and parental emotion-regulation influence co-regulative processes. In particular, the capacity to adjust own emotions may support parental co-regulation.</p>

<p>To address this issue, we currently run an anonymous online study that assesses crying, sleeping and eating behavior in infants aged 0 to 18 month and parental strategies to regulate their child&rsquo;s distress as well parental strategies to regulate own negative emotions. We hypothesize that more dysfunctional co-regulation strategieswill be associated with more sleeping and feeding difficulties and more crying in early childhood, and may bepredicted by dysfunctional parental emotion regulation. Furthermore, we are interested in parental values, which are associated with soothing strategies. Our findings will be presented at the conference and could be the basis for family-based prevention programms that may be delivered in community settings.</p>