title: The natural history and predictors of persistent problem behaviours in cystic fibrosis: a multicentre, prospective study.
abstract: BACKGROUND
  In cystic fibrosis (CF), problems with sleep, eating/mealtime behaviours, physiotherapy adherence and parental mental health issues are common, yet their natural history and the extent of service use to address them are unknown.
  
  
  OBJECTIVE
  Follow up the 2007 cohort to determine: (1) prevalence of child sleep, eating/mealtime behaviours, physiotherapy adherence, and externalising/internalising problem behaviours and primary caregiver mental health status after a 3-year period; (2) natural history of child behaviours; (3) potentially modifiable predictors of persistent problems; and (4) service use for behaviours.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Royal Children's Hospital, Monash Medical Centre and Sydney Children's Hospital (Australia) CF clinics.
  
  
  METHODS
  Caregivers, of children aged 3-8 years, who completed the baseline questionnaire.
  
  
  METHODS
  Child sleep, eating/mealtime behaviours, adherence with therapy and externalising and internalising behaviours.
  
  
  METHODS
  parenting style (low warmth), caregiver mental health status and sleep quality at baseline.
  
  
  RESULTS
  102 of 116 (88%) families participated. The prevalence of sleep and eating/mealtime problems at follow-up was similar to baseline. The prevalence of caregiver mental health symptoms remained higher than the community data. 71 out of 102 (70%) of the children experienced at least one persistent behaviour problem. Caregiver mental health difficulties predicted persistent child moderate to severe sleep problems (adjusted OR 6.5, 95% CI 1.2 to 36.2, p=0.03) and their persistently poor adherence to the physiotherapy regimen (adjusted OR 3.5, 95% CI 1.3 to 9.2, p=0.01).
  
  
  CONCLUSIONS
  Child problem behaviours are common in children with CF, persist and are often predicted by the mental health of the parent. Routine surveillance for and management of child problem behaviours are recommended.
authors.affiliation: Centre for Community Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville VIC 3052, Australia. jane.sheehan@mcri.edu.au
authors.forename: Jane
authors.initials: J
authors.lastname: Sheehan
authors.forename: John
authors.initials: J
authors.lastname: Massie
authors.forename: Margaret
authors.initials: M
authors.lastname: Hay
authors.forename: Adam
authors.initials: A
authors.lastname: Jaffe
authors.forename: Judith
authors.initials: J
authors.lastname: Glazner
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
mesh_terms: D017028:Caregivers / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D019959:Feeding and Eating Disorders of Childhood / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007389:Internal-External Control; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D009517:New South Wales / Q000453:epidemiology; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D026741:Physical Therapy Modalities / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D014739:Victoria / Q000453:epidemiology