The Interrelations between Toddler Temperament, Risky Behaviour, and Unintentional Injury: A model and pilot study

A MODEL OF CHILD UNINTENTIONAL INJURY 1

‘The Interrelations between Toddler Temperament, Risky Behaviour, and Unintentional

Injury: A model and pilot study’ Ashleigh M. Barber

Supervisor: Dr. Merrilyn Hooley

Deakin University

2013

213080375

“I, the undersigned, declare that this Empirical Report is less than the specified word limit, and that it comprises original work and writing by me, and that due acknowledgement has been made to all other material used.

Signed: A.M. Barber

Dated: 9/11/13


Abstract

There is a paucity of research investigating multivariate factors in paediatric unintentional injury, yet uni- or bivariate risk factors do not suffice in explicating complex aetiological pathways. A first-phase pilot study was conducted to explore relations and structure of three toddler-variables proposed in a model of unintentional injury. The study aimed to determine the psychometric properties of measures and assess feasibility of methods. Forty-eight toddlers (15-26 months) comprised the sample, and were observed for 10 minutes in a playroom (a parent was present but facing away). The room was fit out with pseudo-risky items (e.g., plastic knife and fork, water-filled cleaning bottle) to mirror real-world environmental hazards. Parents completed questionnaires about child’s temperament and injury history prior to testing. Sound reliability and validity was found for the five observed Risky Behaviours (latency to engage with risky item; proximity to parent; visual-verbal interactions; innocuous engagement; hazardous engagement). Parent-report temperament and Injury Scores, derived from a novel, post-data collection rating scale for injury histories, revealed good internal consistency and convergent validity. Results revealed only one of five temperament factors (comprised of three traits: positive anticipation, low intensity pleasure, and sociability), was significant, revealing an interaction with toddler’s sex to produce differential risk of unintentional injury in girls and boys. It is concluded that multivariate investigations reveal important interactions that are cannot be intuitively or statistically discerned through single or dual variables alone.


‘The Interrelations between Toddler Temperament, Risky Behaviour, and Unintentional

Injury: A model and pilot study’

Each child injury event is underpinned by a chronology of factors that engage in a

bidirectional interplay long before an injury even occurs. This makes it difficult to

discern a child who is definitively ‘at-risk’, because risk by definition is asymptomatic

before an injury occurs. Schwebel and Barton (2005) allude to the idea of explicating

the phenomena that places children at risk of injury, which would allow aetiological

processes to be better understood, and in turn, effective preventative methods be

developed. However, research in the area of paediatric unintentional injury has long

explored individual risk factors, such as being male (Sorenson, 2011), having a difficult

temperament (i.e., negative emotionality; irritability) (Schwebel, Brezausek, Ramey, &

Ramey, 2004), prior injuries (Johnston & Martin-Herz, 2010; Ramsay et al., 2003) and

showing externalising behaviour such as hyperactivity (Karazsia, Guilfoyle, &

Wildman, 2012). These are too general to be useful identifiers of children at risk.

Furthermore, developmental outcomes are the product of child-environment interplay,

indicating that extant univariate models lack the explanatory capacity to discern the

latent multivariate processes in paediatric injury (Allegrante, Hanson, Sleet, & Marks,

2010).

The purpose of this research project is therefore to develop a model exploring the

multiple pathways involved in child injury risk, which involve factors at the child,

parent and environmental levels. In this thesis, a model is proposed that involves two

tiers, the first of parent factors (parental personality, style, and behaviour) and the

second of child factors (temperament, behaviour, injury) which interact in a

bidirectional manner. In this first stage of pilot testing, preliminary testing of the

second, toddler tier is undertaken. First, measures of temperament are analysed to

confirm factor structure. Second, the psychometric properties of a novel Injury History

Rating Scale, and of observed risky behaviours are assessed. Finally, initial regression

analyses are undertaken to explore the combinations of factors involved in unintentional

injury. In order to orient the reader to the importance of developing a model of child

injury, a brief summary of research taking a univariate approach to injury risk factors if

presented. This is followed by an introduction to the model, and an explication of the


second tier, toddler factors, which will be the focus of pilot testing in this thesis.

Preschool children aged 1 to 4-years are particularly at risk of injury, since their

development renders them limited in their capacity to first discern unsafe situations, and

second safely manipulate them if they arise. As such, young children rely on caregivers

to maintain their safety (Simpson, Turnball, Ardagh, & Richardson, 2009). Parents are

suggested to moderate child injury risk via three fundamental mechanisms; supervision,

teaching safety rules, and modifying the environment (Morrongiello, Ondejko, &

Littlejohn, 2004a; Morrongiello, Ondejko, & Littlejohn, 2004b). Many complex factors

are implicated in determining the quality and quantity of which a parent might

implements these (Schwebel, Brezausek, Ramey, & Ramey, 2004). For example,

assessing environmental risks (Schwebel et al., 2004), accurately predicting the child’s

behaviour (Wells, Morrongiello, & Kane, 2012), and modifying such parental behaviour

as supervision according to the perceived fit between behaviour prediction and risk

assessment (Munro, Van Niekerk, & Seedat, 2006). Patently, several factors determine

how successfully parents perform each of these, with both parent- and child-oriented

factors being important. A set of factors such as the aforementioned parenting

behaviours are more fitting to the phenomena which places or protects against a child at

risk of injury.

Aforementioned factors that have been shown to be fundamental in moderating

child injury risk (e.g., supervision, teaching about safety and hazards), are indeed

important to add to the understanding of injury but being able to predict why some

parents engage in positive levels of these behaviours and others do not is more

important. Morrongiello (2005) highlighted this, by stating the importance of

identifying predictors of specific caregiver behaviours because behaviours vary

according to the context they appear in. There is a paucity of research on the factors that

might explain the differences found in parent-child interactions, even when outward

characteristics appear to be similar. Specifically, what factors could provide an

explanation at a more stable level than behaviour, such as why children have high and

low injury histories when their temperaments are similar and their parents have similar

parenting styles. Personality is a psychobiological characteristic that has been found to

be a sound determinant of behaviour. Likewise, temperament has strong biological

components but due to the plasticity associated with early childhood development, is


not as stable as personality, but is the most stable predictor of child behaviour

(Schwebel & Plumert, 1999).

Toddler temperament is thus always referenced as a leading risk or protective

factor in injury. The three strongest predictor traits of injury risk in toddlers are reported

as (high) activity level, (high) impulsivity, and (low) inhibitory control (Schwebel &

Barton, 2006; Schwebel & Gaines, 2007). High activity and impulsivity have been

found to strongly link with externalised problem behaviours (De Pauw et al., 2009) such

as hyperactivity and low compliance with parental demands (Cole, Koulouglioti,

Kitzman, Sidora-Arcoleo, & Anson, 2009; Morrongiello, Midgett, & Shields, 2001).

Since externalising behaviour is consistently found to relate to increased injury risk

(Van Aken, Junger, Verhoeven, Van Aken, & Deković, 2007; Williams et al., 2009),

and high levels of activity and impulsivity predict greater externalised than internalised

behaviour (Prinzie et al., 2012), children high on these traits are considered to be at a

greater risk of injury. Research has found significant relationships between

temperament and both risk-taking behaviour and the number of injuries endured

(Bijttebier, Vertommen, & Florentie, 2003). One tentative explanation for the pathway

between overestimation of physical abilities and temperament might be that children

with high impulsivity and poor inhibitory control overestimate their ability to complete

a task by way of rapid and incautious judgments about their physical abilities

(Schwebel, 2004a). However, these studies included school-aged children who have

enough cognitive maturity to engage in risk taking consciously.

Figure 1: A Conceptual Risk-Protection model of Childhood Injury.


The conceptual model proposed in this pilot study was developed in response to a

few of the discerned gaps in the child injury literature. The six-variable model is nested

within the framework of developmental theory (Bronfenbrenner’s Bioecological

systems), and thus supports cross-tier interplay or interactional effects between any

combinations of its variables. One of the leading gaps discovered in extant research is

the limited research with a multivariate-focus, especially in child injury and parenting.

That is, the extensive research that has been done on uni- or bivariate relations is likely

to have missed important mutual influences and interaction effects, perhaps leading to

spurious results. This explains why there is no definitive answer to why personality

dimensions as predictors are not consistent across studies when they so reliability and

validly measure the construct, and why studies exploring temperament dimensions do

not consistently derive the same conclusions about the same traits. Parental personality

and Temperament are predictors of emotional climate (warmth, responsiveness, control)

and risky behaviour respectively, while personality also predicts parenting behaviour

but is mediated by emotional climate. That is, parenting behaviour must always be

presented in an emotional context such as a tone of voice or body language, and this

interacts with toddler temperament to influence toddler behaviour. Parenting behaviour

is comprised of supervision, teaching, and modification of the environment, which have

the opportunity to moderate risk twice in the process towards injury. First, it may

moderate the relationship between temperament and risky behaviour, by reducing the

effects of risky traits, and second, by moderating the relationship between risky

behaviour and injury, for example by removing hazards from the environment.

The purpose of this pilot study is to determine the feasibility, reliability, and

validity of the measures (questionnaires) and methods (observation) in order to test the

proposed model of childhood injury. The aims are two-fold, first, to identify the most

influential clusters of temperamental and behavioural factors in unintentional injury,

and secondly to explore and describe interrelations between toddler temperamental,

behavioural and injury variables. Specific hypotheses concerning the variable relations

are not presented as robust extant evidence is lacking. All analyses in this pilot study are

considered exploratory.

Method.


Participants.

The sample included 62 parent-child dyads (56% female, 44% male), who

volunteered to participate either in the survey and observation (n = 48, 77.4%) or online

surveys (no observation; n = 14, 22.6%). Toddlers ranged in age from 16 and 25 months

(M = 21.31, SD = 3.56). Participants were recruited from local relevant sites such as toy

libraries, playgroups, swimming pools, and kindergyms by leaving flyers and promoting

the study in-person. Sociodemographic information about the sample is presented in

Table 1, which shows that toddlers were primarily Australian (61.3%), from dual-parent

families (93.5%), had caregivers who were tertiary educated (61.3%), and from a

residential area associated with a high socioeconomic background (59.7%), according to

Australian Bureau of Statistics’ (ABS) postcode-to-socioeconomic status concordance

(ABS, 2006).

Table 1 Sample sociodemographic characteristics

Males Females Total n % n % n % Cultural background Australian 19 54.3 20 74.1 39 62.9 Australian-other 7 20 3 11.1 10 16.1 Other 9 25.7 4 14.8 13 21.0 Family composition Dual-parent 33 94.3 25 92.6 58 93.5 Single-parent 2 5.7 2 7.4 4 6.5 Postcode socioeconomic status Low 3 8.6 5 18.5 8 12.9 Middle 10 28.6 7 25.9 17 27.4 High 22 62.9 15 55.6 37 59.7 Primary caregivers highest level of education Bachelor/Postgraduate 22 62.8 16 40.7 38 61.3 Diploma or school 13 37.2 11 59.2 24 38.7

Measures.

Questionnaires.

Demographics

The parent-report demographics questionnaire requested information about the

child’s developmental history and familial background such as toddler age, parent’s

education level, and family cultural identity and composition (see Appendix B).


Toddler Temperament.

The Early Childhood Behaviour Questionnaire (ECBQ; Putnam, Ellis, &

Rothbart, 2001) is a 201-item parent-report instrument, which was used to measure

temperament (Appendix B). The measure produces 18 temperament dimension scores

by averaging item scores, with higher scores indicating greater levels of that trait. A 7-

item response scale (1, never to 7, always) gauged the incidence of behavioural displays

of each trait in various situations over the past two weeks. For example, items from the

High Intensity Pleasure (HIP) subscale (HIP is feeling enjoyment at times of intense,

novel, or complex sensory stimuli), ask such questions as “While playing outdoors

[situation], how often did your child, want to climb to high places (for example, up a

tree or on the jungle gym) [behaviour]” The internal consistency of the ECBQ in this

sample was very good, Cronbach’s alpha for 18 dimensions were very good (all α =

>.99). Sound internal consistency is also reported by the original authors’, with α

ranging from .57 for impulsivity to .90 for perceptual sensitivity (Putnam, Ellis, &

Rothbart, 2006).

Injury history.

Injury data were collected from parents retrospectively via the Injury History

Survey (Appendix B), which was developed for an associated project. It is a qualitative

5-columned grid with the following headers: Frequency in past month (e.g., 7 times),

Injury-related activity (e.g., climbing), Injury Description (e.g., bump), Severity (e.g.,

no medical attention), Location/circumstances (e.g., at home). Each row corresponded

to a particular injury type, not an individual event (i.e., frequency of each type were

recorded).

Injury behaviours.

The Injury Behaviour Checklist (IBC; Speltz, Gonzales, Sulzbacher, & Quan,

1990) (Appendix B) is a 24-item parent-report questionnaire, which measures toddlers’

risk of subsequent injuries, based on their risky behaviour and injuries within the past 6

months. Scoring uses a Likert scale from 0 (not at all) to 5 (very often/more than once a

week), and higher scores indicate greater habitual risky behaviour. Of the 24 items, 18

pertain to behaviours that increase risk of injury (e.g., ‘tries to climb on top of furniture

etc.’), while 4 items relate to injuries (e.g., ‘falls down’, ‘burns self with hot objects’).


Internal consistency is found to be very good (.89) (Speltz et al., 1990).

Apparatus

Timers that were used were DSE Digital LCD stopwatches, while Sony

HandyCam (DVDRDVD653) filmed the freeplay sessions, which were recorded onto

an attached Tevion DVD recorder (TEV-605).

Procedures.

Recruitment.

Ethics approval for this research project was granted by the Human Ethics

Research Unit at Deakin University (Appendix A). This study is part of a larger project,

for which invitations to participate were distributed over the first six months of the

years 2010 through 2013. Local toy libraries, kindergyms, and swimming centres in

Victoria, Australia were approached and invited to support the research by promoting

participation. One or two researchers attended consenting sites and conducted short (i.e.,

5 to 10 minute) information sessions about child injury in Australia, and what

participation in the study would entail. If this was not possible, flyers were left on-site

for potential parents. To increase participation rates and allow parents who could not

partake in the observation component to still contribute, the 2013 flyer included a web-

link to online versions of the surveys in the questionnaire pack, which was typically

mailed to participants’ residential address.

Data Collection

Questionnaires

Survey data from parents of toddlers partaking in the observation were collected

by mailing them a questionnaires pack before the observation date for return on testing

day. These packs included the Plain Language Statement and Consent Forms (Appendix

A), and the questionnaires described above (ECBQ, IBC, Injury History, and

demographics). Consent was obtained by signed consent or assumed when they

completed and submitted the survey online.

Observation

The coding protocol for the observation data was designed to measure risky


behaviour using the following five variables: Proximity from parent (seconds), Visual

references (frequency), Verbal bids for attention (frequency), Risky and Innocuous

engagement with hazardous items (seconds), which respectively refer to using items for

their intended purpose or hazardously. To control for experimenter biases, all risky

behaviour variables were either double or tripled coded, in such cases the mean was

used as the raw value.

Toddlers’ risky behaviour observations took place in contrived play area (a 600cm

by 170cm corridor) within the University. Prior to beginning the observation,

questionnaires were collected from parents and the procedure for the session was

explained. Instructions to parents were to try to not interact with their child (i.e.,

interfere with child’s natural behaviour) but also to attend to the child if necessary. The

toddler was directed into the play room, which was setup with nine pseudo-hazardous

items (i.e., an unplugged fan, plastic knife and fork, water-filled cleaning product, pill

bottle, stepladder, extension cord, cord-telephone, and skipping rope) to resemble a

risky home setting (see Figure 2). A plastic box filled with age-appropriate books and

toys, and a small table and chair containing the knife, fork, phone, and pills were also a

part of the playroom. A chair was placed in the corner for the parent to sit on, facing

away from their child during the session. The main and second experimenter began

timing in sync by starting stopwatches pre-set to 10 minutes, once the toddler began

independently playing in the novel environment (see Figure 1). The parent completed a

distractor task. All experimenters were hidden from view. To covertly film the

observation, a video camera was positioned behind a curtain with a viewing hole for the

lens, and operated by the second experimenter. The camera was connected to a

television monitor and DVD recorder in the next room so that observations could be

made in real time and coded later. When the timers finished, recording stopped and the

parent and child were shown out of the corridor; were thanked for their participation,

and debriefed. Testing sessions took from 30 to 60 minutes.


Data Analysis Procedures

Injury history score

To create a quantitative outcome variable ‘Injury’ from the qualitative Injury

History Survey, the data were evaluated and categorised into four subscales (see Table

x). Subscales and items were adapted from the most common injury causes, types, and

body site in 0-14 year olds, according to Victorian Injury Surveillance Unit (2007).

Three items were deemed unsuitable due to their minimal counts of data falling into

these categories: Natural/ environmental/ animals (replaced with ‘other’), skin reaction

(replaced with ‘other’), and non-emergency treatment and emergency treatment (both

were removed; substituted by ‘medically attended injuries’). For each participant, total

frequency (count of all injuries reported on survey) and subtotal frequencies (number of

these attributable to each item, e.g., 1 fall, 1 crush) was recorded. The items totals were

then multiplied by its corresponding score value for two reasons. Firstly, it allows the

injury history scale to function as a measure of both frequency and severity, which

increases reliability and variability, and secondly, it controls for parents’ over- or

erroneous reporting of non-injury events such as crying, shock, or no treatment required

Figure 2: Contrived Playroom set up for Behavioural Observation


(multiplying by zero eliminates them from the score). Importantly, non-injury events

like near misses do not indicate injury but risk of injury, and including them would

affect construct validity, and create a circular argument within the model. Scores were

determined by using Department of Communities, Child Safety and Disability Services’

(CCDS, 2013) severity indicators, with higher scores indicating greater potential for an

injury item to result in extensive injury, lasting damage, or significantly impact

development.

Table 2.

Injury History Subscales and Items n % Subscale

Score value

Cause total 519.00 Falls <1m (level, low e.g., furniture or height e.g., stairs) 413.00 79.58 1 Hit, struck, collide, crush (impact with object/person) 24.00 20.23 2 Natural/ environmental/ animals a Other b 1.00 0.19 1

Body region total 494.00 Head, face, neck 165.00 33.4 2 Trunk 11.00 2.23 1 Upper extremities (hands, fingers, arms) 109.00 22.06 1 Lower extremities (feet, toes, legs) 70.00 14.17 1

Injury type total 330.00 Shock/crying 141.00 28.54 0 Superficial, no blood (bump, bruise) 286.00 86.67 1 Skin reaction (rash, hives)a other b 3.00 0.91 1 Superficial, visible blood (graze, scratch) 32.00 9.7 1 Deep cut, open wound (bleeding requires pressure) 9.00 2.73 2

Treatment total 497.00 No first aid 426.00 85.71 0 Basic first aid 66.00 13.28 1 Non-emergency tx. a 3.00 0.6 Emergency tx. a

Medically attended 2.00 0.4 2 a Items removed due to accounting for low percentages of their subscale totals b Replacement item

Data screening

Data were entered into an SPSS statistics (Version 21) datafile, and examined for

data entry accuracy, missing values, outliers, and distribution normality. After reverse

coding relevant items on the ECBQ, univariate distributions of toddler temperament,


risky behaviour, and injury subscore variables were examined using histograms and

skew and kurtosis statistics; square root transformations were conducted on three

positively skewed independent variables (cuddliness, visual references-verbal bids,

impulsivity). Boxplots and Z-scores identified four outliers using the cut off of ± 3.29

(Field, 2009), the raw values were replaced by converting z 3.29 back into a score value.

The dependent variable Toddler Injury was checked for normality and three outlying

observations were removed from the dataset before satisfying the Shapiro-Wilk test of

normality. Temperament variables were all missing data in the same two cases, these

were removed since they contributed little data.

A Multiple regression analysis was conducted to determine the best linear

combination of risky behaviour and temperament factors (obtained from PCA) for

predicting injury. Assumptions of linearity, normally distributed errors and uncorrelated

errors were satisfied). Independent demographic variables toddler sex and age were

significant and included.

Results.

Preliminary Analyses

The Risky Behaviour observation variables showed good convergent validity,

with five of six behaviours correlating significantly with the IBC subscale ‘risk of

future injury’ (see Table 3). Correlations ranged from .49 for risky engagement (p <.01)

to -.30 (p <.05) for close proximity. Inter-rater reliability based on two or more ratings

was excellent for all variables (r >.90, p <.001).

Table 3.

Correlations between observation variables and criterion measures Risky behaviours IBC risk

Innocuous engagement with risk items .36** Risky engagement with risk items .49** Latency to engage with risk items -.44** Total engagement with risk items .43* Close proximity to parent -.30*

*p<0.05 **p<0.01

Injury history rating scale (IHRS)

Internal consistency (alpha) coefficients for the IHRS’s four subscales were good,

ranging from .76 (treatment) to .80 (body region) (see Table 4). The total Injury Score


reliability was excellent (α =.92). The IHRS also showed sound convergent validity

when compared with the IBC Injury subscale (Injury Score, r = .47, p<.01).

Table 4. Inter-item correlations, reliability and validity statistics N = 47.

M SD α 1 2 3 4 5 Treatment 4.11 2.64 .76 .56** .53** .84** .84** Type 6.06 4.13 .78 .62** .44** .82** Body Region 4.81 3.15 .80 .62** .83** Cause 5.30 2.98 .77 .82** Injury Score b 5.13 2.62 .92 IBC Injury a 0.20* 0.21* 0.22* 0.33* .47** **p <0.01, *p<0.05 a validity, b Total scale score.

Factor Analysis

Toddler temperament

A principal component analysis (PCA) was conducted on the 18 temperament

dimensions using varimax orthogonal rotation to reduce them into factors.

Appropriateness of PCA was supported by Kaiser-Meyer-Olkin’s measure of sampling

adequacy was .647, and Bartlett’s test of sphericity was significant χ2 (153; N = 59) =

394.611, p < .0001. Applying the Kaiser criterion (Eigenvalues ≥ 1) revealed a five

factor structure that retained all traits (see Table 5). The scree plot suggested a sixth

may have been present, so another PCA was run, but only one trait loaded onto the sixth

factor and thus five components were included in the final structure. The communalities

all exceeded .3, further confirming that each item shared some common variance. The

five-factor structure accounted for 65.93% of the variance.

Table 5. Component Loadings, Internal Consistency Estimates, Means, and Standard Deviations for the Five-Factor Toddler Structure of Toddler Temperament

Factor loading α % Variance % Cumulative M SD Factor 1: Negative emotionality

Discomfort .82 0.80 17.508 17.508 2.06 0.81

Fear .68 2.38 0.75

Frustration .69 3.43 0.64

Motor activation .57 2.13 0.81 Sadness .81 2.57 0.76 Factor 2: Focused and controlled

Attentional shifting .64 0.67 16.073 33.581 4.26 0.62

Attentional focusing .76 4.06 0.70

Inhibitory control .65 3.69 0.87 Perceptual sensitivity .64 3.60 1.00


Factor 3: Positive anticipation & Sociability

Low intensity pleasure .55 0.67 13.182 46.763 4.78 0.94

Positive anticipation .75 4.41 1.14 Sociability .71 4.87 1.23 Factor 4: Active & High-intensity seeking

Activity level .85 0.68 9.95 56.712 4.46 0.88 High intensity pleasure .76 4.51 0.83

Impulsivity .48 4.56 0.64 Factor 5: Shy and Cuddly

Soothability .84 0.70 9.212 65.924 5.19 0.74 Cuddliness .78 4.65 0.80 Shyness .80 3.23 0.88

Observed risky behaviour

The same approach was used for PCA of the observed Toddler Behaviour

variables as temperament variables. Five behaviours (latency to engage, risky

engagement, visual references/verbal bids, innocuous engagement, close proximity)

observed during free play were included in the analysis. Table 6 shows four variables

loaded onto a single factor, ‘Risky Behaviour’, after removal of ‘visual

references/verbal bids’ (.274) due to its loading being smaller than 0.3.

Multiple Regression

Linear multiple regression was conducted using the seven identified independent

factors (see Table 7; only statistically significant results are shown) and the interaction

term between toddler sex and Factor 3: Positive Anticipation & Sociability. Table 7. Multiple Regression Coefficients, p-values and confidence intervals for significant predictors and interactions Regression

coefficient p-value 95% CI

Risky behaviour 5.16 0.015 1.08; 9.24 Placid with positive emotionality - 4.80 0.028 - 9.06; - 0.53 Sex × (Positive anticipation & Sociability) 8.31 0.050 - 0.31; 16.94

Table 6. Factor loadings for observed risky behaviour

Factor 1 Risky engagement .675 Close proximity -.506 Innocuous engagement .422 Latency to engage -.398 Visual ref verbal bids .274


The signs of the presented regression coefficients (Table 7) indicate the direction

of the impact of the corresponding variables on the risk of injuries. For example, the

variable with the highest significance is the observation variable Risky behaviour. The

positive sign of the coefficient corresponding to this variable (factor) means that, as

expected, increasing risky behaviour results in increasing injury probability.

The model coefficient adjusted to the sample size R2 = 0.22 means that ~ 22% of

the overall variance of Toddler Injury Score can be explained by the considered

multiple regression model (i.e., by toddler temperament and behaviour adjusted to sex

and age). While this is not a great amount of variance, it satisfies a preliminary purpose

in this pilot study that there are significant interactions, even with a sample that is

relatively small and homogeneous, and using pilot measures.

The conducted regression analysis determined the dependences of the injury risks

(Injury History Score) on the statistically significant independent variables/factors. For

example, Fig. 1 shows the dependence of injury risk on Positive anticipation &

Sociability – Factor 3 from the Toddler Temperament characteristic. This figure gives a

quantitative illustration of how significantly the injury score decreases with increasing

the score for Positive anticipation & Sociability, which is the only statistically

significant factor from the Toddler Temperament characteristic. The presented 95%

prediction intervals for the regression line (Fig. 3) mean that regression lines based on

other possible data samples will lie with 95% probability within the indicated band.

This is a demonstration that Positive anticipation & Sociability, including the significant

variables constituting this factor, is important for the prediction and prevention of

toddler injuries.

Figure 3. The dependence of the injury history score (boys only) on Factor 3 (Positive anticipation & Sociability) from the Toddler Temperament characteristic for all considered


ages. The error bars show the 95% prediction intervals. For girls, the dependence of the injury score on Positive anticipation & Sociability is not significant – not presented here.


Discussion

The findings of this exploratory pilot study determined the feasibility of data

collection methods (observed Risky Behaviour) and measures (Injury History Rating

Scale; Early Childhood Behaviour Questionnaire), and assessed their psychometric

properties. The 18 toddler temperament dimensions were reduced to five factors that

explain almost 70% of the variance, and all other than impulsivity had sound

coefficients over .55. Similarly, the five behavioural observation variables, or Risky

Behaviours, all reduced onto the same factor, allowing analysis to include a single

measure of toddler behaviour. Finally, the Injury History Rating Scale, which produces

four subscale scores (cause, type, body, and treatment) and a total Injury Score, was

developed as a post data collection tool for quantifying qualitatively reported injury

histories. The overall score had excellent validity with another measure of past injuries

(IBC injuries subscale). Moreover, to support the scale’s psychometric robustness in

this sample, patterns such as most common causes in the 1 to 4 years age group were

congruent (i.e., falls most common; location is often home).

The primary analyses strongly underscore the importance of multivariate

investigations. For example, toddler sex was not statistically significant as a separate

variable in multiple regression, however, it appeared as a significant moderating

variable affecting the risk of injuries through its interaction with Factor 3: Positive

anticipation & Sociability (Table 7). Thus, has two different channels of impact on the

injury score – the direct impact with the negative regression coefficient – 4.80, and the

impact through the interaction term with the regression coefficient + 8.31 (Table 7). As

a result, risk of injury for boys is significantly reduced with increasing the Positive

anticipation & Sociability factor, because the interaction term with the positive

regression coefficient is cancelled by the value boys = 0 for the categorical variable

toddler sex. The findings are very different for girls, corresponding to the value girls ≡ 1

for the sex categorical variable. In this case, the contribution of the interaction term with

the positive regression coefficient is not cancelled, and the impact of Positive

anticipation & Sociability on the risk of injury in girls is significantly reduced. In turn,

the overall impact of the Positive anticipation & Sociability Sex factor on risk of

injuries in girls is not statistically significant (with p = 0.35 > 0.05). These contradictory

outcomes for the Positive anticipation & Sociability factor and its impact on the risk of


injuries in boys and girls are important preliminary findings for this study. Nonetheless,

they are disparate to the large body of research suggesting that the most important ‘risk

traits’ are those like activity level and impulsivity (Prinzie et al., 2012; Van Aken,

Junger, Verhoeven, Van Aken, & Deković, 2007; Williams et al., 2009).

Further contradiction to the wealth of research on Activity level as a risk factor for

injury (e.g., Schwebel & Barton, 2006a; Schwebel & Gaines, 2007), toddler boys in this

study with enhanced Activity level and High-intensity pleasure are actually at a lesser

risk of sustaining unintentional injuries (p = 0.042). Although higher levels of activity

and high-intensity pleasure theoretically should increase the risk of injuries, these traits

might also be associated with better developed social skills or better control over

inappropriate responses and behaviour. One explanation is that elevated activity levels

cause a child to experience more environments, and thus develop advanced cognitive

and physical skills that allow them to better manipulate the environment than those

without experience (Plumert, 1995; Plumert and Schwebel, 1997). Therefore, despite

the expectation of higher injury risks with increasing level of activity, the opposite co-

existing tendency towards improved control and satisfaction (positive anticipation)

appears to dominate the increased exposure to potential risks and cause the overall

reduction of injury probability. No such significant dependence has been derived for

girls (p = 0.27).

A Positive toddler’s attitude to the environment and good social skills are

suggested to be a safeguard against potential injuries even though these traits tend to

increase social contact and activity (and in turn, more opportunities for risk; Schwebel,

2001). It may be hypothesised that such increase of the social skills and contact, as well

as positive anticipation from the environment and surrounding people, cause more

compliance with parents and less risky behaviour, for example, due to and thus lesser

incentives towards breaking the existing boundaries and safety limitations. This relates

to evidence of children with externalising behavioural problems or disorders, such as to

non-compliance, poor social skills, or negative emotionality towards their environments

(conversely to these proposed protective traits), for example children with ADHD or

conduct disorder are reported to have experienced more injuries than their unaffected

siblings Shilon, Pollak, Aran, Shaked, & Gross-Tsur, 2011)


Recommendations for follow up study

‘Time constraints’ was the most commonplace reason given by parents of young

children for not participating in the behavioural observation. An online version of the

questionnaires was created in an attempt to counteract this, however, for such reasons as

anonymity (no accountability), and abandonment, participation rates were very low (14

out of >400 parents saw the online advertisement). It is therefore suggested for that

interested participants register and receive a single-user login that allows their survey to

be left and returned to. Registration could also allow for email reminders to be sent. In

addition, a proposed new version of the injury history scale is included in Appendix C,

and is based on the data collected in this pilot.

Conclusion

This pilot study used both observational and survey data, online and face-to-face

participants, and both novel and well-established measures and methods, and rigorously

analysed each to ensure that the follow up studies are both methodologically and

conceptually sound. As such, the aims of the study pertaining to preliminary analyses

was addressed. The overarching model furthermore was developed in response to a gap

in both literature and thus knowledge concerning the aetiological pathways

underpinning paediatric injury. In such an important line of developmental research, it

is crucial to undertake such pilot studies as this one so as to ensure findings and

conclusions are not accepted or rejected erroneously.


References . Practice guide: The assessment of harm and risk of harm. (2013). Queensland, Australia:

Retrieved from http://www.communities.qld.gov.au/resources/childsafety/practice-manual/pg-assess-risk-of-harm.pdf.

Wells, M., Morrongiello, B. A., & Kane, A. (2012). Unintentional injury risk in school-age

children: Examining interrelations between parent and child factors. Journal of Applied Developmental Psychology, 33 189–196.

Shilon, Y., Pollak, Y., Aran, A., Shaked, S., & Gross‐Tsur, V. (2012). Accidental injuries are more common in children with attention deficit hyperactivity disorder compared with their non‐affected siblings. Child: Care, Health and Development, 38(3), 366-370.

Prinzie, P., Deković, M., van den Akker, A. L., de Haan, A. D., Stoltz, S. E., & Jolijn Hendriks, A. (2012). Fathers’ personality and its interaction with children’s personality as predictors of perceived parenting behavior six years later. Personality and Individual Differences, 52(2), 183-189.

Karazsia, B. T., Guilfoyle, S. M., & Wildman, B. G. (2012). The mediating role of hyperactivity and inattention on sex differences in paediatric injury risk. Child Care Health Development, 38(3), 358-365. doi: 10.1111/j.1365-2214.2011.01243.x

Sorenson, S. B. (2011). Gender disparities in injury mortality: consistent, persistent, and larger

than you'd think. Am J Public Health, 101 Suppl 1, S353-358. doi: 10.2105/AJPH.2010.300029

Williams, L. R., Degnan, K. A., Perez-Edgar, K. E., Henderson, H. A., Rubin, K. H., Pine, D.

S., . . . Fox, N. A. (2009). Impact of behavioral inhibition and parenting style on internalizing and externalizing problems from early childhood through adolescence. Journal of abnormal child psychology, 37(8), 1063-1075.

Simpson, J. C., Turnbull, B. L., Ardagh, M., & Richardson, S. (2009). Child home injury prevention: understanding the context of unintentional injuries to preschool children. International Journal of Injury Control and Safety Promotion, 16(3), 159-167.

Field, A. (2009). Discover statistics using SPSS: SAGE Publications Ltd, London, UK. Cole, R., Koulouglioti, C., Kitzman, H., Sidora-Arcoleo, K., & Anson, E. (2009). Maternal

rules, compliance, and injuries to preschool children. Family & Community Health, 32(2), 136.

Van Aken, C., Junger, M., Verhoeven, M., Van Aken, M., & Deković, M. (2007). Externalizing behaviors and minor unintentional injuries in toddlers: common risk factors? Journal of pediatric psychology, 32(2), 230-244.

Schwebel, D. C., & Gaines, J. (2007). Pediatric unintentional injury: behavioral risk factors and implications for prevention. Journal of Developmental & Behavioral Pediatrics, 28(3), 245-254.

Cassell, E., & Clapperto, A. (2007). Preventing unintentional injury in Victorian children aged 0-14 years: a call to action. Melbourne, VIC.: Monash University Accident Research Centre Retrieved from www.monash.edu.au/muarc/visu.

Schwebel, D. C., Hodgens, J. B., & Sterling, S. (2006). How mothers parent their children with

behavior disorders: Implications for unintentional injury risk. Journal of safety


research, 37(2), 167-173. Schwebel, D. C., & Barton, B. K. (2006). Temperament and children’s unintentional injuries.

Handbook of personality and health, 51-71. Putnam, S. P., Gartstein, M. A., & Rothbart, M. K. (2006). Measurement of fine-grained

aspects of toddler temperament: The Early Childhood Behavior Questionnaire. Infant Behavior and Development, 29(3), 386-401.

Munro, S. A., Van Niekerk, A., & Seedat, M. (2006). Childhood unintentional injuries: the perceived impact of the environment, lack of supervision and child characteristics. Child: care, health and development, 32(3), 269-279.

Schwebel, D. C., & Barton, B. K. (2005). Contributions of multiple risk factors to child injury. Journal of pediatric psychology, 30(7), 553-561.

Morrongiello, B. A. (2005). Caregiver supervision and child-injury risk: I. Issues in defining and measuring supervision; II. Findings and directions for future research. Journal of Pediatric Psychology, 30(7), 536-552.

Schwebel, D. C., Brezausek, C. M., Ramey, S. L., & Ramey, C. T. (2004). Interactions between child behavior patterns and parenting: Implications for children's unintentional injury risk. Journal of Pediatric Psychology, 29(2), 93-104.

Schwebel, D. C. (2004). Interactions Between Child Behavior Patterns and Parenting: Implications for Children's Unintentional Injury Risk. Journal of Pediatric Psychology, 29(2), 93-104. doi: 10.1093/jpepsy/jsh013

Morrongiello, B. A., Ondejko, L., & Littlejohn, A. (2004). Understanding toddlers’ in-home

injuries: II. Examining parental strategies, and their efficacy, for managing child injury risk. Journal of pediatric psychology, 29(6), 433-446.

Morrongiello, B. A., Ondejko, M. A., & Littlejohn, A. . (2004). Understanding Toddlers' In-Home Injuries: 1. Context, Correlates, and Determinants. Journal of Pediatric Psychology, 29(6), 16. doi: 10.1093

Ramsay, L., Moreton, G., Gorman, D., Blake, E., Goh, D., Elton, R., & Beattie, T. (2003).

Unintentional home injury in preschool-aged children: looking for the key—an exploration of the inter-relationship and relative importance of potential risk factors. Public health, 117(6), 404-411.

Bijttebier, P., Vertommen, H., & Florentie, K. (2003). Risk-taking behavior as a mediator of the relationship between children's temperament and injury liability. Psychology and Health, 18(5), 645-653.

Schwebel, D. C. (2001). Relations between children's temperament, ability estimation, and unintentional injuries. ProQuest Information & Learning.

Putnam, S. P., Ellis, L. K., & Rothbart, M. K. (2001). The structure of temperament from infancy through adolescence. Advances in research on temperament, 165-182.

Morrongiello, B. A., Midgett, C., & Shields, R. (2001). Don't run with scissors: young children's knowledge of home safety rules. Journal of Pediatric Psychology, 26(2), 105-115.

Schwebel, D. C., & Plumert, J. M. (1999). Longitudinal and concurrent relations among temperament, ability estimation, and injury proneness. Child development, 70(3), 700-712.

Plumert, J. M., & Schwebel, D. C. (1997). Social and temperamental influences on children's overestimation of their physical abilities: Links to accidental injuries. Journal of Experimental Child Psychology, 67(3), 317-337.


Plumert, J. M. (1995). Relations between children's overestimation of their physical abilities and accident proneness. Developmental Psychology, 31(5), 866.

Speltz, M. L., Gonzales, N., Sulzbacher, S., & Quan, L. (1990). Assessment of injury risk in young children: A preliminary study of the Injury Behavior Checklist. Journal of Pediatric Psychology, 15(3), 373-383.

Plain&Language&Statement&&&Consent&Form&to&Parents&of&toddlers& &2013-031: Individual difference in toddlers' water-play behaviour:&version&1:&14th&March,&2013& & Page&1&of&5 &

!!PLAIN!LANGUAGE!STATEMENT!AND!CONSENT!FORM!!TO:!!Parents of toddlers aged 16-25 months! !&&

Plain!Language!Statement!!

Date:!16th!April,!2013!

Full!Project!Title:!Individual!differences!in!toddlers’!waterNplay!behaviour!

Principal!Researcher:!Dr.!Merrilyn!Hooley!Student!Researchers:!Ashleigh!Barber,!Manuela!Barichello,!Mei!Kee!Chun,!Krystal!!Kelley,!Karen!Lim,!Cassandra!Whelan!&

&

1. Your Consent

You are invited to take part in this research project.

This Plain Language Statement contains detailed information about the research project. Its purpose is to explain to you as openly and clearly as possible all the procedures involved in this project so that you can make a fully informed decision whether you are going to participate.

Please read this Plain Language Statement carefully. Feel free to ask questions about any information in the document. You may also wish to discuss the project with a relative or friend or your local health worker. Feel free to do this.

Once you understand what the project is about and if you agree to take part in it, you will be asked to complete the linked Survey. By completing and submitting the survey you indicate that you understand the information provided and that you give your consent to participate in the research project.

You are welcome to print a copy of the Plain Language Statement for your records.

2. Purpose and Background

The purpose of this project is to identify factors (such as parent personality/parenting style, and toddlers’ temperament) that are associated with toddlers’ risk of accidental injury. A number of student researchers are involved in this project; they are all post-graduate students in the School of Psychology, working towards a Graduate Diploma in Psychology.

A total of approximately 300 parents will participate in this project.

Ashleigh Barber

Appendix APlain Language Statement and Ethics Approval


Previous experience has shown that accidental injury is the leading cause of death for children aged 0-4 years with male children suffering higher rates of injury than female children. Our research is designed to help identify some characteristics of the environment and of toddlers, and explore how these factors interact to influence toddlers’ injury history. Some aspects of our research involve observing toddlers aged 16-25 months exploring in a play area at Deakin University; if you would like to be involved in these experiments please contact the researchers. Other aspects of our research involve surveying a large number of parents of toddlers to see how parent/child interactions might be associated with risk. You are invited to participate in the online survey.

3. Methods and Participant demands

The online survey can be accessed by clicking on the link below. Completing, and submitting the survey will be taken as consent to participate. Participation in the survey should take approximately 20 minutes. In completing the survey you will be asked to provide some background information about your child and provide information about you and your child’s personalities and your child’s recent injury history. The survey information we are collecting will provide us with background information about your child that might help us to understand individual differences in the ways different children explore the environment, and the types and rates of injuries that these different children suffer. Examples of questions you will be asked about your child are:

“How quickly does your child adapt to new surroundings?”

“How often does your child suffer accidental injuries that require some attention?”

“Has your child ever had an accident that required a visit to a hospital? If so, describe the accident, or accidents, if more than one?”

We will also ask you some questions about yourself. This is because we are studying the relationship between the approach that parents use in the way they raise children, and the way that children behave in the Perception and Action Laboratory. Examples of questions that you will be asked are:

“How quickly do you adapt to new surroundings?”

How strongly do you agree with the following statement: “As a parent, I consistently give my children direction and guidance in rational and objective ways”

How strongly do you agree with the following statement: “It is easy for me to understand what my child wants or needs”

4. Possible Benefits and risks to participants

There are no direct benefits to you for participating in this research however your contribution will help us to better understand the factors that contribute to child injury and inform targeted interventions.

5. Possible Risks and risks to the wider community

Possible benefits of this research include improvements to evidence-based injury interventions and educational programs which may help to reduce the rate of injuries in toddlers within the general community.

6. Privacy, Confidentiality and Disclosure of Information

No identifying information will be collected as part of the survey so you will not be able to be identified. The overall results of the research will be made public at conferences and by publication in journals.

7. Results of Project

The results of the project will be disseminated via articles in peer-review journals and conferences. A website will be set up which will summarise the results of the first phase of the research at the


completion of the project for participants. You will be provided a URL when you submit the survey. A summary of results should be available after November.

8. Participation is Voluntary

9. Ethical Guidelines

This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007) produced by the National Health and Medical Research Council of Australia. This statement has been developed to protect the interests of people who agree to participate in human research studies.

The ethics aspects of this research project have been approved by the Human Research Ethics Committee of Deakin University.

10. Complaints

If you have any complaints about any aspect of the project, the way it is being conducted or any questions about your rights as a research participant, then you may contact:

The Manager, Research Integrity, Deakin University, 221 Burwood Highway, Burwood Victoria 3125, Telephone: 9251 7129, [email protected]

Please quote project number 2013-031.

11. Further Information, Queries or Any Problems

If you require further information, wish to withdraw your participation or if you have any problems concerning this project, you can contact the principal researcher.

The researcher responsible for this project is:

Dr. Merrilyn Hooley PhD

School of Psychology,

Deakin University

221 Burwood Highway,

Burwood, 3125

Ph: B/H 92446499

Email: [email protected]


!!PLAIN!LANGUAGE!STATEMENT!AND!CONSENT!FORM!!TO:!!Parents of toddlers aged 16-25 months!&

Third!Party!Consent!Form!

(To!be!used!by!parents/guardians!of!minor!children,!or!carers/guardians!consenting!on!behalf!of!adult!participants!who!do!not!have!the!capacity!to!give!informed!consent)!

!

Date:!


Principal!Researcher:!Dr.!Merrilyn!Hooley!Student!Researchers:!Ashleigh!Barber,!Manuela!Barichello,!Mei!Kee!Chun,!Krystal!!Kelley,!Karen!Lim,!Cassandra!Whelan!&

&I&have&read&and&I&understand&the&attached&Plain&Language&Statement.!

I&give&my&permission&for&……………………………………………………(name&of&participant)&to&participate&in&this&project&according&to&the&conditions&in&the&Plain&Language&Statement.&&&I&have&been&given&a&copy&of&Plain&Language&Statement&and&Consent&Form&to&keep.&

The&researcher&has&agreed&not&to&reveal&my&identity&and&personal&details,&including&where&information&about&this&project&is&published,&or&presented&in&any&public&form.&&&

&&!&&Participant’s&Name&(printed)&……………………………………………………&

Name&of&Person&giving&Consent&(printed)&……………………………………………………&&&

Relationship&to&Participant:&………………………………………………………&&

Signature&………………………………………………………& Date&&…………………………&

& &


!!PLAIN!LANGUAGE!STATEMENT!AND!CONSENT!FORM!!TO:! Parents of toddlers!!

Release!Consent!Form!

(To!be!used!by!parents/guardians!of!minor!children,!or!carers/guardians!consenting!on!behalf!of!adult!participants!who!do!not!have!the!capacity!to!give!informed!consent)!

Date:!


Principal!Researcher:!Dr.!Merrilyn!Hooley!Student!Researcher:! Ashleigh!Barber,!Manuela!Barichello,!Mei!Kee!Chun,!Krystal!!Kelley,!Karen!Lim,!Cassandra!Whelan!

I have read and I understand the attached Plain Language Statement and understand that my child will be videotaped while they explore and play in two novel environments. I also understand that I will also appear in some of this video when I am in proximity to my child.

I give my permission for the image of my child to be used during the presentation of the results of this research FOR EDUCATIONAL PURPOSES ONLY (e.g. in research conference presentation). I understand that my image may also appear in the background of my child’s image. I understand that my child’s (and in cases my) images will ONLY be used in restricted environments, and will remain under the control of the Principal Investigator who will NOT release the images for use by other individuals. I give my consent to the restricted use of my child’s …………………………………………………… (name of participant) and my images for use for educational purposes. The researcher has agreed not to reveal my identity and personal details.

Participant’s Name (printed) ……………………………………………………

Name of Person giving Consent (printed) ……………………………………………………

Relationship to Participant: ………………………………………………………

Signature ……………………………………………………… Date …………………………

Memorandum

To:

From:

Date:

Subject: 2013-031

Individual difference in toddlers' water-play behaviour

Dr Merrilyn Hooley

School of Psychology

B

Deakin University Human Research Ethics Committee (DUHREC)

13 May, 2013

Please quote this project number in all future communications

The modification to this project, submitted on 1/05/2013 has been approved by the committee executive on13/05/2013.

cc:

Human Research Ethics

Deakin Research Integrity 70 Elgar Road Burwood Victoria Postal: 221 Burwood Highway Burwood Victoria 3125 Australia Telephone 03 9251 7123 Facsimile 03 9244 6581 [email protected]

Approval has been given for Dr Merrilyn Hooley, School of Psychology, to continue this project as modified to14/03/2017.

In addition you will be required to report on the progress of your project at least once every year and at theconclusion of the project. Failure to report as required will result in suspension of your approval to proceed withthe project.

DUHREC may need to audit this project as part of the requirements for monitoring set out in the NationalStatement on Ethical Conduct in Human Research (2007).

• Serious or unexpected adverse effects on the participants• Any proposed changes in the protocol, including extensions of time.• Any events which might affect the continuing ethical acceptability of the project.• The project is discontinued before the expected date of completion.• Modifications are requested by other HRECs.

The approval given by the Deakin University Human Research Ethics Committee is given only for the project andfor the period as stated in the approval. It is your responsibility to contact the Human Research Ethics Unitimmediately should any of the following occur:

Human Research Ethics [email protected]: 03 9251 7123

1

Some information about your child Would you please provide some background information about your child and your household. The purpose of this information is to allow us to describe our sample, as well as identify aspects of your child’s stage of development. 1. Please circle your child’s gender? Male / Female 2. What is your child date of birth? ______/________/______ 3. Please indicate you child’s height ___________________ (cm) 4. Please indicate you child’s weight ____________________(kg) 5. How long has your child been crawling? _______________ Months 6. How long has your child been standing? ________________ Months 7. How long has your child been walking using supports? ______________ Months 8. How long has your child been walking without supports? ____________ Months 9. Does your child, or has your child ever participated in any of the following structured activities? If yes, please note for how long they have been involved and how often participation occurs. Leave blank if No. Activity Yes Duration (months) Daily / Weekly / Fortnightly / Monthly Swimming Lessons Kiddy gym Play group Music Other 10. Does your child attend child care or have regular formal or informal care? Carer Yes Daily/ Weekly / Fortnightly/ Monthly Child Care Nanny Family Friends / Neighbours 11. Does your child have a disability or special needs? Yes / No Please describe ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Ashleigh Barber

Appendix BParent-Report Questionnaires

2

Household information 12. What is your cultural identity? ________________________________________ 13. What is your postcode? _____________________________ 14. Do you own a swimming pool or spa? Yes / No 15. If yes, is the water site fenced to Australian standards? Yes / No 16. Please indicate the primary carer for your child. Primary Caregiver Tick Myself My Partner Myself and My partner Other Family member Friend / Neighbour Nanny / Professional Other (please note) 17. Does your child have any siblings? If yes, please circle their gender and note their year of birth Sibling Gender Year of birth 1 Male / Female 2 Male / Female 3 Male / Female 4 Male / Female 18. Are you a single parent family? No / Yes Female / Yes Male 19. What is your highest level of education? Please include your partner if applicable. Level of Education You Your Partner Primary / secondary school Diploma Degree Post-graduate 20. What is your labour force status? Please include your partner if applicable. Labour force status You Your Partner ‘Stay-at-home’ carer Unemployed Employed Casual Employed Part time Employed Full time Thank you

Early Childhood behaviour QuestionnaireChild’s name: ______________________ Child’s birthdate: Mo:____ Day:____ Yr:____

Today’s date: Month:____ Day:____ Year:____ Child’s Age: ______ Years, ______Months

Relation to child: ______________________ Sex of child (circle one): Male Female

INSTRUCTIONS: Please read carefully before starting.

As you read each description of the child’s behaviour below, please indicate how often the child did this during the last two weeks by circling one of the numbers in the right column. These numbers indicate how often you observed the behaviour described during the last two weeks.

less about morevery than half half than half almost does not

never rarely the time the time the time always always apply1 2 3 4 5 6 7 NA

The “Does Not Apply” column (NA) is used when you did not see the child in the situation described during the last two weeks. For example, if the situation mentions the child going to the doctor and there was no time during the last two weeks when the child went to the doctor, circle the (NA) column. “Does Not Apply” (NA) is different from “NEVER” (1). “Never” is used when you saw the child in the situation but the child never engaged in the behaviour mentioned in the last two weeks. Please be sure to circle a number or NA for every item.

When told that it was time for bed or a nap, how often did your child react with anger? 1 2 3 4 5 6 7 NAget irritable? 1 2 3 4 5 6 7 NA

When approached by an unfamiliar person in a public place (for example, the grocery store), how often did your child remain calm? 1 2 3 4 5 6 7 NApull back and avoid the person? 1 2 3 4 5 6 7 NAcling to a parent? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your childstartle at loud noises (such as a fire engine siren)? 1 2 3 4 5 6 7 NAtap or drum with fingers on tables or other objects? 1 2 3 4 5 6 7 NAget irritated by scratchy sounds? 1 2 3 4 5 6 7 NAbecome uncomfortable when his/her socks were not

aligned properly on his/her feet? 1 2 3 4 5 6 7 NA

After getting a bump or scrape, how often did your child forget about it in a few minutes? 1 2 3 4 5 6 7 NA

While playing outdoors, how often did your childlike making lots of noise? 1 2 3 4 5 6 7 NAenjoy sitting quietly in the sunshine? 1 2 3 4 5 6 7 NAwant to climb to high places (for example, up a tree

or on the jungle gym)? 1 2 3 4 5 6 7 NA

When s/he was carried, how often did your childlike to be held? 1 2 3 4 5 6 7 NApush against you until put down? 1 2 3 4 5 6 7 NAsquirm? 1 2 3 4 5 6 7 NAstruggle to get away? 1 2 3 4 5 6 7 NAsnuggle up next to you? 1 2 3 4 5 6 7 NA

While having trouble completing a task (e.g., building, drawing, dressing), how often did your childget easily irritated? 1 2 3 4 5 6 7 NAbecome sad? 1 2 3 4 5 6 7 NA

When a familiar child came to your home, how often did your childengage in an activity with the child? 1 2 3 4 5 6 7 NAseek out the company of the child? 1 2 3 4 5 6 7 NA

When offered a choice of activities, how often did your childstop and think before deciding? 1 2 3 4 5 6 7 NAdecide what to do very quickly and go after it? 1 2 3 4 5 6 7 NAseem slow and unhurried about what to do next? 1 2 3 4 5 6 7 NA

When asked NOT to, how often did your childrun around your house or apartment anyway? 1 2 3 4 5 6 7 NA

touch an attractive item (such as an ornament) anyway? 1 2 3 4 5 6 7 NAplay with something anyway? 1 2 3 4 5 6 7 NA

During daily or evening quiet time with you and your child, how often did your childenjoy just being quietly sung to? 1 2 3 4 5 6 7 NAsmile at the sound of words, as in nursery rhymes? 1 2 3 4 5 6 7 NAenjoy just being talked to? 1 2 3 4 5 6 7 NAenjoy rhythmic activities, such as rocking or swaying? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your childbecome distressed when his/her hands were dirty and/or sticky? 1 2 3 4 5 6 7 NAnotice that material was very soft (cotton) or rough (wool)? 1 2 3 4 5 6 7 NAnotice low-pitched noises such as the air-conditioner, heater,

or refrigerator running or starting up? 1 2 3 4 5 6 7 NAblink a lot? 1 2 3 4 5 6 7 NAget very enthusiastic about the things s/he was going to do? 1 2 3 4 5 6 7 NA

While at home, how often did your childshow fear at a loud sound (blender, vacuum cleaner, etc.)? 1 2 3 4 5 6 7 NAseem afraid of the dark? 1 2 3 4 5 6 7 NA

When visiting the home of a familiar adult, such as a relative or friend, how often did your childwant to interact with the adult? 1 2 3 4 5 6 7 NA

While bathing, how often did your childsit quietly? 1 2 3 4 5 6 7 NAsplash, kick, or try to jump? 1 2 3 4 5 6 7 NA

While playing outdoors, how often did your childlook immediately when you pointed at something? 1 2 3 4 5 6 7 NAchoose to take chances for the fun and excitement of it? 1 2 3 4 5 6 7 NAnot like going down high slides at the amusement park

or playground? 1 2 3 4 5 6 7 NA

When s/he was upset, how often did your childchange to feeling better within a few minutes? 1 2 3 4 5 6 7 NAsoothe only with difficulty? 1 2 3 4 5 6 7 NAstay upset for 10 minutes or longer? 1 2 3 4 5 6 7 NA

When engaged in play with his/her favourite toy, how often did your childplay for 5 minutes or less? 1 2 3 4 5 6 7 NAplay for more than 10 minutes? 1 2 3 4 5 6 7 NAcontinue to play while at the same time responding

to your remarks or questions? 1 2 3 4 5 6 7 NA

When approaching unfamiliar children playing, how often did your childwatch rather than join? 1 2 3 4 5 6 7 NAapproach slowly? 1 2 3 4 5 6 7 NAseem uncomfortable? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your childcomplain about odors on others, such as perfume? 1 2 3 4 5 6 7 NAseem to be bothered by bright light? 1 2 3 4 5 6 7 NA move quickly from one place to another? 1 2 3 4 5 6 7 NA notice the smoothness or roughness of objects s/he touched? 1 2 3 4 5 6 7 NA become sad or blue for no apparent reason? 1 2 3 4 5 6 7 NA

After having been interrupted, how often did your childreturn to a previous activity? 1 2 3 4 5 6 7 NA have difficulty returning to the previous activity? 1 2 3 4 5 6 7 NA

While watching TV or hearing a story, how often did your childseem frightened by ‘monster’ characters? 1 2 3 4 5 6 7 NA

When you suggested an outdoor activity that s/he really likes, how often did your childrespond immediately? 1 2 3 4 5 6 7 NA run to the door before getting ready? 1 2 3 4 5 6 7 NA

When told that loved adults would visit, how often did your childget very excited? 1 2 3 4 5 6 7 NA become very happy? 1 2 3 4 5 6 7 NA

When taking a quiet, warm bath, how often did your childseem to relax and enjoy him/herself? 1 2 3 4 5 6 7 NA

When s/he couldn’t find something to play with, how often did your childget angry? 1 2 3 4 5 6 7 NA During sleep, how often did your childtoss about in the bed? 1 2 3 4 5 6 7 NA sleep in one position only? 1 2 3 4 5 6 7 NA

During quiet activities, such as reading a story, how often did your childswing or tap his/her foot? 1 2 3 4 5 6 7 NAfiddle with his/her hair, clothing, etc.? 1 2 3 4 5 6 7 NA show repeated movements like squinting, hunching up

the shoulders, or twitching the facial muscles? 1 2 3 4 5 6 7 NA

While playing indoors, how often did your childlike rough and rowdy games? 1 2 3 4 5 6 7 NAenjoy playing boisterous games like ‘chase’? 1 2 3 4 5 6 7 NA enjoy vigorously jumping on the couch or bed? 1 2 3 4 5 6 7 NA

In situations where s/he is meeting new people, how often did your childturn away? 1 2 3 4 5 6 7 NA become quiet? 1 2 3 4 5 6 7 NA seem comfortable? 1 2 3 4 5 6 7 NA

When being gently rocked or hugged, how often did your childseem eager to get away? 1 2 3 4 5 6 7 NAmake protesting noises? 1 2 3 4 5 6 7 NA

When encountering a new activity, how often did your childsit on the sidelines and observe before joining in? 1 2 3 4 5 6 7 NAget involved immediately? 1 2 3 4 5 6 7 NA

When visiting the home of a familiar child, how often did your childengage in an activity with the child? 1 2 3 4 5 6 7 NA seek out the company of the child? 1 2 3 4 5 6 7 NA

When another child took away his/her favorite toy, how often did your childscream with anger? 1 2 3 4 5 6 7 NA not become angry? 1 2 3 4 5 6 7 NA sadly cry? 1 2 3 4 5 6 7 NA not react with sadness? 1 2 3 4 5 6 7 NA

When engaged in an activity requiring attention, such as building with blocks, how often did your childmove quickly to another activity? 1 2 3 4 5 6 7 NA stay involved for 10 minutes or more? 1 2 3 4 5 6 7 NA tire of the activity relatively quickly? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your childpay attention to you right away when you called

to him/her? 1 2 3 4 5 6 7 NAseem to be disturbed by loud sounds? 1 2 3 4 5 6 7 NAstop going after a forbidden object (such as a VCR)

when you used a toy to distract her/him? 1 2 3 4 5 6 7 NAnotice small things, such as dirt or a stain, on

his/her clothes? 1 2 3 4 5 6 7 NA

While in a public place, how often did your childseem uneasy about approaching an elevator or escalator? 1 2 3 4 5 6 7 NA cry or show distress when approached by an unfamiliar animal? 1 2 3 4 5 6 7 NA seem afraid of large, noisy vehicles? 1 2 3 4 5 6 7 NA show fear when the caregiver stepped out of sight? 1 2 3 4 5 6 7 NA

When playing outdoors with other children, how often did your child seem to be one of the most active children? 1 2 3 4 5 6 7 NA sit quietly and watch? 1 2 3 4 5 6 7 NA

During daily or evening quiet time with you and your child, how often did your child want to be cuddled? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your child seem frightened for no apparent reason? 1 2 3 4 5 6 7 NA seem to be irritated by tags in his/her clothes? 1 2 3 4 5 6 7 NA notice when you were wearing new clothing? 1 2 3 4 5 6 7 NA react to beeping sounds (such as when the microwave

or oven is done cooking)? 1 2 3 4 5 6 7 NA show repeated movements like squinting, hunching up

the shoulders, or twitching the facial muscles? 1 2 3 4 5 6 7 NA

When being dressed or undressed, how often did your child squirm and try to get away? 1 2 3 4 5 6 7 NA stay still? 1 2 3 4 5 6 7 NA

When told “no”, how often did your child stop an activity quickly? 1 2 3 4 5 6 7 NA stop the forbidden activity? 1 2 3 4 5 6 7 NA ignore your warning? 1 2 3 4 5 6 7 NA become sadly tearful? 1 2 3 4 5 6 7 NA

Following an exciting activity or event, how often did your child calm down quickly? 1 2 3 4 5 6 7 NA have a hard time settling down? 1 2 3 4 5 6 7 NA seem to feel down or blue? 1 2 3 4 5 6 7 NA become sadly tearful? 1 2 3 4 5 6 7 NA

When given something to eat that s/he didn’t like, how often did your child become angry? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your child seem able to easily shift attention from one activity to another? 1 2 3 4 5 6 7 NA do more than one thing at a time (such as playing with

a toy while watching TV)? 1 2 3 4 5 6 7 NA

While playing indoors, how often did your child run through the house? 1 2 3 4 5 6 7 NA climb over furniture? 1 2 3 4 5 6 7 NA not care for rough and rowdy games? 1 2 3 4 5 6 7 NA enjoy activities such as being spun, etc.? 1 2 3 4 5 6 7 NA

When playing alone, how often did your child become easily distracted? 1 2 3 4 5 6 7 NA play with a set of objects for 5 minutes or longer at

a time? 1 2 3 4 5 6 7 NA scratch him/herself? 1 2 3 4 5 6 7 NA tear materials close at hand? 1 2 3 4 5 6 7 NA

Before an exciting event (such as receiving a new toy), how often did your child get so worked up that s/he had trouble sitting still? 1 2 3 4 5 6 7 NA get very excited about getting it? 1 2 3 4 5 6 7 NA remain pretty calm? 1 2 3 4 5 6 7 NA seem eager to have it right away? 1 2 3 4 5 6 7 NA

When s/he asked for something and you said “no”, how often did your child become frustrated? 1 2 3 4 5 6 7 NA protest with anger? 1 2 3 4 5 6 7 NA have a temper tantrum? 1 2 3 4 5 6 7 NA become sad? 1 2 3 4 5 6 7 NA

While playing or walking outdoors, how often did your child notice sights or sounds (for example, wind chimes

or water sprinklers)? 1 2 3 4 5 6 7 NA notice flying or crawling insects? 1 2 3 4 5 6 7 NA

When you gave your child an attractive toy, how often did your child grab the object as soon as it was set down? 1 2 3 4 5 6 7 NA look the object over before touching it? 1 2 3 4 5 6 7 NA

When asked to wait for a desirable item (such as ice cream), how often did your child seem unable to wait for as long as 1 minute? 1 2 3 4 5 6 7 NA go after it anyway? 1 2 3 4 5 6 7 NA wait patiently? 1 2 3 4 5 6 7 NA whimper and cry? 1 2 3 4 5 6 7 NA

When being gently rocked, how often did your child smile? 1 2 3 4 5 6 7 NA make sounds of pleasure? 1 2 3 4 5 6 7 NA

While visiting relatives or adult family friends s/he sees infrequently, how often did your child stay back and avoid eye contact? 1 2 3 4 5 6 7 NA hide his/her face? 1 2 3 4 5 6 7 NA “warm up” to the person within a few minutes? 1 2 3 4 5 6 7 NA

When you removed something s/he should not have been playing with, how often did your child become sad? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your child become bothered by sounds while in noisy environments? 1 2 3 4 5 6 7 NA become bothered by scratchy materials like wool? 1 2 3 4 5 6 7 NA notice changes in your appearance (such as wet hair,

a hat, or jewellery)? 1 2 3 4 5 6 7 NA appear to listen to even very quiet sounds? 1 2 3 4 5 6 7 NA seem full of energy, even in the evening? 1 2 3 4 5 6 7 NA

When interrupted during a favuorite TV show, how often did your child immediately return to watching the TV program? 1 2 3 4 5 6 7 NA not finish watching the program? 1 2 3 4 5 6 7 NA

While being held on your lap, how often did your child pull away and kick? 1 2 3 4 5 6 7 NA seem to enjoy him/herself? 1 2 3 4 5 6 7 NA mould to your body? 1 2 3 4 5 6 7 NA seek hugs and kisses? 1 2 3 4 5 6 7 NA

While a story was being read to your child, how often did s/he enjoy listening to the story? 1 2 3 4 5 6 7 NA

When hearing about a future family outing (such as a trip to the playground), how often did your child become very enthusiastic? 1 2 3 4 5 6 7 NA look forward to it? 1 2 3 4 5 6 7 NA remain pretty calm? 1 2 3 4 5 6 7 NA

While looking at picture books on his/her own, how often did your child stay interested in the book for 5 minutes or less? 1 2 3 4 5 6 7 NA stay interested in the book for more than 10 minutes

at a time? 1 2 3 4 5 6 7 NA become easily distracted? 1 2 3 4 5 6 7 NA enjoy looking at the books? 1 2 3 4 5 6 7 NA

When tired after a long day of activities, how often did your child become easily frustrated? 1 2 3 4 5 6 7 NA

When a familiar adult, such as a relative or friend, visited your home, how often did your child want to interact with the adult? 1 2 3 4 5 6 7 NA

When asked to do so, how often was your child able to stop an ongoing activity? 1 2 3 4 5 6 7 NA lower his or her voice? 1 2 3 4 5 6 7 NA be careful with something breakable? 1 2 3 4 5 6 7 NA

When visiting a new place, how often did your child not want to enter? 1 2 3 4 5 6 7 NA go right in? 1 2 3 4 5 6 7 NA

While you were showing your child how to do something, how often did your child jump into the task before it was fully explained? 1 2 3 4 5 6 7 NA

While you were talking with someone else, how often did your child easily switch attention from speaker to speaker? 1 2 3 4 5 6 7 NA

During everyday activities, how often did your child become irritated when his/her clothes were tight? 1 2 3 4 5 6 7 NA notice smells from cooking? 1 2 3 4 5 6 7 NA crock back and forth while sitting? 1 2 3 4 5 6 7 NA notice sirens from fire trucks or ambulances at a distance? 1 2 3 4 5 6 7 NA When you mildly criticised or corrected her/his behaviour, how often did your child get mad? 1 2 3 4 5 6 7 NA have hurt feelings? 1 2 3 4 5 6 7 NA

When s/he was upset, how often did your child cry for more than 3 minutes, even when being comforted? 1 2 3 4 5 6 7 NA cheer up within a minute or two when being comforted? 1 2 3 4 5 6 7 NA become easily soothed? 1 2 3 4 5 6 7 NA

When you were busy, how often did your child find another activity to do when asked? 1 2 3 4 5 6 7 NA

While playing outdoors, how often did your child want to jump from heights? 1 2 3 4 5 6 7 NA

want to go down the slide in unusual ways (for example, head first)? 1 2 3 4 5 6 7 NA

enjoy being pushed fast on a wheeled vehicle? 1 2 3 4 5 6 7 NA enjoy sitting down and playing quietly? 1 2 3 4 5 6 7 NA

When playing alone, how often did your child chew his/her lower lip? 1 2 3 4 5 6 7 NA stick out his/her tongue when concentrating? 1 2 3 4 5 6 7 NA move from one task or activity to another without

completing any? 1 2 3 4 5 6 7 NA have trouble focusing on a task without guidance? 1 2 3 4 5 6 7 NA

When given a wrapped present, how often did your child become extremely animated? 1 2 3 4 5 6 7 NA

When around large gatherings of familiar adults or children, how often did your child want to be involved in a group activity? 1 2 3 4 5 6 7 NA enjoy playing with a number of different people? 1 2 3 4 5 6 7 NA

When s/he was asked to share his/her toys, how often did your child become sad? 1 2 3 4 5 6 7 NA

Injury History Survey

Most toddlers experience some injuries as they learn to navigate their environment. Frequently these injuries occur because toddlers are unable to control their own movements or regulate their own behaviours. Examples of ‘self-inflicted injury’ situations are: climbing on furniture and falling off, stumbling down stairs and falling, jamming fingers in doors, standing beneath low benches and bumping heads, running downhill and falling, slipping over and unintentionally immersing while trying to stand in the bath etc. Would you please provide us with some information about the types of injuries your toddler has experienced over the past month. The information we are collecting include (i) the most common types of injuries that your child has suffered in the past month, (ii) a description of the type of injury, and (iii) how severe the injuries were (e.g. your child required your attention, medical attention, medical intervention, hospitalisation etc.), (iv) the location/circumstances. If you require more space, please continue your description on the other side of the paper. Frequency in past month

Injury-related activity

Injury descriptions

Severity Location/circumstances

Examples x times in last month

Climbing on furniture

1 x Bump on head

Had a bruise for 2 days, did not require medical attention

At home with Mum In playground at child care

Injury History Log Record Sheet Page 1

WEEK 1 01/01/2014 to 07/01/2014 Injury incidents (tick each applicable box vertically)

Child name/ID: 1 2 3 4 5 Totals

Cause Fall (height, off-ground, & level) Collision (impact hit, strike, collide,

crush)

Other: (please describe)

Body region Head, face, neck Trunk Upper extremities Lower extremities Shock/crying Injury type Superficial, no blood (bump, bruise)

Skin reaction (rash, hives) Superficial, visible blood (graze,

scratch)

Deep cut, open wound (bleeding requires pressure)

Treatment No first aid Basic first aid (band aids, icepack) Medically attended

Incident Totals

Ashleigh Barber

Appendix CProposed New Injury History Rating Scale Log

Ashleigh Barber

Ashleigh Barber

Injury History Log Descriptions of Causes, Types, Body Locations, and Treatments GUIDE

Cause Fall Climbing, reaching, leaning, pulling or pushing, running, tripped

a. Height (1m or less) b. Off-ground (e.g. couch) c. Level (trips over)

Collision (impact)

a. Hit b. Strike c. Collide d. Crush e. Other

Body region

a. Head b. Face c. Neck

Trunk Upper extremities

a. Hands b. Fingers c. Arms

Lower extremities

a. Toes b. Feet c. Legs

Shock/crying

a. No physical injury, but child might be frightened or in shock (NB must proceed an injury event – crying is not considered if it does not follow a near-miss or mild injury).

Injury type Superficial No blood or broken skin

a. Bump b. Bruise c. Swelling

Skin reaction

a. Rash b. Hives

Superficial Broken skin, visible blood but not bleeding

a. Graze b. Scratch c. Cut

Deep skin broken Bleeding requires pressure to stop

a. Open wound b. Piercing c. Cut

Treatment

a. No first aid (no medical treatment – e.g., a cuddle or a rub)

b. Basic first aid (band aids, icepack, anything at home)

c. Medically attended (calling a nurse, doctor, visiting hospital, doctors appointment next day – any attention sought relating to that incident that is professional medical attention is considered).

The Interrelations between Toddler Temperament, Risky Behaviour, and Unintentional Injury: A model and pilot study

Documents