Showing papers in "Journal of Developmental and Behavioral Pediatrics in 2014"

Neurodevelopmental outcomes of infants born prematurely.

Abstract: Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Later school start time is associated with improved sleep and daytime functioning in adolescents.

Abstract: Objective: Chronic insufficient sleep is a growing concern among adolescents and is associated with a host of adverse health consequences. Early school start times may be an environmental contributor to this problem. The purpose of this study was to examine the impact of a delay in school start time on sleep patterns, sleepiness, mood, and health-related outcomes. Method: Boarding students (n 5 197, mean age 5 15.6 yr) attending an independent high school completed the School Sleep Habits Survey before and after the school start time was experimentally delayed from 8:00 a.m. to 8:25 a.m. Results: The delay in school start time was associated with a significant (29 min) increase in sleep duration on school nights. The percentage of students receiving 8 or more hours of sleep on a school night increased to more than double, from 18% to 44%. Students in 9th and 10th grade and those with lower baseline sleep amounts were more likely to report improvements in sleep duration after the schedule change. Daytime sleepiness, depressed mood, and caf- feine use were all significantly reduced after the delay in school start time. Sleep duration reverted to baseline levels when the original (earlier) school start time was reinstituted. Conclusions: A modest (25 min) delay in school start time was associated with significant improvements in sleep duration, daytime sleepi- ness, mood, and caffeine use. These findings have important implications for public policy and add to research suggesting the health benefits of modifying school schedules to more closely align with adolescents' circadian rhythms and sleep needs.

Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study.

Abstract: The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSM-IV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.

PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial.

Abstract: Objective: To evaluate the effectiveness of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASDs) compared with CS only. Methods: Children (N 5 128) with autism or PDD-NOS (DSM-4 criteria) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were randomized in two 1-year cohorts. Using videotape and written feedback within a developmental framework, PLAY con- sultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/ language and occupational therapy and public education services. Primary outcomes included change in parent-child interactions, language and development, and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression and home consultant fidelity. Data were collected pre- and post-intervention. Results: Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group, although functional development improved signif- icantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers' stress did not increase, and depressive symptomatology decreased. Home consultants administered the intervention with fidelity. Conclusions: PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents' stress/depression. ADOS findings must be interpreted cautiously because results do not align with clinical experience. PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents. (J Dev Behav Pediatr 35:475-485, 2014) Index terms: developmental outcomes, early intervention, parent-mediated intervention.

Associations between parenting, media use, cumulative risk, and children's executive functioning.

Abstract: Objective This study was designed to examine how parenting style, media exposure, and cumulative risk were associated with executive functioning (EF) during early childhood. Methods A nationally representative group of US parents/caregivers (N = 1156) with 1 child between 2 and 8 years participated in a telephone survey. Parents were asked to report on their child's exposure to television, music, and book reading through a 24-hour time diary. Parents also reported a host of demographic and parenting variables as well as questions on their child's EF. Results Separate multiple regressions for preschool (2-5 years) and school-aged (6-8 years) children grouped by cumulative risk were conducted. Parenting style moderated the risks of exposure to background television on EF for high-risk preschool-age children. Educational TV exposure served as a buffer for high-risk school-aged children. Cumulative risk, age, and parenting quality interacted with a number of the exposure effects. Conclusions The study showed a complex pattern of associations between cumulative risk, parenting, and media exposure with EF during early childhood. Consistent with the American Academy of Pediatrics, these findings support the recommendation that background television should be turned off when a child is in the room and suggest that exposure to high-quality content across multiple media platforms may be beneficial.

Intervention for Optimal Outcome in Children and Adolescents with a History of Autism

Abstract: Objective: Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. These children are considered to have achieved "optimal outcomes" (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA). Method: The current study examined intervention histories in 25 individuals with OO and 34 individuals with HFA (current age, 8-21 years), who did not differ on age, sex, nonverbal intelligence, or family income. Intervention history was collected through detailed parent questionnaires. Results: Children in the OO group had earlier parental concern, received earlier referrals to specialists, and had earlier and more intensive intervention than those in the HFA group. Substantially more children with OO than HFA received applied behavior analysis (ABA) therapy, although for children who received ABA, the intensity did not differ between the groups. Children in the HFA group were more likely to have received medication, especially antipsychotics and antidepressants. There were no group differences in the percent of children receiving special diets or supplements. Conclusion: These data suggest that OO individuals generally receive earlier, more intense interventions, and more ABA, whereas HFA individuals receive more pharmacologic treatments. Although the use of retrospective data is a clear limi- tation to the current study, the substantial differences in the reported provision of early intervention, and ABA in particular, is highly suggestive and should be replicated in prospective studies. (J Dev Behav Pediatr 35:247-256, 2014) Index terms: autism spectrum disorder, optimal outcomes, intervention history, medication.

Age at first autism spectrum disorder diagnosis: the role of birth cohort, demographic factors, and clinical features

Abstract: Objective This study sought to identify factors that may be associated with delays in autism spectrum disorder (ASD) diagnosis, including birth cohort, sociodemographic characteristics, and clinical features. Methods Participants included 1716 children and adolescents with ASD enrolled in the Autism Speaks Autism Treatment Network (AS-ATN) between the years 2008 and 2011. Data were collected at enrollment using AS-ATN parent- and clinician-report forms and standardized measures of I.Q., ASD symptoms, adaptive function, and psychiatric symptoms. Results Age at first ASD diagnosis was positively correlated with current age, suggesting a birth cohort effect. Sociodemographic and clinical features were also associated with age at diagnosis, even after controlling for current age. Hierarchical linear regression results showed that older current age, lower socioeconomic status (SES), higher I.Q. score, and lower levels of autism symptoms were associated with later age at initial diagnosis. There was also a significant interaction between current age and I.Q., with higher functioning children being diagnosed at younger ages than in previous years. Conclusions Early diagnosis of ASD is critically important for improving access to interventions; however, many children experience diagnostic delays. In this sample, children from the most recent birth cohorts were diagnosed earlier, suggesting that early signs of ASD are being increasingly recognized. However, socioeconomic barriers to diagnosis still seem to exist. Children with less severe ASD symptoms and with higher I.Q. are also diagnosed at later ages. Efforts are still needed to reduce diagnostic disparities for families of low SES and to improve early recognition of more subtle symptoms.

Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits

Abstract: Objective: To assess the effectiveness of a child care center-based parent and teacher healthy lifestyle role-modeling program on child nutrition and physical activity outcomes. Methods: Child care cen- ters (N 5 28) serving low-income families were randomized to intervention or control arms. Intervention centers (N 5 12) implemented (1) menu modifications, (2) a child's healthy lifestyle curriculum, and (3) an adult (teacher- and parent-focused) healthy lifestyle role-modeling curriculum. Control centers (N 5 16) received an attention control safety curriculum. Nutrition and physical activity data were collected at the beginning (T1) and at the end (T2) of the school year. Exploratory factor analysis identified positive and negative nutrition and physical activity practices by children, parents, and teachers. Results: Intervention parents' baseline ( b5 .52, p < .0001) and school year consumption ( b5 .47, p < .0001) of fruits/vegetables significantly increased their children's consumption of fruits/vegetables from T1 to T2. Intervention parents significantly influenced a decrease in children's junk food consumption ( b5 2.04, p < .05), whereas control parents significantly influenced an increase in their children's junk food consumption ( b5 .60, p < .001) from T1 to T2. Control children showed a significant increase in junk food consumption ( b5 .11, p 5 .01) and sedentary behavior ( b5 .09, p < .005) from T1 to T2. Teachers did not significantly influence preschool-age children's nutrition or physical activity patterns from T1 to T2. Conclusions: Parent nutrition and physical activity patterns significantly influence their preschool-age children's consumption of fruits/vegetables, junk food, and level of sedentary behavior. Future obesity prevention intervention efforts targeting this age group should include parents as healthy lifestyle role models for their children. (J Dev Behav Pediatr 35:378-387, 2014) Index terms: obesity, preschool, childcare, prevention, early childhood.

Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools

Abstract: :Objective:To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD).Method:Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n

Meta-Analytic Findings of the Relation Between Maternal Prenatal Stress and Anxiety and Child Cognitive Outcome

Abstract: :Objective:Different studies have revealed mixed findings regarding the relation between maternal prenatal stress or anxiety (MPSA) and early child cognitive outcome. Different methodological considerations may be linked to the absence of clear support for this hypothesized link. The purpose

Predictive validity of the Bayley, Third Edition at 2 years for intelligence quotient at 4 years in preterm infants.

Abstract: OBJECTIVE To determine the predictive validity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at age 2 years for cognitive abilities in preschool children born at ≤ 30 weeks' gestation. METHODS This prospective regional study included all 187 liveborn infants ≤ 30 weeks' gestation born between July 2005 and June 2006. Of the 172 children who survived to 4 years, 156 (91%) were evaluated at 2 and 4 years. A socioeconomically matched term control group also was recruited to provide normative data. The predictive validity of the Bayley-III cognitive and language scales for the Weschler Preschool and Primary Scale of Intelligence-III (WPPSI-III) was examined through correlation coefficients and sensitivity and specificity of the Bayley-III to predict normal and abnormal cognitive outcomes. RESULTS Correlations of the WPPSI-III intelligence quotient (IQ) score with the Bayley-III cognitive and language scores were .81 and .78, respectively. The preterm children were classified as normal (Bayley Scales of Infant Development-Third Edition [BSID-III] cognitive score or WPPSI-III IQ score not lower than 1 SD below the control group mean), mild to moderately delayed (scores between 1 and 2 SD deviations below the control group mean), or severely delayed (scores greater than 2 SD below the control group mean). At 2 and 4 years, 126 (81%) preterm children retained the same developmental classification. CONCLUSIONS In contrast with previous editions of the BSID, the Bayley-III has strong predictive validity for WPPSI-III IQ at age 4 years in preterm children. This has important implications for more timely evaluation of perinatal interventions, establishment of guidelines for neonatal care, and counseling parents.

A national profile of Tourette syndrome, 2011-2012

Abstract: Tourette Syndrome (TS) is a tic disorder characterized by motor and phonic tics, usually emerging between 5–8 years of age, with tics persisting for at least one year.1 Prevalence estimates of TS among children vary widely, ranging from 0.4%–5.0% in community samples.2 The first prevalence estimate based on a large, nationally representative sample of non-institutionalized US children, the 2007 National Survey of Children s Health, reported that 0.3% of US children aged 6–17 years had ever been diagnosed with TS.3 TS is a chronic condition, with tic severity generally peaking between ages 10–12 years, and often diminishing by early adulthood.4, 5 Given the age of presentation, children with tics may first present to primary care physicians and are often co-managed with subspecialists, such as developmental and behavioral pediatricians, psychologists, neurologists and psychiatrists. TS often co-occurs with one or more other neurobehavioral conditions, including attention-deficit/hyperactivity disorder and obsessive-compulsive disorder.1, 5, 6 Tics and symptoms of co-occurring conditions can both independently, and concurrently, impact family and peer relationships, education and health, including increased parent aggravation and health care needs, problems making friends or being teased, and problems in academic performance including with reading, speaking and concentration.5, 7–9 However, previous studies examining the impact of TS have been limited by small sample sizes, no control groups, or clinic or convenience samples with limited generalizability to larger populations. Given the chronicity of TS, the presence of co-occurring conditions, and its impact across a number of settings (school, health, peers, family), children with TS may benefit from coordinated care within a medical home.10 One study found that children with TS and a co-occurring mental disorder are less likely than children without TS to have a medical home.7 Our study provides a broad overview of TS among a nationally representative sample of US children by providing the recent estimates available for the prevalence of TS and co-occurring conditions, the association of TS with indicators of health, parenting aggravation and academic functioning, and the relationship between the presence of a co-occurring condition and TS severity with health and functioning among children with TS.

Adverse events in children: predictors of adult physical and mental conditions

Abstract: CASE: A senior member of a 5-person pediatric group recently heard a presentation about the Adverse Childhood Experiences (ACE) study. He decided to present the study to his colleagues with the intention of incorporating a similar screening tool for ACE in their practice.The ACE study assessed adverse child experiences recalled by 17,000 adult patients who were participating in a comprehensive medical evaluation at a large Health Maintenance Organization. The ACE questionnaire assessed emotional, physical, and sexual abuse; emotional and physical neglect; mother treated violently; household substance abuse; household mental abuse; parental separation or divorce; and incarcerated household members (http://www.acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf).Thirty-six percent of the participants did not endorse any ACE. One, 2 or 3 ACE's were endorsed by 26%, 16%, and 9.5%, respectively. Four or more ACEs were endorsed by 12% of the cohort. The study found that "the major risk factors for causes of death in adults, smoking, alcohol abuse, obesity, physical inactivity, use of illicit drugs, promiscuity, and suicide attempts, were all increased by ACEs. Compared with persons with an ACE score of 0, those with an ACE score of 4 or more were twice as likely to be smokers, 12 times more likely to have attempted suicide, 7 times more likely to be alcoholic, and 10 times more likely to have injected street drugs" (2).When he researched the ACE study further, the pediatrician discovered that there was a modified form of the ACE study questions available for parents of children and adolescents. The members of the pediatric practice were intrigued by the reported relationship between ACEs and the high prevalence of chronic physical and mental health conditions and economic outcomes. Could this be a method for pediatricians to screen for risks of serious physical and psychiatric diseases in adult life? A brisk discussion followed about what they would do with this information if the ACE screening questions were used in their practice. Is it an effective strategy for primary care pediatric practice? Language: en

Trajectories and predictors of nocturnal awakenings and sleep duration in infants

Abstract: :Objectives:To examine the trajectories of sleep duration and nocturnal awakenings in infants from 6 to 18 months of age and to identify predictors of short sleep duration and nocturnal awakeningsMethods:Data for this study come from the Norwegian Mother and Child Cohort Study conducted at

Conceptualization of autism in the Latino community and its relationship with early diagnosis.

Abstract: :Objective:Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non-Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the

Maternal behaviors promoting language acquisition in slow-to-talk toddlers: prospective community-based study.

Abstract: OBJECTIVE: To determine, in a community-based sample of slow-to-talk toddlers, the extent to which specific maternal responsive behaviors at 24 months predict child language at 24 and 36 months. METHODS: Mother-child dyads were recruited for this prospective longitudinal study from 3 local government areas spanning low, middle, and high socioeconomic status in Melbourne, Australia. At child age 18 months, 1138 parents completed a 100-word expressive vocabulary checklist; the 251 (22.1%) children scoring ≤20th percentile were then followed up to comprise this study. PREDICTORS: Six maternal responsive behaviors (imitations, interpretations, labels, expansions, supportive directives and responsive questions) were derived from mother-child free-play videos collected at 24 months of age and coded using the Observer XT system. OUTCOMES: Expressive and receptive language measured at 24 and 36 months of age (Preschool Language Scale-4), blind to maternal responsiveness ratings. RESULTS: Two hundred and twenty-six of the 251 (90.0%) mother-child dyads were followed up at 36 months. In confounder-adjusted linear regression analyses, expansions, imitations, and responsive questions were strongly associated with better receptive and expressive language at 24 and 36 months. Labels unexpectedly predicted poorer expressive language at 36 months. Expansions were the only maternal behavior that predicted improvement in language between 24 and 36 months. CONCLUSIONS: Maternal responsive behaviors, particularly expansions, offer promise in enhancing early language learning in slow-to-talk toddlers. Parent-child interactions characterized by frequent use of maternal labels at 24 months could also be a predictive marker of those slow-to-talk toddlers at greater risk of persistent language problems.

Race and ethnic differences in early childhood maltreatment in the United States

Abstract: OBJECTIVE:: In the United States, over 6 million children were referred to child protective services in 2012. Black children are overrepresented among children investigated for child abuse and neglect. Understanding why black children are disproportionately reported for maltreatment is critical to informing policy and practice solutions. Two competing theories attribute disproportionality to either racial bias or concentrated risk factors. Although prior work has focused on national data, this study examines the relationship between risk factors and maltreatment at the state level, focusing on outcomes for young children. METHOD:: We examine the relationship between early childhood poverty and maltreatment victimization across white, black, and Hispanic children (0-3 years). Using state-level data (N = 48), we determine ratios of disproportionate outcomes in child maltreatment and associations to poverty and other risk factors. RESULTS:: Study findings for state-level data show greater disproportionality of black and Hispanic children living in poverty relative to their white counterparts. This imbalance is associated with greater disproportionality in maltreatment rates. RESULTS also indicate that disproportionality of maltreatment rates was associated with state disproportionality in rates of unmarried and teenage mothers for blacks and Hispanics. CONCLUSION:: Exposure to risks such as poverty is an important factor driving the overrepresentation of minority groups in the child welfare system. Effective strategies for reducing maltreatment must include strategies for reducing poverty and supporting young at-risk mothers. Language: en

Standardized screening facilitates timely diagnosis of autism spectrum disorders in a diverse sample of low-risk toddlers.

Abstract: Objective Routine, standardized screening for autism spectrum disorder (ASD) has been hypothesized to reduce known racial/ethnic and socioeconomic status (SES) disparities in age of first diagnosis. This study explored demographic differences in toddlers' age and performance on developmental measures at the time of ASD assessment. Method Toddlers (16-39 months at evaluation) who screened at-risk for developmental delay on the Modified Checklist for Autism in Toddlers (M-CHAT) or M-CHAT-Revised (M-CHAT-R) and follow-up interview participated in a diagnostic assessment. Of these, 44.7% were racial/ethnic minorities and 53.5% were non-minorities. Child race/ethnicity, years of maternal education (MEd), and household yearly income (YI) were parent-reported. Results Small but significant correlations were observed between MEd or YI and evaluation age and adaptive communication, socialization, and motor scores. Controlling for MEd and YI, minority racial/ethnic group did not predict child's performance on most measures and did not predict likelihood of ASD diagnosis. Differences in age at evaluation and receptive language skills were small effects. Conclusion Significant but small effects emerged for SES and minority status on toddlers' age at evaluation and parent-reported adaptive skills, but these did not predict ASD diagnosis. The small magnitude of these effects suggests that routine, standardized screening for ASD in toddlers and timely access to diagnostic evaluation can reduce disparities in age at diagnosis and possibly reduce racial/ethnic disparities in access to services for ASD and other developmental delays.

Utilization Patterns of Conventional and Complementary/Alternative Treatments in Children with Autism Spectrum Disorders and Developmental Disabilities in a Population-Based Study

Abstract: :Objective:To compare the utilization of conventional treatments and utilization of complementary and alternative medicine in preschoolers with autism spectrum disorders (ASD) and other developmental disabilities (DD).Methods:Participants were 578 children who were part of an ongoing populat

Associations Between Adult Attachment Style, Emotion Regulation, and Preschool Children's Food Consumption

Abstract: :Objective:The goal of this study was to test 3 serial mediation models of how caregiver adult attachment style influences children's food consumption through its influence on emotion regulation. Three mediators that have been shown to increase the risk for pediatric obesity and that are lik

Fine motor skills in children with prenatal alcohol exposure or fetal alcohol spectrum disorder.

Abstract: Objective Prenatal alcohol exposure (PAE) can cause fetal alcohol spectrum disorders (FASD) and associated neurodevelopmental impairments. It is uncertain which types of fine motor skills are most likely to be affected after PAE or which assessment tools are most appropriate to use in FASD diagnostic assessments. This systematic review examined which types of fine motor skills are impaired in children with PAE or FASD; which fine motor assessments are appropriate for FASD diagnosis; and whether fine motor impairments are evident at both "low" and "high" PAE levels. Methods A systematic review of relevant databases was undertaken using key terms. Relevant studies were extracted using a standardized form, and methodological quality was rated using a critical appraisal tool. Results Twenty-four studies met inclusion criteria. Complex fine motor skills, such as visual-motor integration, were more frequently impaired than basic fine motor skills, such as grip strength. Assessment tools that specifically assessed fine motor skills more consistently identified impairments than those which assessed fine motor skills as part of a generalized neurodevelopmental assessment. Fine motor impairments were associated with "moderate" to "high" PAE levels. Few studies reported fine motor skills of children with "low" PAE levels, so the effect of lower PAE levels on fine motor skills remains uncertain. Conclusions Comprehensive assessment of a range of fine motor skills in children with PAE is important to ensure an accurate FASD diagnosis and develop appropriate therapeutic interventions for children with PAE-related fine motor impairments.

Parent and provider perspectives on procedural care for children with autism spectrum disorders.

Abstract: :Objective:Children with autism spectrum disorders (CWASDs) have more difficulty tolerating hospital procedures than many other children. The aim of this study was to identify parent and provider perspectives on barriers and facilitators to procedural care for CWASDs.Methods:Semistructured i

Anxiety associated with asthma exacerbations and overuse of medication: the role of cultural competency.

Abstract: CASE Toshi, a 14-year-old Japanese boy, had uncontrolled asthma after relocating from Japan with his family 1 year ago. In Japan, he was diagnosed with moderate, persistent asthma, which was controlled with salmeterol and albuterol on an as needed basis. Since moving to the United States, Toshi complained of frequent dyspnea.Initially, he was seen by a Japanese physician who prescribed 200 mg of fluticasone 3 times a day and albuterol nebulization as needed. When Toshi came to the Pediatric Primary Care Clinic, he reported using his nebulizer up to 25 times daily. A physical examination revealed a thin, anxious, jittery, hypertensive, and tachycardic adolescent with hyperreflexia and dysmetria. Toshi complained of difficulty breathing, in the absence of wheezing or respiratory distress; peak flow recordings in the office were normal. Furthermore, he had a history of "panic attacks," being a "worrier," and stopped attending school, playing sports, and socializing over the past 6 months due to his "breathing difficulties."Citalopram was prescribed for anxiety, but the family's apprehension about mental health disorders led to resistance to treatment recommendations. With motivational interviewing and negotiation, Toshi and his family agreed to a trial of citalopram. Three months later, he no longer took fluticasone or albuterol. The tachycardia, hypertension, and neurological symptoms improved. As he gained weight and improved his strength, he attended classes and participated in sports.A few months later, with improvement of his health, Toshi and his parents decided to discontinue citalopram. He then developed behaviors consistent with generalized anxiety and obsessive-compulsive disorder. Currently, his symptoms associated with anxiety have worsened, but he and his family are resistant to medication or initiating cognitive behavioral therapy due to their cultural beliefs regarding mental health disorders.

Sensory over-responsivity in a sample of children seeking treatment for anxiety

Abstract: Sensory over-responsivity (SOR) refers to an exaggerated, intense, or prolonged behavioral response to ordinary sensory stimuli.1 Although many terms have been used to label this phenomenon (e.g., sensory intolerance, hypersensitivity, hyper-responsiveness, sensory defensiveness, sensory-processing sensitivity), all share a core symptom description of a heightened and atypical reaction to sensory stimulation to a degree that impacts daily functioning. SOR is most commonly reported in association with tactile and auditory stimuli, such as clothing textures, sticky substances, and alarms or sirens.2 Developmental research suggests that elevated SOR symptoms are early-emerging, chronic, and associated with child and family impairment and increased risk for social and emotional problems.3,4 SOR symptoms have long been recognized in the field of occupational therapy,5 but the relation of SOR to psychopathology has only begun to be studied in recent years. Existing data suggest that SOR occurs both concurrently and independently of psychiatric disorders, leading to debate about the proper nosological classification and diagnostic validity of SOR.6,7 SOR is not currently recognized in the International and Statistical Classification of Diseases and Related Health Problems8 and is included in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)9 only as a symptom of autism spectrum disorders (despite evidence that SOR is not specific to autism).10 The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised (DC:0–3R)11 includes the provisional diagnostic category, “Regulation Disorder of Sensory Processing,” of which “hypersensitive” is a subtype (along with other provisional symptom clusters such as hyposensitive and sensory stimulation-seeking). Although this is the most commonly used DC:0–3R category, diagnostic reliability is poor among experts and existing criteria lack empirical backing.11,12 Therefore, there is no universally agreed upon operational definition of SOR, nor are there established criteria upon which to identify clinically significant SOR symptoms or to differentiate SOR from other symptoms or disorders. Controversy over how to properly conceptualize and classify SOR is largely due to limited data concerning the construct’s clinical significance, etiology, and relationship to existing psychiatric diagnoses in terms of distinct clinical characteristics and rates of co-occurrence. Recent research indicates that SOR does occur independently of existing DSM diagnoses. Two large scale studies examined rates of SOR and co-occurring DSM-IV13 diagnoses in well-characterized, population-based samples of typically developing children (i.e., children without cognitive disabilities or autism spectrum disorders).3,14,15 Both samples were school-aged children (7–10 years old;3 7 years old15) whose parents completed a structured diagnostic interview (Diagnostic Interview Schedule for Children)16 and the Sensory Over-Responsivity Inventory (SensOR),17 a parent-report measure of SOR in the tactile and auditory domains. SOR status was based on the SensOR but criteria differed in each study, such that children were classified has having SOR if parents endorsed ≥ 4 items in the Carter et al. study and ≥ 6 tactile or ≥ 4 auditory items in the Van Hulle et al. study. Across both studies, SOR was found to occur in isolation in approximately 8–15% of children. SOR co-occurred with DSM-IV disorders in about 5–12% of children, such that about 25–60% of children with SOR also met criteria for a psychiatric disorder. Rates of co-occurrence between SOR and specific DSM diagnoses remain unclear. Most research to date has focused on SOR among those with autism spectrum disorders (ASD), and estimates of SOR and ASD co-occurrence range from 23%18 to 56%.19 While some have viewed this high rate of co-occurrence as evidence that SOR is specific to ASD (as DSM 5 criteria imply), other evidence indicates that these results may be better attributable to a general maturational delay. For example, Baranek et al.10 found that mental age was an equally strong predictor of hyperresponsiveness across groups of children with autism, developmental delays, and typical development, such that increased mental age was associated with decreased hyperresponsivity across all three groups. The authors concluded that SOR may reflect an important developmental, transdiagnostic process rather than a specific ASD symptom or distinct syndrome. Among typically developing children, there are speculations in the literature that SOR is more common in those with anxiety disorders, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). However, this information is largely based on anecdotal case reports,20,21 studies using a broader definition of sensory problems14 (e.g., including both over- and under-responsiveness), and research using unsystematically diagnosed or poorly characterized samples. In the Carter et al.3 and Van Hulle et al.15 studies, rates of specific psychiatric disorders were not reported, but the rate of diagnoses within the broad domains of internalizing disorders among those with SOR ranged from 10.0%3 to 70.4%15 and externalizing disorders from 18.5%3 to 50.4%.15 In order to better understand the relationship of SOR to psychopathology, quantitative research examining the construct within well-characterized clinical samples is needed. One particular clinical sample that warrants further examination in this regard is children with anxiety disorders. Anxiety is one of the most frequently implicated internalizing problems among children with both SOR and psychopathology.22 In studies examining infant and preschooler temperament, SOR in the auditory and tactile domains has been found to be positively correlated with anxiety22,23 and fearfulness.24 Among toddlers with ASD, SOR was found to emerge before anxiety and predict later development of anxiety.18 While these studies suggest a relationship between SOR and anxiety broadly defined, some have argued that SOR may be more specific to certain anxiety disorders, such as obsessive-compulsive disorder (OCD).21,25 However, research on the relationship between anxiety and SOR is extremely limited, making it difficult to evaluate the possible ways in which these constructs may be distinct or overlap. To date, no studies have examined SOR within a sample of children with clinically significant anxiety who do not have developmental delays or disabilities. Therefore, we sought to examine the SOR construct within a sample of children presenting for outpatient treatment with primary complaints of anxiety. The current study was exploratory in nature and sought to examine the phenomenology of SOR in this sample of youth who all demonstrated clinically significant psychiatric symptoms. The SOR construct was examined broadly using the SensOR, a parent-report checklist of bothersome sensory experiences. Study aims were to: 1) examine the frequency and course of SOR symptoms in this sample, 2) compare prevalence rates of SOR to those reported in population-based samples, 3) explore whether SOR symptom frequency differs across categorical demographic variables and psychiatric disorder diagnoses, and 4) examine the relationship between SOR symptoms and continuous measures of psychopathology.

The effects of a stress management intervention in elementary school children.

Abstract: :Objective:This preliminary study tests the effectiveness of an elementary school-based stress management technique on anxiety symptoms and heart rate variability (HRV) in children.Methods:In this controlled prospective longitudinal study, children in third-grade classroom participated in a

An evaluation of the efficacy of a triple P-positive parenting program podcast series.

Abstract: Parenting programs based on cognitive-behavioral and social learning principles are effective in changing child behavior problems and parenting styles. However, such programs typically have limited population reach. The current study aimed to evaluate the efficacy of a brief radio series that provided parenting advice based on the Triple P-Positive Parenting Program. One hundred thirty-nine parents of children aged 2 to 10 years who had concerns about their child's behavioral and/or emotional adjustment were recruited, randomly assigned to either an intervention or waitlist control group, and completed online self-report measures. Parents in the intervention group were given access to seven Triple P podcasts online over a period of 2 weeks. Parents in the intervention group improved significantly more than parents in the control group, from pre- to postintervention, on measures of child behavioral problems and parenting style, self-efficacy, and confidence. These short-term intervention effects were maintained at the 6-month follow-up. These results suggest that brief radio and online parenting programs can be effective and have the potential to reach a large proportion of parents experiencing child behavior problems. Limitations, clinical significance, and future research suggestions are discussed.

Family routines and social-emotional school readiness among preschool-age children.

Abstract: Objective To determine whether preschool-age children's participation in family routines is associated with greater likelihood of having high social-emotional health (SEH). Methods Data come from the Early Childhood Longitudinal Study-Birth Cohort preschool wave, a nationally representative sample of children born in 2001. Based on the literature and distribution of responses, 5 routines were categorized as present if children participated in family dinners ≥5 days per week, reading, storytelling, or singing ≥3 times per week, and play ≥few times per week. A total routines score (0-5) was also computed. Mothers rated children's SEH on 24 items scored 1 through 5. Items were summed into a total score, which was dichotomized at >1 SD above the mean, to reflect low/high SEH. Multivariable analyses assessed associations between SEH, routines score, and individual routines, adjusting for confounders. Results Among ∼8550 children, 16.6% had high SEH. For each additional routine in which a child participated, there was a 1.47 greater odds of having high SEH. In adjusted models, participating in dinners: 1.4 (95% confidence interval [CI], 1.3-1.6), storytelling: 1.9 (95% CI, 1.6-2.4), singing: 1.5 (95% CI, 1.2-1.9), and play: 1.3 (95% CI, 1.1-1.5) was associated with increased odds of high SEH. Reading was not associated with greater odds of high SEH (1.2, 95% CI, 0.9-1.5). Conclusions Participation in a higher number of routines and in select routines was associated with increased likelihood of having high SEH. Promoting family routines may contribute to greater SEH before school entry.

Child and adolescent psychopathology predicts increased adult body mass index: results from a prospective community sample.

Abstract: OBJECTIVE To examine the relationship between childhood and adolescent symptoms of (1) depression, (2) attention-deficit hyperactivity disorder (ADHD), and (3) conduct disorder (CD) with adult body mass index (BMI) in a prospective longitudinal study of 3294 community participants in the Ontario Child Health Survey. METHODS One thousand nine hundred ninety-two children aged 4 to 11 years and 1302 adolescents aged 12 to 16 years at study entry in 1983 underwent follow-up in 2000. Body mass index data were available for 1886 adult participants in the year 2000, which comprised the final study sample. Data were collected from youth, parents, and teachers using a combination of parental, youth, and teacher self-report and semistructured interview. Body mass index is a derived variable determined from the self-reported height and weight in 2000. RESULTS Adults with depression, ADHD, or CD identified in childhood had increased body weight (BMI = 27.2 kg/m, 27.7 kg/m, and 27.9 kg/m, respectively) compared with their nonaffected peers (BMI = 24.8 kg/m; p < .001). Greater depressive symptoms in childhood were associated with increased adult BMI among boys (p = .02). Among adolescents, depression and sex interact in the association with adult BMI (p = .01). The association of childhood ADHD with adult overweight was completely accounted for by the effect of comorbid child conduct disturbance (p < .001) for both girls and boys. Greater conduct symptoms were associated with increased adult BMI (p = .04) among adolescent girls. CONCLUSION This epidemiologic study suggests that psychopathology in childhood is associated with increased adult BMI. Early identification of psychiatric illness may present key opportunities for targeted prevention of obesity.

Primary care providers' initial treatment decisions and antidepressant prescribing for adolescent depression.

Abstract: Adolescent depression is a serious public health problem which is under-recognized as well as undertreated.1 The primary care setting may be a key place where adolescent mental health concerns can be addressed. Most adolescents have a usual place of health care,2 and up to one-third of adolescents presenting to primary care have an emotional problem, with 14% screening positive for depression.3, 4 Furthermore adolescents with mental health problems more frequently visit their primary care provider (PCP) than do adolescents without mental health problems.5 Understanding how PCPs make treatment decisions for depressed adolescents and identifying the factors that influence these decisions may help increase the initiation of depression treatment in the primary care setting. Current PCP guidelines for adolescent depression recommend active support and monitoring (or watchful waiting) for mild depression, and cognitive behavioral therapy (CBT) and/or selective serotonin reuptake inhibitors (SSRIs) for moderate or severe depression.6-8 CBT is recommended for first-line treatment in the primary care setting,9 especially for moderate depression which may respond to CBT alone.7, 8 SSRIs, which show a greater benefit for lowering depressive symptoms for severely depressed teens compared with moderate or mildly depressed teens, are the first-line treatment for patients with a severe major depressive disorder diagnosis with or without psychotherapy.7, 10 A mental health consultation is also strongly encouraged for severely depressed teens.7 Of note, a recent systematic review and meta-analysis found limited evidence for the effectiveness of antidepressants in children and adolescents, especially at follow-up,11 and there are a small number of trials with positive findings.12 However, many factors beyond treatment guidelines influence PCPs’ treatment decisions for adolescent depression, such as structural barriers to care including poor access to mental health specialists, insurance barriers, and insufficient training in depression management.13 For families in many parts of the United States, access to specialty pediatric mental health care is characterized by long waits for appointments associated with an insufficient and poorly distributed mental health workforce, particularly child psychiatrists.14-16 Many pediatric PCPs lack training in the treatment of depression, and therefore, may lack confidence to prescribe antidepressants independently.17-19 Indeed, studies suggest that only one quarter of pediatric PCPs had recently independently prescribed an SSRI for an adolescent.17, 19 PCPs are particularly likely to refer patients to mental health specialists when symptoms are severe,20, 21 and due to discomfort with prescribing antidepressants,17, 18, 22 may prefer to refer a more severely depressed adolescent to child psychiatry for medication management as opposed to initiating medication themselves. While prior studies have examined PCP treatment decisions for adolescent depression, in many cases structural barriers may have dominated PCP decision-making, reducing the ability to study other PCP-level factors that influence treatment decisions for depressed adolescents. For this reason, we sought to examine this issue in a practice environment with fewer structural barriers due to frequent access to on-site mental health therapists, PCP training in depression diagnosis and management, and communication between PCPs and mental health providers through an integrated electronic health record. The current work addresses this gap by examining PCP beliefs about adolescent depression treatment in a setting with few structural barriers, allowing a clearer perspective on the impact of PCP characteristics and beliefs on their intentions. We examined PCPs’ initial treatment decisions using adolescent depression scenarios, assessing the impact of depression severity and other related factors on these treatment decisions. These other factors were exploratory due to limited research in this area. We hypothesized that PCPs would be sensitive to the severity of adolescent depression, and would alter treatment decisions based on the clinical information available in structured vignettes. We also hypothesized that PCPs with better knowledge of depression and more positive attitudes toward managing psychosocial problems would be more likely to prescribe antidepressants.

Pornography and sexual experiences among high school students in Sweden.

Abstract: Objectives:The study investigated the differences between high school boys and girls in: 1) use of pornography, 2) sexual experiences, 3) experience of sexual abuse, and 4) perceptions of sexuality ...