Showing papers in "Journal of Developmental and Behavioral Pediatrics in 2015"

Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis.

Abstract: :Objective:Sleep problems such as difficulties in sleep initiation, nighttime awakening, and shortened sleep time are often subjectively reported in children with autism spectrum disorder (ASD). However, results of objective studies have been mixed. Our goal was to evaluate the existing data

Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit

Abstract: Objective To compare the trajectories and determine the predictors of maternal distress defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety, and perinatal-specific posttraumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization. Method Sixty-nine mothers completed psychological questionnaires within the first month of their infant's NICU hospitalization and again 2 weeks before NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress. Results Perinatal-specific posttraumatic stress remained stable throughout the NICU hospitalization, whereas other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress. Conclusions Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

Epigenetics of Autism-related Impairment: Copy Number Variation and Maternal Infection

Abstract: Objective: Epidemiological data have suggested maternal infection and fever to be associated with increased risk of autism spectrum disorder (ASD). Animal studies show that gestational infections perturb fetal brain development and result in offspring with the core features of autism and have demon- strated that behavioral effects of maternal immune activation are dependent on genetic susceptibility. The goal of this study was to explore the impact of ASD-associated copy number variants (CNVs) and prenatal maternal infection on clinical severity of ASD within a dataset of prenatal history and complete genetic and phenotypic findings. Methods: We analyzed data from the Simons Simplex Collection sample including 1971 children with a diagnosis of ASD aged 4 to 18 years who underwent array comparative genomic hybridization screening. Information on infection and febrile episodes during pregnancy was collected through parent interview. ASD severity was clinically measured through parent-reported interview and questionnaires. Results: We found significant interactive effects between the presence of CNVs and maternal infection during pregnancy on autistic symptomatology, such that individuals with CNVs and history of maternal infection demonstrated increased rates of social communicative impairments and repetitive/restricted behaviors. In contrast, no significant interactions were found between presence of CNVs and prenatal infections on cog- nitive and adaptive functioning of individuals with ASD. Conclusions: Our findings support a gene- environment interaction model of autism impairment, in that individuals with ASD-associated CNVs are more susceptible to the effects of maternal infection and febrile episodes in pregnancy on behavioral out- comes and suggest that these effects are specific to ASD rather than to global neurodevelopment. (J Dev Behav Pediatr 36:61-67, 2015) Index terms: autism, autism spectrum disorders, fever, gene-environment, infection, pregnancy.

Service and treatment use among children diagnosed with autism spectrum disorders.

Abstract: Objective Children diagnosed with autism spectrum disorder (ASD) require substantial support to address not only core ASD symptoms but also a range of co-occurring conditions. This study explores treatment and service use among children with ASD with and without intellectual disability (ID) and parents' perception of unmet needs from these treatments. Methods Data were retrieved from a probability-based national sample of 2077 children diagnosed with ASD, ID, or both (ASD and ID). Weighted multivariate logistic regressions examined differences between diagnostic groups for current medication and service utilization with a subanalysis exploring differences among those with co-occurring psychiatric conditions. Additional modeling examined parents' perception of unmet needs. Results Children diagnosed with ASD and ID were significantly more likely to be receiving current medication and services when compared with children with ID only or ASD only. Children with a co-occurring psychiatric diagnosis, from all 3 diagnostic groups, were more likely to be receiving a current medication, but not more likely to be receiving a current service when compared with children without a co-occurring psychiatric diagnosis. Children with ASD and a co-occurring psychiatric diagnosis were significantly more likely to have parents who reported unmet needs when compared with parents of children with ASD without a co-occurring psychiatric diagnosis. Conclusions Children diagnosed with ASD and ID, especially those with a comorbid psychiatric condition, represent a vulnerable population with substantial rates of current service (98%) and medication (67%) usage, but despite these high rates, approximately 30% of parents report that their child's developmental needs are still not being met by their current treatment and services.

Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial.

Abstract: :Objective:This study assessed the impact of Family Nurture Intervention (FNI) on the quality of maternal caregiving behavior (MCB) while in the neonatal intensive care unit (NICU). FNI is a randomized controlled trial conducted in a high-acuity NICU to facilitate an emotional connection bet

Medical marijuana: review of the science and implications for developmental-behavioral pediatric practice.

Abstract: Marijuana policy is rapidly evolving in the United States and elsewhere, with cannabis sales fully legalized and regulated in some jurisdictions and use of the drug for medicinal purposes permitted in many others. Amidst this political change, patients and families are increasingly asking whether cannabis and its derivatives may have therapeutic utility for a number of conditions, including developmental and behavioral disorders in children and adolescents. This review examines the epidemiology of cannabis use among children and adolescents, including those with developmental and behavioral diagnoses. It then outlines the increasingly well-recognized neurocognitive changes shown to occur in adolescents who use cannabis regularly, highlighting the unique susceptibility of the developing adolescent brain and describing the role of the endocannabinoid system in normal neurodevelopment. The review then discusses some of the proposed uses of cannabis in developmental and behavioral conditions, including attention-deficit hyperactivity disorder and autism spectrum disorder. Throughout, the review outlines gaps in current knowledge and highlights directions for future research, especially in light of a dearth of studies specifically examining neurocognitive and psychiatric outcomes among children and adolescents with developmental and behavioral concerns exposed to cannabis.

Prevalence and Health Correlates of Overweight and Obesity in Children with Autism Spectrum Disorder.

Abstract: Children with autism spectrum disorder (ASD) may be at increased risk for overweight and obesity, but little information is known about correlates of overweight and obesity in this population. This study compared prevalence rates of parent-reported overweight and obesity and specific health behaviors (i.e., parent report of child sleep, family meal patterns, child screen time, and child physical activity) among children with ASD (N = more than 900 [weighted to represent 690,000; age 10-17]) compared with children without ASD using data from a nationally representative sample. Additionally, the relationship between specific health behaviors (i.e., child sleep, family meals, screen time, and physical activity) and weight status was examined in the ASD population. Data were from the National Survey of Children's Health 2011-2012. Results indicate that children with ASD were more likely to be obese but not more likely to be overweight than non-ASD youth. Children with ASD engaged in physical activity less than children without ASD, but no differences were found on sleep, most measures of screen time, and mealtimes. However, parent perceived poorer sleep was associated with increased weight status, and fewer family meals were associated with normal weight status among children with ASD.

How Valid Is the Checklist for Autism Spectrum Disorder When a Child Has Apraxia of Speech

Abstract: Objective Our objective was to determine if the Checklist for Autism Spectrum Disorder (CASD) was inadvertently overemphasizing autism symptoms in a population of children without autism. Methods Children noted with communication delays were referred to both a developmental pediatrician and a speech and language pathologist for an apraxia and autism evaluation. All children who underwent both autism and apraxia evaluations and met rule-in or rule-out criteria for both diagnoses were included in the study, resulting in a sample size of 30. Results Our results show that 63.6% of children initially diagnosed with autism also had apraxia, 36.8% of children initially diagnosed with apraxia also had autism, 23.3% had neither, and 23.3% had both. Overall diagnostic accuracy for the CASD was 96.7%. Overall accuracy for the CASD for children without apraxia was 100% and accuracy for children with apraxia was 94.7%. Specificity for the CASD was 100%, while sensitivity was 90.9%. The PPV was 100% and the NPV was 95.0%. Conclusion This study demonstrates that the CASD does not overemphasize autism symptoms in a population of children without autism. It also shows that autism and apraxia are highly comorbid. Thus, it is important to monitor all children diagnosed with apraxia for signs of autism and all children diagnosed with autism for signs of apraxia. This will help identify children as early as possible and allow them access to services appropriate to their needs.

Late diagnosis of autism spectrum disorder after initial negative assessment by a multidisciplinary team.

Abstract: Objective Describe a cohort of children who received a diagnosis of autism spectrum disorder (ASD) after age 6 and after having undergone a comprehensive multidisciplinary assessment before the age of 6, through which they were not diagnosed with ASD. Methods Extensive chart review of patients' electronic medical records comprised a representative population-based registry of patients seen during 2004 to 2011. The study focused only on the cohort of children who were diagnosed with ASD after the age of 6 but were not diagnosed with ASD at an earlier age. The charts were reviewed for the number of developmental assessments completed and the clinician's diagnostic impressions. The charts were also examined for documentation of ASD-suggestive features pulled directly from the text of the evaluators' reports. Results A total of 221 patients (189 males) were diagnosed with ASD after age 6 although their initial comprehensive developmental evaluations before the age of 6 were negative for ASD. The study cohort underwent a total of 1028 developmental evaluations before the age of 6, with initial diagnostic impressions that included language deficits (70%), motor difficulties (67%), attention problems (46%), and cognitive difficulties (42%). Less than half of the cohort had ASD-suggesting features documented in their initial assessment. Conclusions Subsequent late diagnosis of ASD after an initial ASD-negative comprehensive assessment is a common clinical experience. Reasons for this scenario may include evolving diagnosis as well as missed and overdiagnosed cases of ASD.

Examining Parents' Experiences and Information Needs Regarding Early Identification of Developmental Delays: Qualitative Research to Inform a Public Health Campaign

Abstract: The purpose of this study was to assess the approach and materials of Centers for Disease Control and Prevention's "Learn the Signs. Act Early." (LTSAE) health education campaign, which aims to improve awareness of developmental milestones and early warning signs of developmental delay among parents of young children.We conducted 2 phases of qualitative research. Focus groups assessed the campaign's objectives by exploring the experiences of parents with children who have developmental delays or disabilities to determine facilitators of and barriers to identification. In-depth interviews were conducted with parents of typically developing children, who reviewed campaign materials and provided feedback on appropriateness, appeal, and clarity with regard to the campaign's objectives.Phase 1: Parents were typically the first to express concern about their child's development, and most talked with their child's health care provider. Two categories of health care providers emerged: those who proactively asked about a child's development, used tools to facilitate conversations, and made referrals, and those who did not ask about development, told parents to "wait and see," and did not provide information about services and supports. Few parents knew about special education services before identification. Phase 2: Participants found the campaign materials appealing, but were unclear about how to act early and why acting early was important.Results affirmed LTSAE's evidence-based approach to educating parents about child development. Additional campaign considerations include providing more information about how to act early and why acting early is important and enhancing outreach to providers to help them communicate with concerned parents.

Behavioral and psychiatric phenotypes in 22q11.2 deletion syndrome

Abstract: :22q11.2 Deletion syndrome (22q11.2DS) is a chromosomal microdeletion that affects approximately 40 to 50 genes and affects various organs and systems throughout the body. Detection is typically achieved by fluorescence in situ hybridization after diagnosis of one of the major features of th

Parent Health Beliefs, Social Determinants of Health, and Child Health Services Utilization among US School-Age Children with Autism

Abstract: Objective Substantial variation exists in ASD care by race, ethnicity, and socioeconomic status; however, the role of parent health beliefs in this variation is poorly understood. Study goals were to (1) examine variation in parent beliefs about ASD prognosis and treatment according to social determinants of health (SDH) and (2) assess whether this variation was associated with variable health services utilization, among 1420 children with special health care needs (CSHCN) having autism spectrum disorder (ASD).

Child Maltreatment and Sexual Risk Behavior: Maltreatment Types and Gender Differences.

Abstract: OBJECTIVE: To compare sexual risk behaviors in maltreated male and female sexually active adolescents with a comparison population and examine whether specific maltreatment experiences were associated with sexual risk behaviors and teen pregnancy. METHOD: Data came from the fourth assessment (M = 7.2 years after baseline) of an ongoing longitudinal study with case-control design. The sample was restricted to only the sexually active adolescents, leaving a sample of 251 (n = 82 comparison, n = 169 maltreated, mean age = 18.49 years, SD = 1.46). Maltreatment type was coded from case records, and sexual behaviors were assessed via computerized questionnaire. RESULTS: Maltreated youth were significantly younger at first consensual intercourse than comparison youth, and males were younger than females. Maltreated males reported significantly higher number of lifetime sexual partners than maltreated females. Neglected, sexually abused, and physically abused youth were more likely to have had a one-night stand than comparison youth. Sexually abused females were at higher risk of having sex under the influence than other maltreated females. Neglected females were more likely to have ever been pregnant than females with other maltreatment types or comparison females. A higher number of maltreatment victimizations predicted a younger age at first pregnancy involvement for both sexes. CONCLUSION: Many maltreated youth continue to be at high risk for engaging in behaviors that may initiate a trajectory of problematic sexual behaviors. The findings highlight maltreated males and neglected females as vulnerable groups that should be targeted in prevention efforts to curtail sexual risk behaviors and prevent teenage pregnancy. Language: en

Bedtime and sleep timing but not sleep duration are associated with eating habits in primary school children.

Abstract: OBJECTIVE In the context of childhood obesity progression, sleep patterns have been associated with unhealthy eating habits and energy intake. The association between several eating habits and sleep patterns in children has been recently studied. The aim of this study was to explore the association between sleep patterns, eating habits, and physical fitness in primary school children. METHODS A total of 236 children of 6 to 10 years old were recruited. Anthropometric characteristics and body composition were measured, and cardiorespiratory (20-m shuttle run test) and musculoskeletal (squat jump and cycling peak power) fitness tests were performed. Parents were asked to fill out an eating habits questionnaire, and children were classified into 4 categories as a function of the number of eating risk factors they presented. Parents completed a questionnaire about their child's bedtime and waking hours during weekdays and weekends. RESULTS Weight (p < .01), waist circumference, and fat mass (p < .05) were significantly higher in late sleepers (27.6 ± 6.3 kg; 60.1 ± 7.6 cm; 19.52 ± 7.44) compared with normal sleepers (25.4 ± 3.7 kg; 58.2 ± 4.9 cm; 17.44% ± 6.23%). None of the physical fitness parameters were associated with sleep duration, bedtime, wake-up time, nor were they significantly different between late and normal sleepers. Bedtime was significantly earlier in children consuming breakfast everyday (08:30 vs. 09:00 PM, p < .01); later in children snacking (09:15 vs. 09:30 PM, p < .05) or watching TV at lunch (10:00 vs 09:30 PM, p < .05). There is an association between the proportion of normal and late sleepers and the accumulation of healthy eating habits (p < .001). CONCLUSION Bedtime and sleep timings (normal or late sleepers) are associated with eating habits in primary school children. It seems necessary to consider the number of unhealthy eating habits adopted by children when studying these associations.

Stability of sleep disorders from preschool to first grade and their bidirectional relationship with psychiatric symptoms.

Abstract: :Objectives:To examine the prevalence and stability of DSM-4–defined sleep disorders from preschool to first grade and to explore the bidirectional relationship between sleep disorders and symptoms of psychiatric disorders.Method:All children born in 2003 or 2004 in Trondheim, Norway, who at

Combating Obesity in Head Start: Outdoor Play and Change in Children's Body Mass Index.

Abstract: Objective To determine whether increased outdoor play time at Head Start was associated with greater changes in body mass index (BMI) over the course of a preschool year. Method The authors used data from 2810 children from the Family and Child Experiences Survey 2006 cohort. With children's spring BMI as the outcome (both continuously measured and dichotomized to measure the risk of obesity), the authors conducted weighted regression analyses, controlling for child-level, family-level, and school-level covariates, including preschool entry BMI. Results Children played outdoors at school for roughly 37 minutes per day, with little variation across half-day and full-day programs. The more children played outdoors, the more their BMI decreased over the preschool year (β = -.05, 95% confidence interval (CI) [-0.08 to -0.01]) and the less likely they were to be obese (odds ratio = 0.99, 95% CI [0.98-0.99]). The difference between high levels and low levels of outdoor play corresponded to 0.18 BMI points and a 42% reduction in children's risk of obesity. Sixty minutes was the "tipping point" for the association between outdoor play time and improvements in children's BMI. These associations were also stronger among children who were obese at the start of the year, less active at home, and living in unsafe neighborhoods. Conclusion Outdoor play time at Head Start is associated with decreases in children's BMI scores and, thus, may serve as an important means of preventing obesity. Head Start programs should consider establishing clear guidelines encouraging more outdoor time.

Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting.

Abstract: Objective To identify child and family characteristics associated with age of diagnosis of autism spectrum disorder (ASD) in a tertiary care setting using objective, standardized assessments ensuring diagnostic validity and timing. Methods The authors conducted a chart review of children who received their initial ASD diagnosis from 2007 to 2011. Child variables included gender, birth order, cognitive functioning, and for children ≤36 months, language and adaptive assessments. Family variables included insurance, maternal age, maternal education, sibling or family member with ASD, and number of children in the house. Primary outcome was age of ASD diagnosis. The authors ran multiple regression models evaluating the impact of child and family variables on the total sample and on the subsample of children ≤36 months. Results Median age of diagnosis was 2.9 years (range, 15 mo-13.8 yr; n = 591). In the total sample, significant predictors of earlier age of diagnosis were later birth order, higher maternal education, fewer children in the house, and a sibling with ASD. In a separate analysis of children ≤36 months of age (n = 315) with additional data for language and adaptive assessments, significant predictors of younger age of diagnosis were higher cognitive and adaptive functioning, lower receptive and expressive language, and having a sibling with ASD. Conclusions This study suggests that both family and child characteristics play an important role in the early identification of ASD and that predictive variables may vary based on a child's age. Future research should help to elucidate this finding so that screening measures and policies aimed at early identification can target the most predictive factors.

Health and Functioning of Families of Children With Special Health Care Needs Cared for in Home Care, Long-term Care, and Medical Day Care Settings.

Abstract: :Objectives:To examine and compare child and parent or guardian physical and mental health outcomes in families with children with special health care needs who have medically complex technology-dependent needs in home care, long-term care (LTC), and medical day care (MDC) settings. The numb

Can Screening with the Ages and Stages Questionnaire Detect Autism

Abstract: :Objective:Parents rely on pediatricians to monitor their child's development. The American Academy of Pediatrics recommends routine developmental screening with both broadband and autism-specific instruments at specified ages. If broadband screeners can detect autism risk, this might minimi

Persisting behavior problems in extremely low birth weight adolescents.

Abstract: Objective To describe behavior problems in extremely low birth weight (ELBW, <1000 g) adolescents born 1992–1995 based on parent ratings and adolescent self-ratings at age 14 years and examine changes in parent ratings from ages 8 to 14 years.

Early Emergence of Delayed Social Competence in Infants Born Late and Moderately Preterm.

Abstract: Objective To assess behavioral outcomes and social competence at 2 years of age in infants born late and moderately preterm (LMPT; 32-36 wk gestation). Method One thousand one hundred and thirty LMPT infants and 1255 term-born (≥37 wk) controls were recruited at birth to a prospective geographical population-based study. Parents completed the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 2 years corrected age to assess infants' behavior problems and social competence. Cognitive development was assessed using the Parent Report of Children's Abilities-Revised. Parent questionnaires at 2 years were completed for 638 (57%) LMPT and 765 (62%) term-born infants. Group differences in the prevalence of behavior problems and delayed social competence between LMPT infants and term-born controls were adjusted for age, sex, small-for-gestational-age, socioeconomic status and cognitive impairment. Results Late and moderately preterm infants were at significantly increased risk of delayed social competence compared with term-born controls (26.4% vs. 18.4%; adjusted-relative risk [RR] 1.28; 95% CI, 1.03-1.58), but there was no significant group difference in the prevalence of behavior problems (21.0% vs. 17.6%; adjusted-RR 1.13, 0.89-1.42). Non-white ethnicity (RR 1.68, 1.26-2.24), medium (RR 1.60, 1.14-2.24) and high (RR 1.98, 1.41-2.75) socioeconomic risk and recreational drug use during pregnancy (RR 1.70, 1.03-2.82) were significant independent predictors of delayed social competence in LMPT infants. Conclusion Birth at 32 to 36 weeks of gestation confers a specific risk for delayed social competence at 2 years of age. This may be indicative of an increased risk for psychiatric disorders later in childhood.

Family impact of acquired brain injury in children and youth

Abstract: OBJECTIVE: To assess the parental view on the impact of pediatric traumatic brain injury (TBI) and nontraumatic brain injury (NTBI) on the family and its determinants. METHODS: Follow-up study including parents of children with a hospital-based diagnosis of acquired brain injury (ABI) aged 4-20 years at onset of ABI. Parents completed the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM), which measures Parent Health-Related Quality of Life, Family Functioning, Communication, and Worry. Additional assessments included the Pediatric Stroke Outcome Measure (PSOM), the Child & Family Follow-up Survey (CFFS), PedsQL General Core and Multiple Fatigue Scales, and sociodemographic and disease characteristics. RESULTS: Parents of 108 patients, median age 13 years (range 5-22), completed the questionnaires 24-30 months after diagnosis. There were 81 patients with TBI of whom 11 (14%) with moderate/severe TBI and 27 patients with NTBI of whom 5 (19%) with moderate/severe NTBI. The median PedsQL FIM Total Scale was 80.4 (SD 16.1). The PedsQL FIM Total Scale and 4 out of 5 Subscale Scores were statistically significantly better in the TBI group than in the NTBI group and in patients with severe NTBI than with mild/moderate NTBI. Moreover, in the total group, there were significant univariate associations between the FIM Total Scale and/or one or more Subscale Scores and age, preinjury patient health problems, and the PSOM, CFFS, PedsQL General Core, and Multiple Fatigue Scales. In the multivariable analysis, the FIM Total Scale was significantly associated with type and severity of injury and preinjury patient health problems. CONCLUSIONS: Two years after onset, the parent-reported that impact of ABI on the family as measured by the PedsQL FIM was considerable especially in patients with moderate/severe NTBI. Language: en

Weight, Weight Perceptions, and Health-Related Quality of Life Among a National Sample of US Girls.

Abstract: Objective To examine associations between 3 weight indices (weight status, perceived weight, and weight status perception accuracy) and heath-related quality of life (HRQOL). Methods Data are for girls in the 2009 Health Behaviors in School-Age Children survey, a nationally representative sample of students in Grades 5 to 10 during the 2009/2010 school year (n = 5018). Controlling for sociodemographics, multivariate linear regressions examined associations between self-reported weight status (underweight/normal/overweight/obese), perceived weight (how children categorize their weight), weight status perception accuracy (underestimate/accurate perception/overestimate), and dimensions of HRQOL, including physical, emotional, social, and school functioning. Results Although obesity was only associated with poor physical and emotional HRQOL, perceptions of being overweight were associated with worse physical, emotional, school, and social HRQOL. Furthermore, girls who overestimated their weight reported poorer HRQOL than those with accurate weight perceptions. Associations of perceptions of being overweight and weight status overestimation with poor HRQOL despite, in most instances, the absence of associations between weight status and HRQOL suggest that weight status perceptions may not merely be a mediator of a weight status-HRQOL association but a significant independent correlate of poor HRQOL. Conclusion These findings raise the issue of whether there is a need to prioritize intervention efforts to promote better HRQOL by redefining the population of girls most at risk. Parents, teachers, and clinicians should be aware that, rather than overweight status, perceptions of being overweight (accurately or not) are associated with a poor HRQOL among girls. Future research should examine the potential negative effect of using specific body image terminologies on adolescents' psychological health.

A meta-analysis of weight status and anxiety in children and adolescents.

Abstract: :Objective:Although some posit that youth who are overweight/obese experience greater amounts of anxiety than their peers who are normal weight, extant literature shows that the association between weight status and anxiety in youth is equivocal. Therefore, the purpose of this study was to e

Effects of a Web-Based Intervention on Family Functioning Following Pediatric Traumatic Brain Injury.

Abstract: OBJECTIVE: Investigate effectiveness of an online Counselor-Assisted Problem-Solving (CAPS) intervention on family functioning after traumatic brain injury. METHODS: Participants were randomized to CAPS (n = 65) or Internet resource comparison (IRC; n = 67). CAPS is a counselor-assisted web-based program. IRC was given access to online resources. Outcomes were examined at 6, 12, and 18 months after baseline. Injury severity, age, and socioeconomic status were examined as moderators. RESULTS: A main effect of time was noted for teen-reported conflict and parent-reported problem solving. CAPS had decreased parent-reported conflict and a reduction in parental effective communication. Effects were specific to subsets of the sample. CONCLUSION: CAPS, a family-based problem-solving intervention designed to address problem behaviors, had modest effects on some aspects of family functioning compared with IRC. Effects were generally limited to subsets of the families and were not evident across all follow-up assessments. Language: en

A model for the development of mothers' perceived vulnerability of preterm infants.

Abstract: :Objective:Some mothers of preterm infants continue to view them as vulnerable after their health has improved. These exaggerated perceptions of vulnerability lead to poor parent-child interactions and, subsequently, to adverse child outcomes. However, there is no theoretical model to explai

Neurodevelopment of Two-Year-Old Children Exposed to Metformin and Insulin in Gestational Diabetes Mellitus.

Abstract: Objective To compare cognitive, language, and motor skills and results of neurological examination in 2-year-old children born to mothers with gestational diabetes mellitus treated with metformin with those treated with insulin. Method The children of mothers with gestational diabetes mellitus randomized to metformin (n = 75) or insulin (n = 71) treatment during pregnancy were examined by standardized developmental and neurological measures; the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Hammersmith Infant Neurological Examination. Results There were no significant differences between the metformin and insulin groups in the Bayley Scales of Infant and Toddler Development (Bayley-III) test of cognitive scale (p = .12), receptive communication (p = .14) or expressive communication (p = .75), fine motor scale (p = .10) or gross motor scale (p = .13), or the global scores of Hammersmith Infant Neurological Examination (p = .14). None of the children had a clinically significant developmental problem. However, compared with age-adjusted norms, a trend for weaker language performance was observed in both study groups. Conclusion No differences in neurodevelopmental outcome were seen in 2-year-old children born to mothers with gestational diabetes mellitus (GDM) treated with insulin or metformin during pregnancy. The results suggest that children born to mothers with GDM and exposed to metformin in utero do not systematically need extensive formal neurodevelopmental assessment in early childhood.

Mandatory Naptimes in Child Care and Children's Nighttime Sleep

Abstract: Objectives: To examine the relationship between mandatory naptimes in child care and children's nighttime sleep duration, both concurrently and 12 months later once in school. Methods: A sample of 168 children (50-72 months; 55% males) attending licensed child care centers were observed across their morning and throughout their scheduled naptime. Mandatory naptime was determined as the period in which children were not permitted any alternative activity except lying on their bed. Teachers reported each child's napping in child care. Nighttime and total sleep duration was reported by parents at 2 time points, in child care and in the second semester of their first school year. General linear models were used to examine group differences in sleep duration between children experiencing 0 to 60 minutes and >60 minutes of mandatory naptime, adjusting for key confounders. Path analysis was conducted to test a mediation model in which mandatory naptime is associated with nighttime sleep duration through increased napping in child care. Results: Children who experienced >60 minutes of mandatory naptime in child care had significantly less nighttime sleep than those with 0 to 60 minutes of mandatory naptime. This difference persisted at 12-month follow-up, once children were in school. Napping in child care mediated the relationship between mandatory naptime and duration of nighttime sleep. Conclusions: Exposure to mandatory naptimes of >60 minutes in child care is associated with decreased duration of nighttime sleep that endures beyond child care attendance. Given the large number of children who attend child care, sleep practices within these settings present an important focus for child health.

Factors affecting parent-child relationships one year after positive newborn screening for cystic fibrosis or congenital hypothyroidism.

Abstract: OBJECTIVE Examine factors that mediate parent-infant relationships 12 months after positive newborn screening (NBS). METHODS We examined effects of infant diagnosis, parents' perceptions of child vulnerability and child attachment, parental depression and anxiety on parent-infant feeding interactions for 131 mothers and 118 fathers of 131 infants whose NBS and diagnostics confirmed cystic fibrosis (CF, n = 23), congenital hypothyroidism (CH, n = 35), CF carrier status (CF-C, n = 38), or healthy normal NBS (H, n = 35). RESULTS Separate composite indicator structural equation models for mothers and fathers showed that neonatal diagnosis was not associated with increased anxiety or depression. In comparison with the healthy group, CF group parents reported higher perceptions of child vulnerability (p < .001, p = .002), and CF-C group fathers viewed their children as more attached (p = .021). High maternal perception of child vulnerability was associated with low perceptions of child attachment (p = .001), which was associated with task-oriented feeding behavior (p = .016, p = .029). Parental task-oriented feeding behavior was associated with less positive (p < .001, p < .001) and more negative interactions (p < .001, p = .001) with their infants. High paternal perception of child vulnerability was associated with negative parent interactions (p < .001). High parental affective involvement and verbalization was associated with high infant affective expressiveness, communicative skills, and social responsiveness (mothers' p < .001, fathers' p < .001). High parental negative effect and/or inconsistent and intrusive behavior were associated with infant dysregulation and irritability (mothers, p < .001, fathers, p < .001). CONCLUSION The severity of conditions identified through NBS can affect parents' perceptions of their child's vulnerability and attachment. Infant feeding problems in the context of chronic health conditions, like CF, could represent signs of more deeply rooted concerns regarding the parent-child relationship that merit additional clinical evaluation.

Use of the Behavior Rating Inventory of Executive Function and Child Behavior Checklist in Ugandan Children with HIV or a History of Severe Malaria.

Abstract: OBJECTIVE: To assess the structural overlap between the Behavior Rating Inventory of Executive Function (BRIEF) and Achenbach Child Behavior Checklist (CBCL) among children in Uganda. METHODS: Caregiver ratings for the BRIEF and CBCL were obtained for 2 independent samples of school-aged children: 106 children (5-12 years old 50% males) with a history of severe malaria and on 144 HIV-infected children (5-12 years old 58% males) in Uganda. Exploratory factor analysis was used to evaluate the factor structure of the 8 subscales for the BRIEF and the 8 scales of the CBCL to determine correlation. RESULTS: Overall children in the severe malaria group had higher (increased symptom) BRIEF and CBCL scores than those in the HIV-infected group. Three factors that provided a reasonable fit to the data and could be characterized as 3 specific domains were identified: (1) Metacognition which consisted of the scales in the BRIEF Metacognition domain (2) Behavioral Adjustment which comprised of the scales in the BRIEF Behavioral Regulation domain and the Externalizing Symptoms scales in the CBCL and (3) Emotional Adjustment which mainly consisted of the Internalizing Symptoms scales in the CBCL. The BRIEF Behavior Regulation and CBCL Externalizing Symptoms scales however did overlap in terms of assessing similar behavior symptoms. These findings were consistent across the severe malaria and HIV-infected samples of children. CONCLUSION: The BRIEF and CBCL instruments offer distinct yet complementary assessments of behavior in clinical pediatric populations in the Ugandan context supporting the use of these measures for similar research settings.