Pub Date : 2019-09-01DOI: 10.1097/DBP.0000000000000717
M. Ignaszewski, Kaizad R. Munshi, Jason M. Fogler, M. Augustyn
CASE Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change.He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation.His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family.Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 mg daily, guanfacine 1 mg 3 times daily, sustained release bupropion 100 mg twice daily, levothyroxine, vitamin D, and a weekly somatropin injection. He has not been able to tolerate psychostimulants or nonstimulant agents because of treatment-emergent SI.Now in the ninth grade, he continues to be easily distracted by peers, with impulsive behaviors and reduced self-regulation. Despite receiving special education services since the fifth grade, his academic performance has been poor, and he has limited motivation. Previous testing indicated average in an intelligence quotient test, with relative deficits in working memory compared with above average strength in fluid reasoning. He dislikes school and has few friends. He has always been noted to be "immature." He displays temper tantrums at home and school around transitions and behavioral expectations and has complained of feeling "different" and misunderstood by peers in addition to having difficulty reading social cues. His interests include acting and playing Fortnite and other video/computer games. His screen time is limited to 1 to 2 hr/d by the family.As the new clinician, you raise the possibility of undiagnosed autism spectrum disorder as a unifying/underlying diagnosis with his mother, who disagrees and does not consent to additional workup despite your recommendations. How would you proceed with next steps to best support your patient and his family in obtaining further clarifying evaluation?
{"title":"Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student.","authors":"M. Ignaszewski, Kaizad R. Munshi, Jason M. Fogler, M. Augustyn","doi":"10.1097/DBP.0000000000000717","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000717","url":null,"abstract":"CASE Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change.He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation.His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family.Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 mg daily, guanfacine 1 mg 3 times daily, sustained release bupropion 100 mg twice daily, levothyroxine, vitamin D, and a weekly somatropin injection. He has not been able to tolerate psychostimulants or nonstimulant agents because of treatment-emergent SI.Now in the ninth grade, he continues to be easily distracted by peers, with impulsive behaviors and reduced self-regulation. Despite receiving special education services since the fifth grade, his academic performance has been poor, and he has limited motivation. Previous testing indicated average in an intelligence quotient test, with relative deficits in working memory compared with above average strength in fluid reasoning. He dislikes school and has few friends. He has always been noted to be \"immature.\" He displays temper tantrums at home and school around transitions and behavioral expectations and has complained of feeling \"different\" and misunderstood by peers in addition to having difficulty reading social cues. His interests include acting and playing Fortnite and other video/computer games. His screen time is limited to 1 to 2 hr/d by the family.As the new clinician, you raise the possibility of undiagnosed autism spectrum disorder as a unifying/underlying diagnosis with his mother, who disagrees and does not consent to additional workup despite your recommendations. How would you proceed with next steps to best support your patient and his family in obtaining further clarifying evaluation?","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76950948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-16DOI: 10.1097/DBP.0000000000000706
H. Bishop, A. Curry, D. Stavrinos, J. Mirman
OBJECTIVE Motor vehicle collisions are the leading cause of death among teenagers, accounting for approximately 1 in 3 deaths for this age group. A number of factors increase crash risk for teen drivers, including vulnerability to distraction, poor judgment, propensity to engage in risky driving behaviors, and inexperience. These factors may be of particular concern and exacerbated among teens learning to drive with attention deficits. To our knowledge, our study is among the first to systematically investigate the experiences of novice adolescent drivers with attention deficits during the learner period of a Graduated Drivers Licensing program. METHOD Survey and on-road driving assessment (ODA) data were used to examine parent and teen confidence in the teens' driving ability, driving practice frequency, diversity of driving practice environments, and driving errors among teens with attention deficits as defined by attention-deficit/hyperactivity disorder (ADHD) diagnosis or parent-reported trouble staying focused (TSF). RESULTS When teens' driving skill was evaluated at the conclusion of the learner period, teens with ADHD exhibited more driving errors than their typically developing (TD) counterparts (p = 0.034). Teens with TSF were more likely to have their ODA terminated (p = 0.019), had marginally lower overall driving scores (p = 0.098), and exhibited more critical driving errors (p = 0.01) compared with TD teens. CONCLUSION These findings may have implications on the learning-to-drive period for adolescents with attention deficits. Adjustments may need to be made to the learner period for teens with attention deficits to account for attention impairments and to better instill safe driving behavior.
{"title":"Characterizing the Learning-to-Drive Period for Teens with Attention Deficits.","authors":"H. Bishop, A. Curry, D. Stavrinos, J. Mirman","doi":"10.1097/DBP.0000000000000706","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000706","url":null,"abstract":"OBJECTIVE\u0000Motor vehicle collisions are the leading cause of death among teenagers, accounting for approximately 1 in 3 deaths for this age group. A number of factors increase crash risk for teen drivers, including vulnerability to distraction, poor judgment, propensity to engage in risky driving behaviors, and inexperience. These factors may be of particular concern and exacerbated among teens learning to drive with attention deficits. To our knowledge, our study is among the first to systematically investigate the experiences of novice adolescent drivers with attention deficits during the learner period of a Graduated Drivers Licensing program.\u0000\u0000\u0000METHOD\u0000Survey and on-road driving assessment (ODA) data were used to examine parent and teen confidence in the teens' driving ability, driving practice frequency, diversity of driving practice environments, and driving errors among teens with attention deficits as defined by attention-deficit/hyperactivity disorder (ADHD) diagnosis or parent-reported trouble staying focused (TSF).\u0000\u0000\u0000RESULTS\u0000When teens' driving skill was evaluated at the conclusion of the learner period, teens with ADHD exhibited more driving errors than their typically developing (TD) counterparts (p = 0.034). Teens with TSF were more likely to have their ODA terminated (p = 0.019), had marginally lower overall driving scores (p = 0.098), and exhibited more critical driving errors (p = 0.01) compared with TD teens.\u0000\u0000\u0000CONCLUSION\u0000These findings may have implications on the learning-to-drive period for adolescents with attention deficits. Adjustments may need to be made to the learner period for teens with attention deficits to account for attention impairments and to better instill safe driving behavior.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84998427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1097/DBP.0000000000000705
Elizabeth Hastings, Jennifer K. Poon, S. Robert, Sarah S Nyp
CASE Kyle is a 10-year-old boy with Down syndrome and intellectual disability who is being followed up by a developmental behavioral pediatrician for attention-deficit hyperactivity disorder (ADHD) and anxiety. Kyle was initially taking a long-acting liquid formulation of methylphenidate for ADHD and fluoxetine for anxiety. Several months ago, the liquid formulation was on back order, and the methylphenidate formulation was changed to an equal dose of a long-acting capsule. Kyle is not able to swallow pills; therefore, the contents of the capsule were sprinkled onto 1 bite of yogurt each morning. Over the course of the next month, Kyle's behaviors became increasingly difficult. He was not able to tolerate loud or crowded places, and despite a visual schedule and warnings, he would become aggressive toward adults when directed to transition away from preferred activities. Fluoxetine was increased from 0.4 to 0.6 mg/kg/day at that time.One month later, his parents reported that although there may have been slight improvement in Kyle's irritability since the increase in fluoxetine, they felt he was nonetheless more aggressive and less cooperative than his previous baseline. Kyle was returned to the long-acting liquid formulation of methylphenidate at that time, and a follow-up was scheduled 2 weeks later.On return to clinic, his parents reported that Kyle's behaviors had continued to become increasingly difficult. He was described as uncooperative and aggressive at home and school. Kyle was easily upset any time he was not given his way, his behavior was corrected, or he felt that he was not the center of attention. When upset, he would yell, bite, kick, spit, or throw his body to the ground and refuse to move. At 110 pounds, Kyle's parents were no longer able to physically move his body when he dropped to the ground. This was a safety concern for his parents because he had displayed this behavior in the parking lot of a busy shopping area. Because of Kyle's aggressive and unpredictable behavior, parents no longer felt comfortable taking him to public places. Family members who had previously been comfortable staying with Kyle while his parents were out for short periods would no longer stay with him. Overall, the behaviors resulted in parents being unable to go to dinner as a couple or provide individual attention to their other children. The parents described the family as "on edge." How would you approach Kyle's management?
{"title":"Attention-Deficit Hyperactivity Disorder, Disruptive Behaviors, and Drug Shortage.","authors":"Elizabeth Hastings, Jennifer K. Poon, S. Robert, Sarah S Nyp","doi":"10.1097/DBP.0000000000000705","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000705","url":null,"abstract":"CASE\u0000Kyle is a 10-year-old boy with Down syndrome and intellectual disability who is being followed up by a developmental behavioral pediatrician for attention-deficit hyperactivity disorder (ADHD) and anxiety. Kyle was initially taking a long-acting liquid formulation of methylphenidate for ADHD and fluoxetine for anxiety. Several months ago, the liquid formulation was on back order, and the methylphenidate formulation was changed to an equal dose of a long-acting capsule. Kyle is not able to swallow pills; therefore, the contents of the capsule were sprinkled onto 1 bite of yogurt each morning. Over the course of the next month, Kyle's behaviors became increasingly difficult. He was not able to tolerate loud or crowded places, and despite a visual schedule and warnings, he would become aggressive toward adults when directed to transition away from preferred activities. Fluoxetine was increased from 0.4 to 0.6 mg/kg/day at that time.One month later, his parents reported that although there may have been slight improvement in Kyle's irritability since the increase in fluoxetine, they felt he was nonetheless more aggressive and less cooperative than his previous baseline. Kyle was returned to the long-acting liquid formulation of methylphenidate at that time, and a follow-up was scheduled 2 weeks later.On return to clinic, his parents reported that Kyle's behaviors had continued to become increasingly difficult. He was described as uncooperative and aggressive at home and school. Kyle was easily upset any time he was not given his way, his behavior was corrected, or he felt that he was not the center of attention. When upset, he would yell, bite, kick, spit, or throw his body to the ground and refuse to move. At 110 pounds, Kyle's parents were no longer able to physically move his body when he dropped to the ground. This was a safety concern for his parents because he had displayed this behavior in the parking lot of a busy shopping area. Because of Kyle's aggressive and unpredictable behavior, parents no longer felt comfortable taking him to public places. Family members who had previously been comfortable staying with Kyle while his parents were out for short periods would no longer stay with him. Overall, the behaviors resulted in parents being unable to go to dinner as a couple or provide individual attention to their other children. The parents described the family as \"on edge.\" How would you approach Kyle's management?","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80792175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1097/DBP.0000000000000699
I. Malaty, D. Shineman, M. Himle
Irene Malaty, MD,* Diana Shineman, PhD,† Michael Himle, PhD‡ It was with great interest that we read the study by Wolicki et al., “Children with Tourette Syndrome in the United States: Parent-Reported Diagnosis, Co-Occurring Disorders, Severity, and Influence of Activities on Tics.” The Tourette Association of America (TAA) recently embarked upon a similar project, the 2018 TAA Impact Survey, which involved an online survey of their constituents. Similar to the study of Wolicki, the purpose of the TAA Impact Survey was to better understand the diagnostic and treatment experiences of individuals living with Tourette Syndrome (TS) and other tic disorders (TDs) as well as to understand the broad impact of tics on health and functioning. Despite key methodological and sample differences, the TAA Impact Survey corroborates a number of findings in the study of Wolicki and when examined in conjunction, provides for the complimentary and comprehensive characterization of the longitudinal impact of TS across the life span. One key methodological difference between the studies was how participants were recruited. Although the Centers for Disease Control (CDC) used cold calls to identify households where currently residing children had been diagnosed with TS, the TAA created a webbased survey disseminated to its constituents through the TAA website, email lists, and social media, as well as through the TAA Centers of Excellence program. Both methods allowed for geographic diversity, but the webbased technique allowed for acquisition of a large number of respondents (N 5 944, including 281 adults with TS/TD and 623 parents of children with TS/TD). The cold call method may have offered the advantage of less bias toward individuals associated with a TS society or comfortable with internet-based communication, whereas there may be other bias toward willing participants in phone surveys. Furthermore, the TAA Impact Survey expands upon the CDC survey by including both children with TS/TD, for whom parents completed the survey, and additionally adults with TS/TD, who selfreported about their experiences. Importantly, although the CDC survey asks only about the diagnosis of TS, the TAA Impact Survey included the broader range of TD diagnoses in addition to TS. Despite their methodological differences, the 2 studies found some consistent noteworthy findings. Encouragingly, both studies suggest that diagnosis is being made earlier. Among adults in our study, the modal time between tic onset and diagnosis was 61 years (reported by 53% of the sample), with only 32.4% being diagnosed within 2 years of tic onset. By contrast, the modal time between symptom onset and diagnosis for children was ,2 years (reported by 70.9% of the sample), which is consistent with the study of Wolicki, who reported an average time to diagnosis of 1.7 years. Consistent with the findings of Wolicki et al. regarding a high reliance on specialists to make the diagnosis (51.8% of cases), the TAA
{"title":"Tourette Syndrome has Substantial Impact in Childhood and Adulthood As Well.","authors":"I. Malaty, D. Shineman, M. Himle","doi":"10.1097/DBP.0000000000000699","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000699","url":null,"abstract":"Irene Malaty, MD,* Diana Shineman, PhD,† Michael Himle, PhD‡ It was with great interest that we read the study by Wolicki et al., “Children with Tourette Syndrome in the United States: Parent-Reported Diagnosis, Co-Occurring Disorders, Severity, and Influence of Activities on Tics.” The Tourette Association of America (TAA) recently embarked upon a similar project, the 2018 TAA Impact Survey, which involved an online survey of their constituents. Similar to the study of Wolicki, the purpose of the TAA Impact Survey was to better understand the diagnostic and treatment experiences of individuals living with Tourette Syndrome (TS) and other tic disorders (TDs) as well as to understand the broad impact of tics on health and functioning. Despite key methodological and sample differences, the TAA Impact Survey corroborates a number of findings in the study of Wolicki and when examined in conjunction, provides for the complimentary and comprehensive characterization of the longitudinal impact of TS across the life span. One key methodological difference between the studies was how participants were recruited. Although the Centers for Disease Control (CDC) used cold calls to identify households where currently residing children had been diagnosed with TS, the TAA created a webbased survey disseminated to its constituents through the TAA website, email lists, and social media, as well as through the TAA Centers of Excellence program. Both methods allowed for geographic diversity, but the webbased technique allowed for acquisition of a large number of respondents (N 5 944, including 281 adults with TS/TD and 623 parents of children with TS/TD). The cold call method may have offered the advantage of less bias toward individuals associated with a TS society or comfortable with internet-based communication, whereas there may be other bias toward willing participants in phone surveys. Furthermore, the TAA Impact Survey expands upon the CDC survey by including both children with TS/TD, for whom parents completed the survey, and additionally adults with TS/TD, who selfreported about their experiences. Importantly, although the CDC survey asks only about the diagnosis of TS, the TAA Impact Survey included the broader range of TD diagnoses in addition to TS. Despite their methodological differences, the 2 studies found some consistent noteworthy findings. Encouragingly, both studies suggest that diagnosis is being made earlier. Among adults in our study, the modal time between tic onset and diagnosis was 61 years (reported by 53% of the sample), with only 32.4% being diagnosed within 2 years of tic onset. By contrast, the modal time between symptom onset and diagnosis for children was ,2 years (reported by 70.9% of the sample), which is consistent with the study of Wolicki, who reported an average time to diagnosis of 1.7 years. Consistent with the findings of Wolicki et al. regarding a high reliance on specialists to make the diagnosis (51.8% of cases), the TAA ","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76799986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1097/DBP.0000000000000709
E. Perrin
Ellen C. Perrin, MD This article provides encouraging data regarding routine systematic developmental screening in busy pediatric primary care practices. First, it demonstrates excellent use of quality improvement principles and methods to study the implementation of an innovative system for routine screening. Second, it shows that routine screening for emotional/behavioral symptoms and social determinants of health can be performed indeed complement each other. Third, it highlights some areas that will benefit from further innovation and research. The instruments used for emotional/behavioral symptom screening were the Pediatric Symptom Checklist for children 6 to 10 years old, the Preschool Pediatric Symptom Checklist for children 18 months to 5 years old, and the Baby Pediatric Symptom Checklist for infants (the latter 2 are components of the Survey of Wellbeing of Young Children, or SWYC: www.theswyc.org). Questions about social determinants of health and about the parent’s concerns are also components of the SWYC. Although the SWYC also includes components assessing the development of cognitive, language, and motor tasks, this realm was not included in the study.
Ellen C. Perrin，医学博士这篇文章提供了令人鼓舞的关于在繁忙的儿科初级保健实践中进行常规系统发育筛查的数据。首先，它很好地运用了质量改进的原则和方法来研究常规筛查创新系统的实施。其次，它表明，对情绪/行为症状和健康的社会决定因素的常规筛查确实可以相互补充。第三，它强调了一些将从进一步创新和研究中受益的领域。用于情绪/行为症状筛查的工具是6 - 10岁儿童的儿科症状检查表，18个月至5岁儿童的学龄前儿童症状检查表和婴儿儿科症状检查表(后两者是幼儿健康调查的组成部分，或SWYC: www.theswyc.org)。关于健康的社会决定因素和父母所关心的问题也是《社会责任公约》的组成部分。尽管SWYC也包括评估认知、语言和运动任务发展的成分，但这一领域并未包括在这项研究中。
{"title":"Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care: Commentary.","authors":"E. Perrin","doi":"10.1097/DBP.0000000000000709","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000709","url":null,"abstract":"Ellen C. Perrin, MD This article provides encouraging data regarding routine systematic developmental screening in busy pediatric primary care practices. First, it demonstrates excellent use of quality improvement principles and methods to study the implementation of an innovative system for routine screening. Second, it shows that routine screening for emotional/behavioral symptoms and social determinants of health can be performed indeed complement each other. Third, it highlights some areas that will benefit from further innovation and research. The instruments used for emotional/behavioral symptom screening were the Pediatric Symptom Checklist for children 6 to 10 years old, the Preschool Pediatric Symptom Checklist for children 18 months to 5 years old, and the Baby Pediatric Symptom Checklist for infants (the latter 2 are components of the Survey of Wellbeing of Young Children, or SWYC: www.theswyc.org). Questions about social determinants of health and about the parent’s concerns are also components of the SWYC. Although the SWYC also includes components assessing the development of cognitive, language, and motor tasks, this realm was not included in the study.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89152415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-01DOI: 10.1097/DBP.0000000000000692
Carol C Weitzman, Oana DeVinck-Baroody, Cristina E. Farrell, Cy B. Nadler, Jennifer K. Poon
Autism, Communication English MS, Tenenbaum EJ, Levine TP, et al. Perception of cry characteristics in 1-month-old infants later diagnosed with autism spectrum disorder. J Autism Dev Disord. 2019;49:834–844. Evidence suggests that the preverbal vocalizations of children with autism spectrum disorder (ASD) differ from children without ASD, but the extent to which parents of children with and without ASD perceive these differences is unknown. This study recruited mothers of children with ASD (n 5 22) or typically developing controls (TD; n 5 20) to rate their perceptions of the cries of 1-month-old infants, some of whom would later be diagnosed with ASD. Audio recordings of cries were standardized 15-second samples obtained from a previous study and matched on developmental level and prenatal exposures. Mothers of children with ASD and TD children both rated the cries of children later diagnosed with ASD to be more distressing [F(1, 36) 5 45.62, p , 0.01], atypical [F(1, 37) 5 18.57, p , 0.01], and more reflective of pain [F(1, 39) 5 32.20, p , 0.01]. Parents of children with ASD had higher scores on a measure of broader autism phenotype (BAP) [t(40) 5 22.16, p 5 0.04], but BAP scores were not significantly correlated with parent perceptions of infant cries. While based on a small sample size, these results support the hypothesis that biomarkers associated with later ASD diagnosis are present in early infancy; moreover, the results do not support that exposure to a child with ASD or elevated BAP is associated with atypical perception of infant cries. Studies with more parent raters, more samples of infant cries, and acoustic analyses to characterize differences in infant cries in ASD are needed. C.B.N.
{"title":"Journal Article Reviews.","authors":"Carol C Weitzman, Oana DeVinck-Baroody, Cristina E. Farrell, Cy B. Nadler, Jennifer K. Poon","doi":"10.1097/DBP.0000000000000692","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000692","url":null,"abstract":"Autism, Communication English MS, Tenenbaum EJ, Levine TP, et al. Perception of cry characteristics in 1-month-old infants later diagnosed with autism spectrum disorder. J Autism Dev Disord. 2019;49:834–844. Evidence suggests that the preverbal vocalizations of children with autism spectrum disorder (ASD) differ from children without ASD, but the extent to which parents of children with and without ASD perceive these differences is unknown. This study recruited mothers of children with ASD (n 5 22) or typically developing controls (TD; n 5 20) to rate their perceptions of the cries of 1-month-old infants, some of whom would later be diagnosed with ASD. Audio recordings of cries were standardized 15-second samples obtained from a previous study and matched on developmental level and prenatal exposures. Mothers of children with ASD and TD children both rated the cries of children later diagnosed with ASD to be more distressing [F(1, 36) 5 45.62, p , 0.01], atypical [F(1, 37) 5 18.57, p , 0.01], and more reflective of pain [F(1, 39) 5 32.20, p , 0.01]. Parents of children with ASD had higher scores on a measure of broader autism phenotype (BAP) [t(40) 5 22.16, p 5 0.04], but BAP scores were not significantly correlated with parent perceptions of infant cries. While based on a small sample size, these results support the hypothesis that biomarkers associated with later ASD diagnosis are present in early infancy; moreover, the results do not support that exposure to a child with ASD or elevated BAP is associated with atypical perception of infant cries. Studies with more parent raters, more samples of infant cries, and acoustic analyses to characterize differences in infant cries in ASD are needed. C.B.N.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77794462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1097/DBP.0000000000000672
Carol C Weitzman, Cy B. Nadler, J. H. Sia, Jennifer K. Poon
Adolescent Victimization, Brain Development Quinlan EB, Barker ED, Luo Q, Banaschewski T, Bokde ALW, Bromberg U, et al. Peer victimization and its impact on adolescent brain development and psychopathology. Mol Psychiatry. Published online December 2018. There is limited neuroimaging research on peer victimization (PV). The aim of this study was to determine the relationship between chronic PV and regional brain volumes. Participants (n 5 682, 46% male) were from the IMAGEN project, a multisite, longitudinal study of adolescent brain development and mental health. At 14, 16, and 19 years of age, PV was assessed using a questionnaire, and a brain MRI was performed. At the age of 19 years, psychopathology symptoms were assessed using the computer-administered Developmental and Well-Being Assessment (DAWBA) and Strengths and Difficulties Questionnaire (SDQ). Results showed the following PV scores (mean [SD, range]) at 14, 16, and 19 years of age, respectively: (4.0 [1.6, 3–13]); (3.5 [1.2, 3–13]); and (3.3 [1.0, 3–15]), respectively. In the latent profile analysis, there were 2 groups identified with no significant difference in sex: chronically high PV (high peer victimization [HPV], n 5 36, 38% male) and low PV (low peer victimization [LPV], n 5 646, 46% male). Compared with the LPV group, the HPV group had higher SDQ scores (emotional symptoms: U 5 7829.0, r 5 20.13, p 5 0.001; hyperactivity: U 5 8223.0, r 5 20.11, p 5 0.003) and higher DAWBA scores (depression: U 5 6557.0, r 5 20.13, p 5 0.001; generalized anxiety: U 5 9101.5, r 5 20.10, p 5 0.006). Further analysis showed that HPV participants had larger left putamen volume at 14 years (t522.966, p5 0.003, d 5 0.49) but not at 19 years (t 5 21.834, p 5 0.067, d 5 0.30), suggesting greater decreases in putamen volume over time compared with LPV, even after controlling for confounders such as sex and childhood trauma. There was also a negative relationship between generalized anxiety and change in putamen volume (t 5 22.31, p 5 0.021). In the indirect effects analysis, PV was indirectly associated with generalized anxiety by decreases in putamen volume (b 5 0.439, 95% confidence interval [95% CI], 0.004–0.109) and decreases in caudate volume (b 5 0.036, [95% CI], 0.002–0.099). The authors concluded that adolescent mental health is related to PV mediated by structural brain changes. These have implications for early intervention among HPV adolescents to prevent PVassociated pathological brain changes. J.H.S.
张建军，张建军，张建军，张建军，等。青少年心理伤害与大脑发育的关系。同伴伤害及其对青少年大脑发育和精神病理的影响。摩尔精神病学。2018年12月在线发布。同伴受害(PV)的神经影像学研究有限。本研究的目的是确定慢性PV与区域脑容量之间的关系。参与者(5682人，46%为男性)来自IMAGEN项目，这是一项针对青少年大脑发育和心理健康的多地点纵向研究。在14岁、16岁和19岁时，使用问卷评估PV，并进行脑MRI。在19岁时，使用计算机管理的发展与幸福评估(DAWBA)和优势与困难问卷(SDQ)评估精神病理症状。结果显示:14、16、19岁患者PV评分(mean [SD, range])分别为4.0 [1.6,3-13];(3.5 [1.2, 3-13]);和(3.3[1.0,3-15])。在潜在特征分析中，有两组在性别上没有显著差异:长期高PV(高同伴受害[HPV]， n 5 36，男性38%)和低PV(低同伴受害[LPV]， n 5 646，男性46%)。与LPV组相比，HPV组的SDQ评分更高(情绪症状:U 5 7829.0, r 5 20.13, p 5 0.001;多动症:U 58223.0, r 5.20.11, p 5.0.003)和更高的DAWBA评分(抑郁症:U 556557.0, r 5.20.13, p 5.0.001;广泛性焦虑:U 9101.5, r 520.10, p 50.006)。进一步分析表明，HPV参与者在14岁时左侧壳核体积较大(t522.966, p5 0.003, d 5 0.49)，但在19岁时则没有(t5 21.834, p5 0.067, d 5 0.30)，这表明即使在控制了性别和童年创伤等混杂因素后，与LPV相比，壳核体积随时间的减少幅度更大。广泛性焦虑与壳核体积变化呈负相关(p < 0.05, p < 0.05)。在间接效应分析中，PV与广泛性焦虑的间接关联是壳核体积减少(b5 0.439, 95%可信区间[95% CI]， 0.004-0.109)和尾状核体积减少(b5 0.036， [95% CI]， 0.002-0.099)。作者认为，青少年心理健康与脑结构变化介导的PV有关。这对早期干预HPV青少年预防与pvv相关的病理性脑改变具有重要意义。J.H.S.
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Pub Date : 2019-02-01DOI: 10.1097/DBP.0000000000000649
Carol C Weitzman, Cristina E. Farrell, Sarah S Nyp, J. H. Sia
ADOLESCENT COGNITION AND SUBSTANCE USE Morin JG, Afzali MH, Bourque J, Stewart SH, Séguin JR, O’Leary-Barrett M, and Conrod PJ. A population-based analysis of the relationship between substance use and adolescent cognitive development. AJP. Published online October 2018. Studies have shown a relationship between alcohol and cannabis misuse and cognitive functioning, but the results are mixed. The authors aimed at determining the relationship between adolescent cognition and substance use over time. Data from the Co-Venture study (a longitudinal study on the efficacy of a drug and alcohol prevention program) were used. In September 2012 or 2013, participating 7th graders in the Montreal area [n 5 3826; 53% male; mean (SD) age 5 12.7 y (0.5); 58% European] completed an annual web-based testing for 4 years to assess cognition (spatial working memory, delayed recall memory, perceptual reasoning, and inhibitory control) and substance use (Detection of Alcohol and Drug Problems in Adolescents questionnaire). Cannabis use at least 33/week was observed in 0.69%, 0.91%, 2.47%, and 3.81% of participants during 7th, 8th, 9th, and 10th grade, respectively, whereas alcohol use at least 33/week was observed in 0.31%, 0.34%, 0.36%, and 0.90% of participants during 7th, 8th, 9th, and 10th grade, respectively. After controlling for covariates (socioeconomic status, ethnicity, and family intactness), results showed that cannabis use was associated with poorer working memory (b 5 0.51, SE 5 0.25, p 5 0.04), perceptual reasoning (b 5 20.25, SE 5 0.08, p 5 0.001), and inhibition (b 5 1.19, SE 5 0.48, p , 0.01) during the same period. Further impairment in inhibition a year later was predicted by increases in cannabis use (b5 1.05, SE 5 0.41, p 5 0.01). Alcohol use was associated with lower spatial working memory (b 5 0.09, SE 5 0.05, p , 0.05), lower perceptual reasoning scores (b 5 20.06, SE 5 0.02, p , 0.01), and poorer inhibition (b 5 0.27, SE 5 0.09, p , 0.01) during the same period. Lagged effects were not observed for alcohol. The authors concluded that cannabis use is associated with more significant concurrent and lasting effects than alcohol use in adolescent cognitive functions. The results have implications on making policies that protect youths from substance use. J.H.S. ADOLESCENT DEPRESSION AND RISK BEHAVIORS Bai S, Zeledon LR, D’Amico EJ, Shoptaw S, Avina C, LaBorde AP, et al. Reducing health risk behaviors and improving depression in adolescents: a randomized controlled trial in primary care clinics. J Pedi Psych. October 2018. Health risk behaviors (HRBs) occur frequently with adolescent depression. The effectiveness of addressing multiple HRBs in primary care (PC) to reduce depressive symptoms has not been well studied. The aims of this study were to determine whether a PC intervention would decrease adolescent HRBs and improve depression and to determine associations between HRBs and depression. Adolescents (age: 16.06 6 1.45 years, 43% male) from
陈晓明，陈晓明，陈晓明，陈晓明。青少年认知与物质使用的关系。基于人群的物质使用与青少年认知发展关系分析。美国精神。2018年10月在线发布。研究表明，酒精和大麻滥用与认知功能之间存在关系，但结果好坏参半。作者的目的是确定青少年认知和长期药物使用之间的关系。数据来自于Co-Venture研究(一项关于药物和酒精预防项目有效性的纵向研究)。2012年9月或2013年9月，蒙特利尔地区参加的七年级学生[n 5 3826;男性53%;平均(SD) 5岁12.7 y (0.5);58%的欧洲人]完成了为期4年的年度网络测试，以评估认知(空间工作记忆、延迟回忆记忆、感知推理和抑制控制)和物质使用(青少年酒精和毒品问题检测问卷)。在7年级、8年级、9年级和10年级期间，分别有0.69%、0.91%、2.47%和3.81%的参与者每周至少使用33次大麻，而在7年级、8年级、9年级和10年级期间，分别有0.31%、0.34%、0.36%和0.90%的参与者每周至少使用33次酒精。在控制了协变量(社会经济地位、种族和家庭完整性)后，结果显示大麻使用与同期较差的工作记忆(b5.0.51, SE 5.0.25, p 5.0.04)、知觉推理(b5.20.25, SE 5.0.08, p 5.0.001)和抑制(b5.1.19, SE 5.0.48, p, 0.01)相关。一年后，大麻使用的增加预示着抑制能力的进一步损害(b5.1.05, SE 5.0.41, p 5.0.01)。在同一时间段内，饮酒与空间工作记忆降低(b5.0.09, SE 5.0.05, p, 0.05)、知觉推理得分降低(b5.20.06, SE 5.0.02, p, 0.01)和抑制能力降低(b5.0.27, SE 5.0.09, p, 0.01)相关。未观察到酒精的滞后效应。作者得出结论，大麻的使用比酒精对青少年认知功能的影响更显著，更持久。研究结果对制定保护青少年远离药物使用的政策具有启示意义。张晓明，张晓明，张晓明，等。青少年抑郁与风险行为的关系。减少青少年健康风险行为和改善抑郁:初级保健诊所的随机对照试验。[J]儿科心理学。2018年10月。健康危险行为(HRBs)在青少年抑郁症中经常发生。在初级保健(PC)中处理多重hrb以减轻抑郁症状的有效性尚未得到很好的研究。本研究的目的是确定PC干预是否会减少青少年hrb和改善抑郁症，并确定hrb和抑郁症之间的关系。青少年(年龄:来自2家PC诊所的患者(年龄为16.06 - 1.45岁，43%男性)，经综合国际诊断访谈确定为过去一年可能/可能患有抑郁症，或目前患有抑郁症[根据流行病学研究中心抑郁量表(ses - d)或儿童诊断访谈表(DISC)]，但未服用精神药物，且至少有1项针对性HRB(吸烟、药物使用、不安全性行为和肥胖风险)，随机接受健康青少年干预[HT:动机策略和认知行为方法的结合，由心理治疗师病例管理人员(CMs)提供的建模和指导，每周10次，每次1小时，在PC诊所或PC附近的办公室进行;[595]或加强常规护理(UC1):向PC临床医生提供抑郁症治疗信息;N 5 92)。HT参与者继续接受UC1。在基线、6个月和12个月时进行青少年和父母评估，青少年完成自我报告问卷。主要终点为HRB指数[HRBI (0-4);hrb的总和]。次要结果是CES-D评分。在年龄、性别、基线HRBI (1.42 6 0.94 vs 1.396 1.07)、DISC标准抑郁症(51% vs 52%)和CES-D“严重”评分(34% vs 29%)方面(HT vs UC1)没有显著的组间差异，尽管UC1组中有更多的拉丁裔/西班牙裔参与者(p 0.05)。HT的平均出勤率为3.69次(SD 5 3.19);30.5%没有参加任何会议。A组(CMs纳入PC诊所)的参与者出勤率高于B组(平均[SD]: 4.18[3.14] vs 2.63 [3.10]， p 5 0.028)。分析显示，在6个月和12个月时，尽管所有参与者的hrb随着时间的推移有所减少(12个月校正优势比为5.0.32,95%可信区间[CI] 0.15-0.72, p . 5.0.006)，但组间无显著差异
{"title":"Journal Article Reviews.","authors":"Carol C Weitzman, Cristina E. Farrell, Sarah S Nyp, J. H. Sia","doi":"10.1097/DBP.0000000000000649","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000649","url":null,"abstract":"ADOLESCENT COGNITION AND SUBSTANCE USE Morin JG, Afzali MH, Bourque J, Stewart SH, Séguin JR, O’Leary-Barrett M, and Conrod PJ. A population-based analysis of the relationship between substance use and adolescent cognitive development. AJP. Published online October 2018. Studies have shown a relationship between alcohol and cannabis misuse and cognitive functioning, but the results are mixed. The authors aimed at determining the relationship between adolescent cognition and substance use over time. Data from the Co-Venture study (a longitudinal study on the efficacy of a drug and alcohol prevention program) were used. In September 2012 or 2013, participating 7th graders in the Montreal area [n 5 3826; 53% male; mean (SD) age 5 12.7 y (0.5); 58% European] completed an annual web-based testing for 4 years to assess cognition (spatial working memory, delayed recall memory, perceptual reasoning, and inhibitory control) and substance use (Detection of Alcohol and Drug Problems in Adolescents questionnaire). Cannabis use at least 33/week was observed in 0.69%, 0.91%, 2.47%, and 3.81% of participants during 7th, 8th, 9th, and 10th grade, respectively, whereas alcohol use at least 33/week was observed in 0.31%, 0.34%, 0.36%, and 0.90% of participants during 7th, 8th, 9th, and 10th grade, respectively. After controlling for covariates (socioeconomic status, ethnicity, and family intactness), results showed that cannabis use was associated with poorer working memory (b 5 0.51, SE 5 0.25, p 5 0.04), perceptual reasoning (b 5 20.25, SE 5 0.08, p 5 0.001), and inhibition (b 5 1.19, SE 5 0.48, p , 0.01) during the same period. Further impairment in inhibition a year later was predicted by increases in cannabis use (b5 1.05, SE 5 0.41, p 5 0.01). Alcohol use was associated with lower spatial working memory (b 5 0.09, SE 5 0.05, p , 0.05), lower perceptual reasoning scores (b 5 20.06, SE 5 0.02, p , 0.01), and poorer inhibition (b 5 0.27, SE 5 0.09, p , 0.01) during the same period. Lagged effects were not observed for alcohol. The authors concluded that cannabis use is associated with more significant concurrent and lasting effects than alcohol use in adolescent cognitive functions. The results have implications on making policies that protect youths from substance use. J.H.S. ADOLESCENT DEPRESSION AND RISK BEHAVIORS Bai S, Zeledon LR, D’Amico EJ, Shoptaw S, Avina C, LaBorde AP, et al. Reducing health risk behaviors and improving depression in adolescents: a randomized controlled trial in primary care clinics. J Pedi Psych. October 2018. Health risk behaviors (HRBs) occur frequently with adolescent depression. The effectiveness of addressing multiple HRBs in primary care (PC) to reduce depressive symptoms has not been well studied. The aims of this study were to determine whether a PC intervention would decrease adolescent HRBs and improve depression and to determine associations between HRBs and depression. Adolescents (age: 16.06 6 1.45 years, 43% male) from ","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75150503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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