Pub Date : 2019-01-01DOI: 10.1097/DBP.0000000000000725
R. Knight, Jeremy J. Albright, Lindsay A. Deling, Dawn Dore-Stites, Amy K. Drayton
OBJECTIVE Time-out is a widely used child discipline strategy and one of the only strategies currently recommended by the American Academy of Pediatrics. Despite its widespread use and significant evidence to support its effectiveness in decreasing problem behavior, time-out is often suggested to be harmful or ineffective by the popular media and select professional organizations. Empirical evidence regarding possible side effects of time-out is limited. The present study examined the relationship between reported use of time-out and child emotional and behavioral functioning and parent-child relationships using longitudinal, archival data. METHODS The study used archival, longitudinal data from the Early Head Start Research and Evaluation study. This study tracked families with children in Early Head Start at 3 different time points as follows: baseline (aged 0-3 years), pre-kindergarten, and fifth grade. Parent interviews, including questions on the use of time-out, were conducted when the children were 36 months old. Indicators of child emotional and behavioral health were measured at 36 months, pre-K, and fifth grade. Statistical analyses were completed to assess for potential side effects of time-out on child behavioral and emotional functioning and parent-child relationships. RESULTS Analyses for all outcome variables suggest no significant difference for children whose parents reported using time-out versus those who did not. CONCLUSION Parental reported use of time-out was not associated with long-term negative outcomes. Further research in this area is necessary to continue to address the multitude of concerns related to time-out that are presented by the media.
{"title":"Longitudinal Relationship Between Time-Out and Child Emotional and Behavioral Functioning.","authors":"R. Knight, Jeremy J. Albright, Lindsay A. Deling, Dawn Dore-Stites, Amy K. Drayton","doi":"10.1097/DBP.0000000000000725","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000725","url":null,"abstract":"OBJECTIVE Time-out is a widely used child discipline strategy and one of the only strategies currently recommended by the American Academy of Pediatrics. Despite its widespread use and significant evidence to support its effectiveness in decreasing problem behavior, time-out is often suggested to be harmful or ineffective by the popular media and select professional organizations. Empirical evidence regarding possible side effects of time-out is limited. The present study examined the relationship between reported use of time-out and child emotional and behavioral functioning and parent-child relationships using longitudinal, archival data. METHODS The study used archival, longitudinal data from the Early Head Start Research and Evaluation study. This study tracked families with children in Early Head Start at 3 different time points as follows: baseline (aged 0-3 years), pre-kindergarten, and fifth grade. Parent interviews, including questions on the use of time-out, were conducted when the children were 36 months old. Indicators of child emotional and behavioral health were measured at 36 months, pre-K, and fifth grade. Statistical analyses were completed to assess for potential side effects of time-out on child behavioral and emotional functioning and parent-child relationships. RESULTS Analyses for all outcome variables suggest no significant difference for children whose parents reported using time-out versus those who did not. CONCLUSION Parental reported use of time-out was not associated with long-term negative outcomes. Further research in this area is necessary to continue to address the multitude of concerns related to time-out that are presented by the media.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90723613","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000710
M. Augustyn, E. Silver, N. Blum, P. High, N. Roizen, R. Stein
OBJECTIVE To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted. DESIGN/METHODS This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses. RESULTS Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity. CONCLUSION This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.
目的探讨非西班牙裔白人(NHW)和非白人(NW)儿童在学术医疗中心发展行为儿科医生(DBP)评估中的转诊问题、评估和诊断是否存在差异，以及社会经济因素在任何差异中所起的潜在作用。设计/方法本观察性研究使用了参与DBPNet的12个站点的56个dbp的调查数据。儿童种族和民族来自DBP报告。混合模型logistic和线性回归分析控制了地点、提供者和社会经济代理变量(保险类型、父母教育和家庭语言)，用于比较两组在转诊关注、评估程序和诊断方面的差异。结果在评估的患者中，349例NHW, 406例NW(187例西班牙裔，135例黑人，58例亚洲/太平洋岛民，26例其他/混合)，29例缺少种族/族裔数据。控制地点和提供者的平均等待时间NHW儿童为20.4周，NW儿童为20.5周。NWH组和NW组的转诊原因相似，只有睡眠问题在NW组儿童中更常见(9.2% vs 3.4% NW, p = 0.01)。两组患者的评价也相似;唯一的差异是NHW儿童比NW儿童有更多的基因检测(33.1%比19.3%，p = 0.02)、眼科评估(8.7%比3.4%，p = 0.03)和精神药理学评估(19.1%比9.7%，p = 0.008)。诊断的数量和类型没有因种族/民族而异。结论本研究表明，当考虑到社会经济因素时，在12个DBP学术中心，NHW和NW儿童在等待护理时间、转诊原因、随访或初始DBP评估的最终诊断方面几乎没有不平等。然而，由于这些相关因素的差异可能是产生种族/民族差异的机制，因此在为服务不足的社区规划模式和护理协议时考虑这些因素将是重要的。
{"title":"DBP Evaluations in DBPNet Sites: Is Race/Ethnicity a Significant Factor in Care?","authors":"M. Augustyn, E. Silver, N. Blum, P. High, N. Roizen, R. Stein","doi":"10.1097/DBP.0000000000000710","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000710","url":null,"abstract":"OBJECTIVE To examine whether there are differences between non-Hispanic white (NHW) and nonwhite (NW) children in referral questions, evaluations, and diagnoses during developmental behavioral pediatrician (DBP) evaluations at academic medical centers and the potential role of socioeconomic factors in any disparities noted. DESIGN/METHODS This observational study used survey data from 56 DBPs at 12 sites participating in DBPNet. Child race and ethnicity were obtained from DBP report. Mixed-model logistic and linear regression analyses controlling for site, provider, and socioeconomic proxy variables (insurance type, parent education, and language spoken at home) were used to compare groups on referral concerns, evaluation procedures, and diagnoses. RESULTS Among the patients evaluated, 349 were NHW, 406 were NW (187 Hispanic, 135 black, 58 Asian/Pacific Islander, and 26 other/mixed), and 29 were missing race/ethnicity data. The mean waiting time controlling for site and provider was 20.4 weeks for NHW children and 20.5 weeks for NW children. Reasons for referral were similar in the NWH and NW groups, with only sleep problem concerns being more frequent among NHW children (9.2% vs 3.4% NW, p = 0.01). Patients also had similar evaluations in the 2 groups; the only differences found were that more NHW than NW children had genetic testing (33.1% vs 19.3%, p = 0.02), ophthalmology evaluations (8.7% vs 3.4%, p = 0.03), and psychopharmacologic evaluations (19.1% vs 9.7%, p = 0.008). Numbers and types of diagnoses did not vary by race/ethnicity. CONCLUSION This study suggests little inequality between NHW and NW children in wait time to care, reasons for referral, workup, or final diagnosis for initial DBP evaluation at these 12 academic DBP centers when socioeconomic factors are considered. Nevertheless, because differences in these related factors may be mechanisms through which racial/ethnic disparities can arise, it will be important to consider them in planning models and care protocols for underserved communities.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74527240","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000633
Carol C Weitzman, Rachel M. Moore, Sarah S Nyp, J. H. Sia
ADHD Dvorsky MR, Langberg JM, Evans SW, et al. The protective effects of social factors on the academic functioning of adolescents with ADHD. J Clin Child Adolesc Psychol. 2018;47:713–726. Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience clinically significant academic disadvantages (e.g., lower grades and standardized test scores, increased likelihood of school dropout). Research suggests that healthy social functioning (e.g., maintenance of close interpersonal relationships, appropriate use of prosocial behavior and skills, and social acceptance) during middle school may be an important protective factor for youth with ADHD because it has previously been associated with higher academic achievement and school involvement. The current study included adolescents (n 5 93; 72% male students, 78% Caucasian) with clinically confirmed ADHD (n 5 50 ADHD inattentive type [ADHD-I]; n 5 43 ADHD combined type) assessed in fifth (39.9%), sixth (31.1%), or seventh (29%) grade; adolescents were all assessed 18 months later. Approximately 47% of participants were prescribed medication. Comorbid conditions included 45% oppositional defiant disorder or conduct disorder, 27% anxiety, and 14% depressive disorder. Outcomes included selfand parent-reported measures of ADHD and oppositional symptoms, social skills, and perceived social acceptance. Academic outcomes included both objective (e.g., grade point average [GPA]) and subjective (e.g., teacher reported impairment ratings) functioning. Results showed that neither parentnor adolescent-rated social skills demonstrated protective effects for any academic outcome. Only ADHD-I was a significant risk factor for poor grades (b5 20.21, p 5 0.02) and teacher-rated impairment (b 5 0.28, p 5 0.04). The relationship between inattention and grades (e.g., mean GPA 5 2.47) was attenuated for adolescents with high social acceptance as reported both by parents (b 5 0.28, p 5 0.006) and the adolescents (b 5 0.32, p 5 0.04). For adolescents with low parent-reported social acceptance, the relationship between inattention and low grades (e.g., mean GPA 5 1.54) was stronger (t(93) 5 22.01, p 5 0.04). The authors stress the importance of considering the role of specific protective factors; pediatricians for youth with ADHD can encourage participation in interest-specific social groups or clubs. R.M. ADHD, prematurity Ask H, Gustavson K, Ystrom E, et al. Association of gestational age at birth with symptoms of attentiondeficit/hyperactivity disorder in children. JAMA Pediatr. 2018;172:749–756. Previous studies have demonstrated an association between prematurity and attention-deficit/hyperactivity disorder (ADHD). This study is unique in that it sought to explore differences in the association between ADHD symptoms and gestational age at 5 and 8 years of age and the potential impact of maternal/perinatal factors and sex on the association between symptoms of ADHD and gestational age at birth. The Norwe
ADHD Dvorsky MR, Langberg JM, Evans SW等。社会因素对ADHD青少年学业功能的保护作用。儿童心理学报，2018;47(1):713 - 726。患有注意力缺陷/多动障碍(ADHD)的青少年通常会经历临床上显著的学业劣势(例如，较低的成绩和标准化考试分数，退学的可能性增加)。研究表明，在中学时期健康的社会功能(例如，维持密切的人际关系，适当使用亲社会行为和技能，以及社会接受)可能是青少年多动症的一个重要保护因素，因为它以前与较高的学业成绩和学校参与有关。目前的研究包括青少年(1993年5月;72%男学生，78%白种人)临床确诊ADHD(共550例ADHD注意力不集中型[ADHD- i];(5 43例ADHD合并型)在第5级(39.9%)、第6级(31.1%)或第7级(29%)进行评估;所有青少年在18个月后接受评估。大约47%的参与者服用处方药。合并症包括45%的对立违抗性障碍或行为障碍，27%的焦虑和14%的抑郁障碍。结果包括自我和父母报告的ADHD和对立症状、社交技能和感知的社会接受度的测量。学业成绩包括客观(例如，平均绩点[GPA])和主观(例如，教师报告的损伤评级)功能。结果显示，父母和青少年评定的社交技能都没有显示出对学业成绩的保护作用。只有ADHD-I是导致成绩差(b5 20.21, p 5 0.02)和教师评定的损害(b5 0.28, p 5 0.04)的显著危险因素。在父母(b5.0.28, p 5.0.006)和青少年(b5.0.32, p 5.0.04)报告的社会接受度较高的青少年中，注意力不集中与成绩(如平均GPA 5.2.47)的关系减弱。对于父母报告的社会接受度低的青少年，注意力不集中与成绩差(例如平均GPA为1.54)之间的关系更强(t(93) 5 22.01, p 5 0.04)。作者强调了考虑特定保护因素作用的重要性;患有多动症的青少年儿科医生可以鼓励他们参加特定兴趣的社会团体或俱乐部。刘建军，刘建军，刘建军，等。出生胎龄与儿童注意缺陷/多动障碍症状的关系美国儿科杂志，2018;172:749-756。先前的研究已经证明了早产和注意力缺陷/多动障碍(ADHD)之间的联系。这项研究的独特之处在于，它试图探索ADHD症状与5岁和8岁时胎龄之间的关联差异，以及母体/围产期因素和性别对ADHD症状与出生胎龄之间关联的潜在影响。本研究采用挪威母婴队列研究，包括1999年1月1日至2008年12月31日期间出生的113,227名儿童(49%为女孩，28%为足月出生)的数据。该样本包括33,081名同性、暴露不一致的兄弟姐妹(49%为女孩，29%为足月出生)。在怀孕22到33周之间出生的婴儿被认为是早期早产。怀孕39至40周出生的婴儿被认为是足月。ADHD症状在5岁时用家长填写的Conner父母评定量表进行测量，在8岁时用家长/老师破坏性行为障碍评定量表进行测量。婴儿性别、多胎状态、出生时小于胎龄状态、先天性畸形、母体胎次和妊娠第13周前母体阴道出血被评估为潜在的混杂变量。与先前的研究一致，早产胎龄早期出生的儿童比足月出生的儿童更有可能出现ADHD(5岁时优势比[OR] 1.55[95%置信区间[CI]， 1.29-1.85])、注意力不集中(8岁时优势比[OR] 1.85 [95% CI, 1.55 - 2.14])和多动/冲动(8岁时优势比[OR] 1.52 [95% CI, 1.29-1.79])等症状。当校正妊娠/母亲风险因素后，早产儿童继续表现出ADHD(5岁时OR为1.63 [95% CI 1.24-2.57])、注意力不集中(8岁时OR为1.79 [95% CI, 1.24-2.57])和多动/冲动(8岁时OR为1.66 [95% CI, 1.14-2.43])的症状增加。与足月出生的兄弟姐妹相比，经妊娠相关危险因素调整后，早产儿童更有可能出现ADHD(5岁时OR为1.79 [95% CI, 1.04-3.08])和注意力不集中(8岁时OR为1.75 [95% CI, 1.09-2.81])的症状，但没有多动症(OR为0.95 [95% CI，
{"title":"Journal Article Reviews.","authors":"Carol C Weitzman, Rachel M. Moore, Sarah S Nyp, J. H. Sia","doi":"10.1097/DBP.0000000000000633","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000633","url":null,"abstract":"ADHD Dvorsky MR, Langberg JM, Evans SW, et al. The protective effects of social factors on the academic functioning of adolescents with ADHD. J Clin Child Adolesc Psychol. 2018;47:713–726. Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience clinically significant academic disadvantages (e.g., lower grades and standardized test scores, increased likelihood of school dropout). Research suggests that healthy social functioning (e.g., maintenance of close interpersonal relationships, appropriate use of prosocial behavior and skills, and social acceptance) during middle school may be an important protective factor for youth with ADHD because it has previously been associated with higher academic achievement and school involvement. The current study included adolescents (n 5 93; 72% male students, 78% Caucasian) with clinically confirmed ADHD (n 5 50 ADHD inattentive type [ADHD-I]; n 5 43 ADHD combined type) assessed in fifth (39.9%), sixth (31.1%), or seventh (29%) grade; adolescents were all assessed 18 months later. Approximately 47% of participants were prescribed medication. Comorbid conditions included 45% oppositional defiant disorder or conduct disorder, 27% anxiety, and 14% depressive disorder. Outcomes included selfand parent-reported measures of ADHD and oppositional symptoms, social skills, and perceived social acceptance. Academic outcomes included both objective (e.g., grade point average [GPA]) and subjective (e.g., teacher reported impairment ratings) functioning. Results showed that neither parentnor adolescent-rated social skills demonstrated protective effects for any academic outcome. Only ADHD-I was a significant risk factor for poor grades (b5 20.21, p 5 0.02) and teacher-rated impairment (b 5 0.28, p 5 0.04). The relationship between inattention and grades (e.g., mean GPA 5 2.47) was attenuated for adolescents with high social acceptance as reported both by parents (b 5 0.28, p 5 0.006) and the adolescents (b 5 0.32, p 5 0.04). For adolescents with low parent-reported social acceptance, the relationship between inattention and low grades (e.g., mean GPA 5 1.54) was stronger (t(93) 5 22.01, p 5 0.04). The authors stress the importance of considering the role of specific protective factors; pediatricians for youth with ADHD can encourage participation in interest-specific social groups or clubs. R.M. ADHD, prematurity Ask H, Gustavson K, Ystrom E, et al. Association of gestational age at birth with symptoms of attentiondeficit/hyperactivity disorder in children. JAMA Pediatr. 2018;172:749–756. Previous studies have demonstrated an association between prematurity and attention-deficit/hyperactivity disorder (ADHD). This study is unique in that it sought to explore differences in the association between ADHD symptoms and gestational age at 5 and 8 years of age and the potential impact of maternal/perinatal factors and sex on the association between symptoms of ADHD and gestational age at birth. The Norwe","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76531269","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000734
Susan B Roman, P. Dworkin, P. Dickinson, Steven C. Rogers
OBJECTIVES To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. METHODS CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. RESULTS A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. CONCLUSION Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.
{"title":"Analysis of Care Coordination Needs for Families of Children with Special Health Care Needs.","authors":"Susan B Roman, P. Dworkin, P. Dickinson, Steven C. Rogers","doi":"10.1097/DBP.0000000000000734","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000734","url":null,"abstract":"OBJECTIVES To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. METHODS CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. RESULTS A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. CONCLUSION Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79805230","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000723
Scott T. Wagoner, Megan R. Schaefer, Alana Rawlinson, S. Shapiro, J. Kavookjian, W. Gray
OBJECTIVE The current study sought to obtain a longitudinal perspective of and quantitatively assess barriers to medication adherence experienced by college students with attention-deficit/hyperactivity disorder (ADHD). Thus, we examined semester-long trends in barriers to adherence in addition to the relationships between barriers and medication adherence and barriers and quality of life. METHODS Participants were college students diagnosed with ADHD. Throughout a Fall semester, participants completed 4 sets of online questionnaires and attended 4 in-person visits, which included pill counts and written questionnaires. Participants completed measures assessing barriers to adherence and health-related quality of life, and adherence was measured via pill counts. Mean values of barriers, adherence rate, and quality of life were used for all analyses. RESULTS Of the 45 students surveyed, mean adherence rate was 56.70%, and 84.45% of participants reported at least 1 barrier. Across the semester, participants reported experiencing an average of 3.07 barriers, and a consistent barrier reported was not realizing when pills run out. Although reported barriers were unrelated to adherence, the results showed that barriers were associated with lowered quality of life, specifically lower overall quality of life in addition to lower emotional functioning, psychosocial health, school functioning, and physical functioning. CONCLUSION Barriers to adherence appear to be common in college students with ADHD, and certain barriers are consistent with the planning difficulties observed in individuals with ADHD. Because students experiencing more barriers had lower quality of life, interventions are needed to improve students' overall illness management experience.
{"title":"Barriers to Treatment Adherence Among College Students with Attention-Deficit/Hyperactivity Disorder.","authors":"Scott T. Wagoner, Megan R. Schaefer, Alana Rawlinson, S. Shapiro, J. Kavookjian, W. Gray","doi":"10.1097/DBP.0000000000000723","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000723","url":null,"abstract":"OBJECTIVE The current study sought to obtain a longitudinal perspective of and quantitatively assess barriers to medication adherence experienced by college students with attention-deficit/hyperactivity disorder (ADHD). Thus, we examined semester-long trends in barriers to adherence in addition to the relationships between barriers and medication adherence and barriers and quality of life. METHODS Participants were college students diagnosed with ADHD. Throughout a Fall semester, participants completed 4 sets of online questionnaires and attended 4 in-person visits, which included pill counts and written questionnaires. Participants completed measures assessing barriers to adherence and health-related quality of life, and adherence was measured via pill counts. Mean values of barriers, adherence rate, and quality of life were used for all analyses. RESULTS Of the 45 students surveyed, mean adherence rate was 56.70%, and 84.45% of participants reported at least 1 barrier. Across the semester, participants reported experiencing an average of 3.07 barriers, and a consistent barrier reported was not realizing when pills run out. Although reported barriers were unrelated to adherence, the results showed that barriers were associated with lowered quality of life, specifically lower overall quality of life in addition to lower emotional functioning, psychosocial health, school functioning, and physical functioning. CONCLUSION Barriers to adherence appear to be common in college students with ADHD, and certain barriers are consistent with the planning difficulties observed in individuals with ADHD. Because students experiencing more barriers had lower quality of life, interventions are needed to improve students' overall illness management experience.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79497079","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000711
Samantha J. Lee, V. Pritchard, N. Austin, Jacqueline M T Henderson, L. Woodward
OBJECTIVE To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk. METHODS Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non-methadone-exposed children were studied from birth (2003-2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score. RESULTS Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0-5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01-1.11]), higher social risk (RR = 1.35 [1.20-1.53]), male sex (RR = 1.69 [1.27-2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94-0.99]). CONCLUSION Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower-quality caregiving environments.
{"title":"Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry.","authors":"Samantha J. Lee, V. Pritchard, N. Austin, Jacqueline M T Henderson, L. Woodward","doi":"10.1097/DBP.0000000000000711","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000711","url":null,"abstract":"OBJECTIVE To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk. METHODS Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non-methadone-exposed children were studied from birth (2003-2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score. RESULTS Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0-5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01-1.11]), higher social risk (RR = 1.35 [1.20-1.53]), male sex (RR = 1.69 [1.27-2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94-0.99]). CONCLUSION Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower-quality caregiving environments.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87932203","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000720
Carol Duh-Leong, Anne E. Fuller, Nicole M. Brown
BACKGROUND Evidence has established the association between risk factors and attention-deficit/hyperactivity disorder (ADHD) severity, but less is known about factors that may have protective effects on clinical, academic, and social outcomes among children with ADHD. OBJECTIVE To examine associations between family cohesion, caregiver social support, community support, and (1) ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. METHODS Cross-sectional study of school-aged and adolescent children with ADHD using data from the 2016 National Survey of Children's Health. Our outcomes were (1) parent-rated ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. Our independent variables were (1) family cohesion, (2) caregiver social support, and (3) community support. We used logistic regression models to examine associations between our independent variables and each of our outcome variables, adjusting for child and parent sociodemographic characteristics. RESULTS In our sample (N = 4,122, weighted N = 4,734,322), children exposed to family cohesion and community support had lower odds of moderate to severe ADHD [adjusted OR (aOR): 0.73 (0.55-0.97); aOR: 0.73 (0.56-0.95), respectively], higher odds of school engagement [aOR: 1.72, (1.25-2.37); aOR: 1.38, (1.04-1.84), respectively], and lower odds of difficulty making or keeping friends [aOR: 0.64, (0.48-0.85); aOR: 0.52, (0.40-0.67), respectively]. CONCLUSION Among children with ADHD, family cohesion and community support show protective effects in clinical, academic, and social outcomes. Systematically identifying family- and community-level strengths may be important components of multimodal treatment strategies in children with ADHD.
{"title":"Associations Between Family and Community Protective Factors and Attention-Deficit/Hyperactivity Disorder Outcomes Among US Children.","authors":"Carol Duh-Leong, Anne E. Fuller, Nicole M. Brown","doi":"10.1097/DBP.0000000000000720","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000720","url":null,"abstract":"BACKGROUND Evidence has established the association between risk factors and attention-deficit/hyperactivity disorder (ADHD) severity, but less is known about factors that may have protective effects on clinical, academic, and social outcomes among children with ADHD. OBJECTIVE To examine associations between family cohesion, caregiver social support, community support, and (1) ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. METHODS Cross-sectional study of school-aged and adolescent children with ADHD using data from the 2016 National Survey of Children's Health. Our outcomes were (1) parent-rated ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. Our independent variables were (1) family cohesion, (2) caregiver social support, and (3) community support. We used logistic regression models to examine associations between our independent variables and each of our outcome variables, adjusting for child and parent sociodemographic characteristics. RESULTS In our sample (N = 4,122, weighted N = 4,734,322), children exposed to family cohesion and community support had lower odds of moderate to severe ADHD [adjusted OR (aOR): 0.73 (0.55-0.97); aOR: 0.73 (0.56-0.95), respectively], higher odds of school engagement [aOR: 1.72, (1.25-2.37); aOR: 1.38, (1.04-1.84), respectively], and lower odds of difficulty making or keeping friends [aOR: 0.64, (0.48-0.85); aOR: 0.52, (0.40-0.67), respectively]. CONCLUSION Among children with ADHD, family cohesion and community support show protective effects in clinical, academic, and social outcomes. Systematically identifying family- and community-level strengths may be important components of multimodal treatment strategies in children with ADHD.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81424399","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000724
Stacey Bevan, Jianghong Liu, Kate E. Wallis, J. Pinto-Martin
BACKGROUND Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the United States, has not been systematically examined. OBJECTIVE This study aims to review the literature of clinically administered developmental and behavioral instruments with Hispanic caregivers to investigate implementation variation due to language and cultural factors. METHODS A systematic literature review using PubMed and PsycINFO was conducted of articles published from January 1, 2006 to December 12, 2017. Abstract, full-text, and critical appraisal resulted in 11 studies that met criteria for inclusion. RESULTS Five different instruments were used to screen Hispanic or Spanish-speaking caregivers of children younger than 6 years. None of the instruments established validity and reliability apart from Spanish translation. Two studies identified differences in screening results with Spanish-speaking caregivers due to language and 6 described cultural differences that impacted screening implementation. Two studies reported differential item functioning in Spanish-translated instruments. CONCLUSIONS Language and cultural considerations are critical to the administration of valid and reliable screening in pediatric health care settings. Available developmental and behavioral Spanish-language-screening instruments function differently because of both language and culture, suggesting the tools are not as psychometrically valid when administered to Spanish-speaking families. Validation of translated screening instruments is essential to eliminate the possibility of detection bias or misidentification of developmental risk, improving early access to clinical services for Hispanic and Spanish-speaking families.
{"title":"Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review.","authors":"Stacey Bevan, Jianghong Liu, Kate E. Wallis, J. Pinto-Martin","doi":"10.1097/DBP.0000000000000724","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000724","url":null,"abstract":"BACKGROUND Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the United States, has not been systematically examined. OBJECTIVE This study aims to review the literature of clinically administered developmental and behavioral instruments with Hispanic caregivers to investigate implementation variation due to language and cultural factors. METHODS A systematic literature review using PubMed and PsycINFO was conducted of articles published from January 1, 2006 to December 12, 2017. Abstract, full-text, and critical appraisal resulted in 11 studies that met criteria for inclusion. RESULTS Five different instruments were used to screen Hispanic or Spanish-speaking caregivers of children younger than 6 years. None of the instruments established validity and reliability apart from Spanish translation. Two studies identified differences in screening results with Spanish-speaking caregivers due to language and 6 described cultural differences that impacted screening implementation. Two studies reported differential item functioning in Spanish-translated instruments. CONCLUSIONS Language and cultural considerations are critical to the administration of valid and reliable screening in pediatric health care settings. Available developmental and behavioral Spanish-language-screening instruments function differently because of both language and culture, suggesting the tools are not as psychometrically valid when administered to Spanish-speaking families. Validation of translated screening instruments is essential to eliminate the possibility of detection bias or misidentification of developmental risk, improving early access to clinical services for Hispanic and Spanish-speaking families.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87423849","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 : 2019-01-01DOI: 10.1097/DBP.0000000000000746
J. Patel, Maxine K Mueller, W. J. Guffey, J. Stegman
OBJECTIVE To describe drug prescribing and outcomes after pharmacogenomic (PGx) testing in children with developmental and/or behavioral disorders. METHODS This is a single-clinic retrospective analysis of patients aged 5 to 17 years with documented behavioral and/or development disorder(s) and having received PGx testing between May 2015 and May 2017. The primary endpoint was frequency of PGx-guided medication changes after testing. Secondary endpoints included frequency of medications in each category from the PGx report (use as directed, use with caution, and use with increased caution), changes in therapy within each category, frequency and type of actionable genes, symptomatic improvement, and frequency of medication changes up to 6 months after PGx-guided therapy. RESULTS Of 200 patients, 75% were male, 78% were white, 83% had attention-deficit/hyperactivity disorder, and 45% had anxiety, and their mean age was 10 years. Most common reasons for ordering PGx testing were lack of response (83%) and/or adverse events (42%). Approximately 84% had PGx-guided medication change(s) after testing. At baseline, 50% of medications were categorized in "use as directed," 40% in "use with caution," and 11% in "use with increased caution." After testing, 8%, 29%, and 30% of medications in "use as directed," "use with caution," and "use with increased caution" categories were discontinued; 85% were added or continued from "use as directed" category. The most common actionable genes were ADRA2A (47%), COMT (22%), and CYP2D6 (20%). Sixty percent were on the same medication(s) suggested by the PGx report 6 months later, and 64% had provider-documented symptomatic improvement. CONCLUSION Pharmacogenomic testing may affect drug prescribing and clinical outcomes in a pediatric behavioral health clinic.
{"title":"Drug Prescribing and Outcomes After Pharmacogenomic Testing in a Developmental and Behavioral Health Pediatric Clinic.","authors":"J. Patel, Maxine K Mueller, W. J. Guffey, J. Stegman","doi":"10.1097/DBP.0000000000000746","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000746","url":null,"abstract":"OBJECTIVE To describe drug prescribing and outcomes after pharmacogenomic (PGx) testing in children with developmental and/or behavioral disorders. METHODS This is a single-clinic retrospective analysis of patients aged 5 to 17 years with documented behavioral and/or development disorder(s) and having received PGx testing between May 2015 and May 2017. The primary endpoint was frequency of PGx-guided medication changes after testing. Secondary endpoints included frequency of medications in each category from the PGx report (use as directed, use with caution, and use with increased caution), changes in therapy within each category, frequency and type of actionable genes, symptomatic improvement, and frequency of medication changes up to 6 months after PGx-guided therapy. RESULTS Of 200 patients, 75% were male, 78% were white, 83% had attention-deficit/hyperactivity disorder, and 45% had anxiety, and their mean age was 10 years. Most common reasons for ordering PGx testing were lack of response (83%) and/or adverse events (42%). Approximately 84% had PGx-guided medication change(s) after testing. At baseline, 50% of medications were categorized in \"use as directed,\" 40% in \"use with caution,\" and 11% in \"use with increased caution.\" After testing, 8%, 29%, and 30% of medications in \"use as directed,\" \"use with caution,\" and \"use with increased caution\" categories were discontinued; 85% were added or continued from \"use as directed\" category. The most common actionable genes were ADRA2A (47%), COMT (22%), and CYP2D6 (20%). Sixty percent were on the same medication(s) suggested by the PGx report 6 months later, and 64% had provider-documented symptomatic improvement. CONCLUSION Pharmacogenomic testing may affect drug prescribing and clinical outcomes in a pediatric behavioral health clinic.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90184921","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 : 2018-12-01DOI: 10.1097/DBP.0000000000000627
Katherine Trier, Elizabeth B. Harstad
with psychosocial, cognitive, and weight outcomes in a longitudinal sample of girls. Transl Issues Psychol Sci. 2015;1:203–216. 23. Anzman SL, Birch LL. Low inhibitory control and restrictive feeding practices predict weight outcomes. J Pediatr. 2009;155: 651–656. 24. Raver CC, Jones SM, Li-Grining C, et al. CSRP’s impact on lowincome preschoolers’ preacademic skills: self-Regulation as a mediating mechanism. Child Dev. 2011;82:362–378. 25. Stifter CA, Braungart JM. The regulation of negative reactivity in infancy: function and development. Dev Psychol. 1995;31:448– 455.
{"title":"Let's Talk: Navigating Communication Services and Supports for Your Young Child With Autism","authors":"Katherine Trier, Elizabeth B. Harstad","doi":"10.1097/DBP.0000000000000627","DOIUrl":"https://doi.org/10.1097/DBP.0000000000000627","url":null,"abstract":"with psychosocial, cognitive, and weight outcomes in a longitudinal sample of girls. Transl Issues Psychol Sci. 2015;1:203–216. 23. Anzman SL, Birch LL. Low inhibitory control and restrictive feeding practices predict weight outcomes. J Pediatr. 2009;155: 651–656. 24. Raver CC, Jones SM, Li-Grining C, et al. CSRP’s impact on lowincome preschoolers’ preacademic skills: self-Regulation as a mediating mechanism. Child Dev. 2011;82:362–378. 25. Stifter CA, Braungart JM. The regulation of negative reactivity in infancy: function and development. Dev Psychol. 1995;31:448– 455.","PeriodicalId":15655,"journal":{"name":"Journal of Developmental & Behavioral Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82693887","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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