Journal of Developmental and Behavioral Pediatrics最新文献

Objective: The present study examined the diagnostic sequencing of co-occurring autism spectrum disorder (ASD) and mental health diagnoses in youth and the impact of demographic factors on diagnostic patterns.

Methods: Data were extracted from the electronic health record of youth (n = 3357) under age 18 years in a pediatric health care system in the midwestern United States. Patients with co-occurring ASD and mental health disorders were categorized based on the order in which they were diagnosed: ASD first, mental health disorder first, or concurrent diagnoses. T-tests and linear and multinomial regressions were used to examine whether age at ASD diagnosis differed based on the presence of a mental health disorder and to examine demographic variables as predictors of diagnostic patterning.

Results: ASD was diagnosed 3 years later in youth with a mental health disorder, t(13,464) = 34.26, p < 0.001. Youth were most often diagnosed with a mental health disorder before ASD. Girls were 0.65 times less likely than boys to receive an ASD diagnosis first compared with a mental health diagnosis first (p = 0.006) and were diagnosed with ASD later than boys (B = 0.97, p = 0.006). Black and multiracial Hispanic children were more likely than White children to receive an ASD diagnosis first compared with a mental health diagnosis (odds ratios 1.37-1.93) and were diagnosed with ASD earlier. Minoritized children were more likely to receive externalizing diagnoses.

Conclusion: Findings highlight issues of diagnostic overshadowing in the diagnosis of ASD and co-occurring mental health conditions, and elucidate demographic groups who may be at risk for late diagnosis of ASD.

Objective: Positive childhood experiences (PCEs) are protective events against the impact of childhood trauma. Previous research has found that children and youth with special health care needs (CYSHCN) are more likely to experience adverse childhood experiences, but the prevalence of PCEs among this population has not been examined. Therefore, this study seeks to evaluate the prevalence of PCEs among CYSHCN.

Methods: Cross-sectional data from the 2021 to 2022 National Survey of Children's Health (n = 47,207) was used to evaluate differences in the prevalence of PCEs between CYSHCN and non-CYSHCN, and to evaluate predictors of PCE exposure among CYSHCN. Rao-Scott χ2 test and multivariable logistic regression, using appropriate survey weights, were used.

Results: Compared with non-CYSHCN, CYSHCN had lower odds of having at least one PCE (adjusted odds ratio [aOR]: 0.35, 95% Confidence Intervals [CIs]: 0.15‒0.83), and having specific types of PCEs: having constructive social engagement (aOR: 0.24, 95% CIs: 0.21‒0.27), having nurturing and supportive relationships (aOR: 0.80, 95% CIs: 0.72‒0.89), living in a safe, stable, and equitable environment (aOR: 0.75, 95% CIs: 0.68‒0.82), and creating social and emotional competency (aOR: 0.62, 95% CIs: 0.56‒0.69). Among CYSHCN, children of color, those with greater poverty, and those with more complex needs have lower odds of experiencing most PCEs.

Conclusion: The results of this study indicate a need for programs aimed at fostering resilience among CYSHCN. There is also a need for additional research creating better measures of evaluating PCEs among CYSHCN and examining how PCEs mitigate the effects of adverse childhood experiences in this population.

Objective: To determine whether mothers' depressive symptoms with or without exposure to selective serotonin reuptake inhibitor (SSRI) antidepressant treatments during pregnancy were associated with executive functions (EFs) in offspring at 6 and 12 years of age.

Methods: A prospective cohort of 191 mothers and their children participated in the study. Clinician-rated reports of mothers' depressive symptoms were obtained spanning the third trimester during pregnancy to 12 years later. Children's EFs were measured using 2 computer-based tasks (Flanker/Reverse Flanker, Hearts and Flowers [HF]) and mothers' reports of EFs using the Behavior Rating Inventory of Executive Function (BRIEF) when the child was 6 and 12 years old.

Results: Longitudinal analyses showed that all children were both faster and more accurate on both Flanker/Reverse Flanker and HF with age. Fewer maternal prenatal depressive symptoms were associated with better accuracy on HF in children at 6 years of age and better EF skills as measured by the BRIEF at 6 and 12 years. Mothers' ratings of their children at 12 years indicated more executive dysfunction in children with prenatal SSRI exposure than for children without prenatal SSRI exposure, but this was no longer significant once prenatal depressive symptoms were taken into account.

Conclusion: Prenatal and later depressive symptoms, not prenatal SSRI exposure, seems to affect offspring that continues into preadolescence, highlighting the importance of long-term mental health follow-up in mothers to ensure optimal development of children's EFs and hence their optimal development in school, in social relations, and in life generally.

Objective: To examine whether self-control in first grade predicts later parenting.

Method: Participants were first graders enrolled in a universal preventive intervention trial in 1993 to improve behavior and school achievement. By 2023, n = 221 participants were parents of children aged 4 to 15 years. Pre-intervention, self-control was assessed using the Teacher Observation of Classroom Adaptation-Revised. Latent profile analysis identified 3 profiles of childhood self-control: high (n = 101, 45.7%), inattentive (n = 87, 39.4%), and inattentive/hyperactive (n = 33, 14.9%). The association between self-control profiles and later parent-rated discipline consistency and enjoyment of parenting from the Structured Interview of Parent Management Skills and Practices was evaluated using latent profile regression. The association between self-control and observed parent sensitivity, intrusiveness, and positive/negative regard for the child was explored in a subset (n = 81).

Results: The high and inattentive childhood self-control profiles were more likely to discipline consistently versus the inattentive/hyperactive profile (Wald(2) = 8.55, p = 0.01). Self-control did not predict enjoyment of parenting (Wald(2) = 3.30, p = 0.19). Compared with the high profile, the inattentive/hyperactive and inattentive profiles exhibited greater positive regard for the child (Wald(2) = 11.03, p = 0.004).

Conclusion: Childhood self-control may provide a foundation for discipline consistency as a parent. Individual differences in regulatory functioning that pose challenges in childhood might confer unexpected parenting benefits, underscoring the need for a life course perspective.

Objective: This study examined whether irritability and sensory over-responsivity (SOR) mediate the relationship between anxiety disorders and sleep problems in preschool-aged children. Although previous research has demonstrated a link between anxiety and sleep disturbances, the specific contributions of irritability and SOR remain unclear.

Methods: The sample included 45 preschool children (24-72 months, 44.4% male) diagnosed with anxiety disorders and 85 healthy controls (24-72 months, 50.6% male). Diagnoses were determined using the Preschool Age Psychiatric Assessment, a structured DSM-5-based clinical interview. Parents completed the Child Behavior Checklist 1.5 to 5 to assess behavioral and emotional symptoms, including sleep problems and irritability.

Results: Children with anxiety disorders showed significantly higher levels of irritability (p = 0.003) and SOR (p < 0.05) compared with controls. Sleep problems were more frequent in the anxiety group compared with the controls (p = 0.003). Multiple regression analyses revealed that irritability and SOR significantly mediated the relationship between anxiety and sleep problems (p < 0.001).

Conclusion: The irritability and SOR seem to play key mediating roles in the development of sleep problems among preschoolers with anxiety disorders. These findings highlight the importance of addressing regulatory and sensory-emotional functioning in the assessment and treatment of young children with anxiety and sleep difficulties.

Objective: There is a growing need for autism evaluations in young children. Wait times to evaluation are long due to the limited specialty workforce. Primary care autism evaluations are 1 solution, but many providers lack training and confidence in autism care. Literature highlights the need for improvement in developmental and behavioral pediatrics training among pediatric residents. This study evaluates resident confidence in autism care after participation in a novel autism evaluation pathway in a primary care pediatric resident continuity clinic.

Methods: Pediatric residents led a primary care autism evaluation with a trained pediatrician in their continuity clinic. Residents were provided with enhanced autism education which included neurodiversity-affirming strategies and training on the use of an autism assessment tool. Presurveys and postsurveys were used to assess resident confidence in autism care before and after the educational intervention. Survey data were compared using Mann-Whitney U tests appropriate for ordinal, nonpaired data.

Results: Thirty resident-led autism evaluations were conducted during the study period. There was statistically significant improvement in resident confidence in autism screening, use of assessment tools, evaluation, diagnosis, treatment recommendations, sharing resources, understanding of neurodiversity, and use of a strength-based approach after participation.

Conclusion: Providing autism education and hands-on primary care autism evaluation training opportunities for residents in pediatric continuity clinic improves confidence in autism care. This model is 1 way to enhance autism education and training during pediatric residency which may have a positive impact on the care provided to autistic patients.

Purpose: Some individuals with autism spectrum disorder (ASD) demonstrate marked behavioral improvements during febrile episodes, which is called febrile effect. This study aimed to investigate the prevalence and characteristics of the febrile effect in children with ASD in China.

Methods: One hundred fifty-seven patients diagnosed with ASD were recruited to participate in the study; the parents completed a self-compiled questionnaire regarding the febrile effect. Children who reportedly improved with fever (Improve Group) were compared with those who reportedly did not improve (No Improve Group) on the core symptoms and developmental status.

Results: Parent reports of 16.56% of children exhibited behavioral improvements during fever. Improvements included reduced problem behaviors, enhanced cognitive or learning abilities, increased social interaction, and decreased stereotypical behaviors. The Improve Group scored higher in Autism Diagnostic Observation Schedule, Second Edition and Social Responsiveness Scale. There were no significant differences in the incidence of infectious diseases during pregnancy among mothers in the 2 groups; however, a marked disparity was observed in the frequency of febrile episodes within the preceding year. The duration of the febrile effect varied, with 76.92% being temporary and 23.08% showing sustained improvements postfever. Children with sustained improvements had more severe social deficits.

Conclusion: The febrile effect is observed in a subset of ASD children and may be associated with more severe social deficits. The heterogeneity in the duration of the febrile effect suggests the need for further research to elucidate the underlying mechanisms and potential therapeutic applications.