Journal of Developmental and Behavioral Pediatrics最新文献

Objective: To evaluate the impact of a national career exploration program, Exploring DBP, on trainee interest in pursuing exploring developmental-behavioral pediatrics (DBP) fellowship, and to describe participant demographics, knowledge gains, and perceived barriers to entering the field.

Method: Presurvey and postsurvey results were analyzed from the program's 2019 to 2023 cohorts assessing demographics, DBP knowledge, program satisfaction, and likelihood to apply for fellowship. Data were analyzed descriptively. Qualitative responses were analyzed to explore career decision factors.

Results: From 2019 to 2023, 239 participants completed the program (50.1% residents, 44.8% medical students, and 5.0% general pediatricians). The cohort had greater representation of trainees from ethnically diverse backgrounds compared with national averages (e.g., 26.6% Hispanic vs 7%-9%). Participants consistently rated mentorship and personal stories from DBP professionals as the most valuable program components. After the program, the proportion of participants who were "likely" or "very likely" to apply for a DBP fellowship rose from 46% to 79%. Key reported barriers to pursuing fellowship included inadequate compensation, training length, student loan burden, and competing interest in fields such as child psychiatry or neurology. A 2022 follow-up survey found that 41% of eligible early participants had successfully matched into a DBP fellowship program.

Conclusion: The program effectively increased knowledge and interest in pursuing a DBP career. Structured early exposure may support recruitment into undersubscribed pediatric subspecialties.

Objective: The Survey of Well-being of Young Children (SWYC) supports developmental screening at well-child visits. However, a US Preventive Services Task Force report suggests insufficient evidence for this approach for speech-language delay identification. The objective of this study was to determine associations between SWYC use and score at 24-month visits and timing of speech-language delay diagnoses and whether timing differed by sociodemographic characteristics.

Methods: Using electronic health records of 7,198 children born January 2016-December 2020 in a mid-sized health care system, we fit Kaplan-Meier survival curves for time to speech-language delay diagnosis based on SWYC use and score. Cox proportional hazards time-to-event analyses were run, and interactions between SWYC use and score and sociodemographics were assessed.

Results: Fifty percent received the SWYC, with use increasing during the study period with no sociodemographic differences detected. While SWYC use had no association with diagnosis (hazard ratio: 0.986, 95% confidence interval: 0.856-1.1136), lower SWYC scores (indicating greater developmental concern) were associated with higher likelihood of diagnosis (hazard ratio: 0.114, 95% confidence interval: 0.095-0.137). Interactions between scores and diagnostic timing by payer type and race/ethnicity were detected. Boys, publicly insured children, and those with lower SWYC scores were more likely to receive a speech-language delay diagnosis at their 24-month visit.

Conclusion: While clinicians likely rely on clinical judgement to identify delays, results suggest the SWYC is associated with speech-language delay identification. The ability of the SWYC to identify speech-language delay was moderated by insurance and race/ethnicity, warranting further study of factors shaping diagnostic decision-making.

Objective: To describe the questions youth with attention-deficit hyperactivity disorder (ADHD) checked on a question prompt list and evaluate the extent to which youth asked these questions during medical visits.

Methods: English-speaking adolescents (N = 102) aged 11 to 17 years with ADHD were enrolled from 2 pediatric primary care clinics in North Carolina; this work focuses on the 52 adolescents in the intervention group. Adolescents who received the intervention watched an educational video and completed a prompt list before visits. Medical visits were recorded, transcribed, and coded for questions asked during visits. The questions adolescents checked on the prompt list were compared with the questions they asked during visits.

Results: Adolescents checked an average of 5.6 questions on the prompt list. Forty percent of adolescents who checked a question asked at least 1 question they checked during visits. The most common questions adolescents checked and asked about ADHD were, "Should I reduce my screen time to help with ADHD?" (50.0%) and "Will I grow out of ADHD?" (34.4%). The most common questions adolescents checked and asked about ADHD treatment were, "Should I take my ADHD medicine before I play sports?" (33.3%), "Should I take my ADHD medicine while I am at school?" (28.6%), and "Would talking to a counselor help my ADHD?" (28.6%).

Conclusion: Adolescents with ADHD have many questions about ADHD; however, about 60% (n = 31) did not ask any of the questions they checked on the prompt list. Future research should examine how to encourage youth who receive a question prompt list intervention to ask questions during visits.

Objective: To explore the feasibility and acceptability of interventions to promote school readiness (SR) in primary care through qualitative analysis of "SR Design Maps" created by Latino families.

Method: Caregivers participated in design thinking to assess benefits, barriers, and desirable characteristics of eight SR interventions to create a final SR Design Map. Qualitative analysis included a content analysis to determine the frequency of each intervention and deductive theme analysis to create a summary of key features, content, and timing preferences. Two coders completed analysis in the source language.

Results: Participants included 32 Latino caregivers from four Oregon clinics with primarily US born children with preschool experience. Most caregivers were monolingual Spanish or bilingual-speakers, born in Mexico, with a high school education or higher. Across 16 distinct "SR Design Maps," 100% included SR Coaching, preschool navigation, library information, and a community coordinator; most included a SR Checklist (92%), TipsByText (88%), and parent groups (81%). The most desired and feasible interventions were Coaching, preschool navigation, SR Checklist, library information, and TipsByText. A "future state" model compiles caregiver preferences from birth to age 5 years.

Conclusion: Latino families gave detailed feedback to integrate multiple SR interventions from pregnancy to 5-year-old well-child visits. Families were most interested in an overview of SR skills (SR Checklist), tips for early math and literacy at home (SR Coaching, TipsByText), preschool information and application support, and reminders about library programs. These findings inform a culturally responsive package of interventions to promote SR in primary care.

Case: Adam is a 15-year-old boy who was born prematurely, with prenatal substance exposure, and was diagnosed in early childhood with combined-type attention-deficit hyperactivity disorder and oppositional defiant disorder. He was not found to meet criteria for fetal alcohol spectrum disorder. Despite treatment with stimulant medications and other adjunctive medications, Adam experienced ongoing difficulties with impulse control, sleep, and aggression. Adam was introduced to digital devices at an early age, resulting in unfiltered, poorly supervised, and prolonged screen exposure.Over time, Adam's digital use escalated into late-night gaming and engaging with social media platforms. Attempts by parents and other caregivers to apply parental controls were inconsistent because of family instability and ongoing caregiver substance use. Exposure to disturbing online content (including violence and conspiracy narratives) disrupted Adam's sleep and resulted in increased emotional lability, often triggering nightmares and severe irritability.The school also implemented restrictions on electronic device use (including phones and laptops). Related disciplinary consequences contributed to social stress and peer conflict. In addition, the patient disclosed a history of childhood sexual trauma, which occurred during unsupervised online interactions, further deepening his reliance on digital environments as a coping mechanism. Subsequent identification and treatment of posttraumatic stress disorder helped to alleviate some of the associated distressing emotional symptoms for Adam but did not alter his compulsive use of digital technology.Finally, when consistent efforts were made to limit Adam's screen time, it provoked severe mood dysregulation, aggressive outbursts, and even suicidal ideation.How can clinicians effectively manage digital addiction in a neurodivergent adolescent when restricting device use provokes severe emotional dysregulation and suicidal ideation?What multimodal treatment strategies can balance behavioral containment with trauma-informed care?How can families and clinicians collaboratively establish digital boundaries that promote recovery without triggering psychological destabilization?What does this case reveal about the need for early screening, prevention, and family education regarding digital addiction in neurodivergent youth?

Objective: To examine the role of developmental and behavioral pediatric clinicians in diagnosing and managing Fetal Alcohol Spectrum Disorders (FASD), identify barriers related to diagnostic system variability and clinician preparedness, and propose a functional framework to complement existing diagnostic systems based on findings from the 2023 Society of Developmental and Behavioral Pediatrics (SDBP) survey.

Methods: An anonymous survey of SDBP members assessed diagnostic practices, clinician preparedness, and training needs regarding FASD. Responses were analyzed descriptively to identify patterns in diagnostic system use and perceived training adequacy.

Results: Of 913 members surveyed, 199 responded (22%), with 97 reporting active involvement in FASD care. Among these, 34% used the University of Washington 4-Digit Code, 34% used Diagnostic and Statistical Manual of Mental Disorders-5 criteria, and 26% followed the Hoyme guidelines. Only 24% felt "very prepared" to diagnose FASD, whereas 58% desired additional training in both diagnosis and management. The lack of a standardized diagnostic framework contributed to variability in clinical practice and clinician confidence.

Conclusion: Findings highlight significant gaps in clinician confidence and the lack of standardized diagnostic practices. This article underscores the importance of enhancing FASD education within medical and psychology training and proposes adopting a functional classification system (FASD levels 1, 2, and 3) to bridge existing diagnostic frameworks and promote consistency in care. Strengthening clinician capacity in FASD recognition and management is essential to improving early identification, timely intervention, and long-term outcomes for affected children.

Objectives: Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, a dual diagnosis of autism spectrum disorder (ASD) and developmental coordination disorder (DCD) has been permitted. This study assessed the prevalence of DCD in children with ASD and whether DCD diagnosis increased after the publication of the DSM-5.

Methods: We retrospectively reviewed data from 19,307 children (≤19 years) assessed for ASD in the province of British Columbia in Canada between 2010 and 2019 (N = 19,307). Data from 2010 to 2013 (DSM-4 in place, n = 6532) and 2014 to 2019 (after publication of DSM-5, n = 12,775) were analyzed separately.

Results: From 2010 to 2013, only 1.1% (37/3261) of children diagnosed with ASD received a co-diagnosis of DCD. Children who were assessed for ASD but not given a diagnosis, 2.4% (62/2559) received a DCD diagnosis. After the publication of the DSM-5 (2014-2019), diagnosis of DCD in children diagnosed with ASD showed a modest increase to 2.8% (172/6152). For children without an ASD diagnosis, 2.9% (99/3396) were given a DCD diagnosis.

Conclusion: This study demonstrates consistently low rates of DCD diagnosis across 2 periods: before and after the publication of the DSM-5. Despite a modest increase, the prevalence of ASD + DCD co-diagnoses after the introduction of DSM-5, DCD rates remain significantly lower than reported in the literature. This discrepancy suggests significant and persistent underdiagnosis of DCD in children with ASD in British Columbia.

Objective: To estimate the risk of incident depressive, anxiety, psychotic disorders, and suicide attempts associated with adolescent psychotic experiences.

Methods: A nested case-control design was used within the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth-cohort study that recruited expectant mothers from 1991 to 1992. Participants were 8822 offspring of ALSPAC mothers who completed the Psychosis-like Symptoms Questionnaire, which assessed Psychotic Experiences (PEs). Depressive disorders were assessed using the Short Mood and Feelings Questionnaire, anxiety disorders using the generalized anxiety disorder (GAD) Assessment and the Clinical Interview Schedule-Revised, and psychotic disorders using the PLIKS structured interviews. Risk of incident depressive disorder, GAD, psychotic disorder, and suicide attempts were compared between participants who had ever versus never reported a PE and those who reported persistent versus transient PEs.

Results: Adolescent PEs were associated with increased risk for incident depressive disorder (adjusted hazard ratio [aHR] = 1.62, 95% confidence interval [CI] = 1.42-1.84), GAD (aHR 1.23, 95% CI = 1.03-1.47), psychotic disorder (adjusted odds ratio [aOR] = 5.08, 95% CI = 2.02-12.79), and suicide attempts (aHR = 2.11, 95% CI; 1.70-2.62). Persistent PEs (compared with transient) were associated with increased risk for depressive disorder (aHR = 1.81, 95% CI = 1.55-2.12), GAD (aHR = 1.34, 95% CI = 1.07-1.68), and psychotic disorder (aOR = 7.39, 95% CI = 2.43-22.19) but not suicide attempts.

Conclusion: Adolescent PEs are a risk factor for multiple mental disorders and suicide attempts, with persistent PEs conferring greater risk. Identifying interventions for adolescents who report PEs, particularly persistent PEs, could lessen the burden of multiple mental health disorders and suicide attempts.

Objective: To understand Black mothers' perspectives on the autism screening process with the Modified Checklist for Autism in Toddlers (M-CHAT) and preferences in provider communications and interactions around autism screening.

Method: This qualitative study thematically analyzed semi-structured interviews of Black mothers (N = 11) whose child screened positive on an autism screener administered as part of a routine well-child visit in primary care. All interviews were audio-recorded, transcribed, and entered into NVivo software for data management and analysis. Coders achieved an average of over 95% agreement in double-coded transcripts across all thematic codes.

Results: Results from a qualitative thematic analysis of Black mothers' experiences with and preferences for early autism screening in primary care produced 5 primary themes: (1) preference for the pediatrician to report positive screening results, (2) desire to discuss developmental concerns with family members, (3) online resources as key information resources on autism and child development juxtaposed to, (4) valuing face-to-face time with early childhood providers, and (5) barriers to completing the M-CHAT.

Conclusion: Black mothers described their preferences for completing autism screening for their children and emphasized the role of the pediatrician, family members, and online resources in providing information about child development and autism concerns. Trust in the pediatrician emerged as a salient theme, which runs counter to prior narratives that describe earned mistrust between Black caregivers and medical providers. Results can inform the improvement of early autism screening processes and health care communication for underrepresented families in primary care settings.