Journal of Developmental and Behavioral Pediatrics最新文献

Objective: Our study assessed child-serving health care providers' attitudes and knowledge related to identification and treatment of tic disorders including Tourette syndrome (TS), among children.

Methods: We analyzed cross-sectional data from the 2022 Fall DocStyles, a web-based survey of health care providers. The analytic sample included 1058 child-serving providers (403 family practitioners, 232 internists, 251 pediatricians, and 172 nurse practitioners or physician assistants). We calculated point prevalence estimates and 95% confidence intervals and used χ2 tests to statistically test differences by provider type and metro status of practice setting.

Results: Less than two-thirds of providers (62.4%) considered evaluation of tics as their role, less than half (40.8%) considered diagnosis of tic disorders their role, and around one-fourth considered treatment of patients with tic disorders to be their role (27.3%). Lack of knowledge of tics/TS and lack of comfort evaluating patients for tics and tic disorders were the most often reported barriers to identification and diagnosis for most provider types, and across practice metro status categories. Online training was the most preferred source of information about tics and tic disorders overall and for each provider type.

Conclusion: These findings support previous reports indicating challenges in health care provider comfort and knowledge in identifying and diagnosing tic disorders, and the need for more education opportunities around evaluation and diagnosis. Communication and training to support the needs of child-serving providers could improve the access to care for children with tics and tic disorders.

Objective: Klinefelter syndrome (KS) is a common genetic condition in males associated with an extra X chromosome (i.e., 47,XXY). Individuals with KS often experience androgen insufficiency and tall stature and are at increased risk for depression, anxiety, and social challenges. This cross-sectional study investigates social and emotional functions in 52 boys with KS and 62 typically developing (TD) boys, aged 8 to 13 years.

Methods: Self-report measures of anxiety, depression, and behavior and parent-report measures of social functioning and behavior were completed. In primary analyses, linear regression was used to test the effect of group (KS, TD) on standardized scores derived from widely used rating scales. In secondary analyses, we explored the influence of pubertal status on these scores and concordance between self- and parent ratings.

Results: Our results indicate that boys with KS exhibit significantly increased anxiety, depression, and social difficulties relative to TD peers. Among participants with KS, peripubertal boys generally experienced more difficulties in aspects of social and emotional functioning as compared to prepubertal boys. Concordance analyses revealed differences between parent- and child-reports.

Conclusion: These findings indicate that alterations in social, emotional, and behavioral functions are present in boys and adolescents with KS and may be influenced by puberty.

Objective: Our study sought to determine if participation in a simulated Individualized Education Program (IEP) meeting improved pediatric medical residents' attitudes toward the IEP team as an interprofessional health care team.

Methods: Pediatric medical residents on the Developmental-Behavioral and Advocacy rotations at an urban medical center participated in a simulated IEP eligibility meeting for a case of a fourth grader with a specific learning disability. Standardized actors portrayed the child's parent, principal, school psychologist, and classroom teacher. Residents were instructed to participate as members of the team. After participation, changes in the residents' readiness to participate on the IEP team were measured by the Interprofessional Socialization and Valuing Scale 9A (presimulation) and 9B (postsimulation).

Results: Sixty-six pediatric residents participated over 24 months. The mean scores of the aggregate pre- (4.92, SD = 0.83) and postsurveys (5.75, SD = 0.74) illustrated residents' improvement in 3 areas of interprofessional practice: understanding their role as a member of an IEP team; appreciation of an IEP team as an interprofessional health care team; and comfort and confidence in working as a member of an IEP team (Z = -6.37; p < 0.001; r = 0.78). Comparison of disaggregated data illustrated improvement for post-graduate year 1 (Z = -4.95; p < 0.001; r = 0.85) and categorical pediatric residents (Z = -5.86; p < 0.001; r = 0.83).

Conclusion: Simulated IEP meetings help pediatric residents reconceptualize their role in the school health of children with disabilities to include participation in and understanding of the IEP process.

Objective: To compare the prevalence of neurodevelopmental and mental health diagnoses in a national sample of youth with sex chromosome trisomies (SCTs) with matched controls.

Methods: Patients in PEDSnet and a diagnosis code mapping to 47,XXY/Klinefelter syndrome (n = 1171), 47,XYY/Double Y syndrome (n = 243), or 47,XXX/Trisomy X syndrome (n = 262) were matched with controls using propensity scores. Generalized estimating equations computed odds ratios (OR) with 95% confidence intervals (CI) for the prevalence of diagnoses within the neurodevelopmental and mental health composites, psychotropic medication prescriptions, and encounters with behavioral health and therapy providers. Alpha was set at 0.0025 to account for multiple comparisons.

Results: Patients with SCTs had higher odds of diagnoses within the neurodevelopmental (OR 6.3, 95% CI, 5.7-7.2) and mental health composites (OR 2.7, 95% CI, 2.3-3.2) compared with matched controls. All neurodevelopmental diagnoses were more prevalent among all SCT groups compared with controls. Within the mental health composite, only the prevalence of anxiety and mood disorder was higher in all SCT groups. A higher proportion of patients with SCTs had psychotropic prescriptions compared with controls (stimulants 13.1% vs 5.2%, selective serotonin reuptake inhibitors 8.7% vs 2.8%, antipsychotics 6.5% vs 2.4%, p < 0.0001 for all). Overall, 48% of patients with SCTs had a clinical encounter with a behavioral health provider vs 16.6% of controls (OR 5.6, 95% CI, 4.1-5.1).

Conclusion: Compared with matched controls, youth with SCTs receiving care at US tertiary care pediatric centers have disproportionately high rates of neurodevelopmental and mental health conditions, emphasizing the need for appropriate screening and intervention in these populations.

Objective: To educate physician trainees using simulation on best management of children with autism spectrum disorder who have neurocognitive and behavioral challenges when experiencing acute illness.

Method: A simulation-based curriculum including baseline assessment, communication techniques, and use of calming resources was developed to educate residents in assessing children with sensory barriers. Traditional simulation and deliberate practice were used to teach this curriculum to second- and third-year pediatric and internal medicine-pediatric residents. Using alternating assignment, residents were placed into 3 groups: deliberate practice, traditional simulation-based debriefing, and control (no simulation training). The residents were assessed on the initial visit, 2 weeks and 4 to 6 months follow-up periods with a sensory assessment tool. Assessment scores were analyzed using a general linear mixed model with random intercept based on Poisson regression to approximate distribution of the total score.

Results: Forty-three residents participated: 46.5% men, 53.5% women. There were 15, 16, and 12 residents in the control, deliberate practice and traditional simulation groups, respectively. Both teaching styles showed improved performance at 2 weeks follow-up. In addition, these groups demonstrated higher performance when compared with the control group. We were able to show that resident physicians were able to learn important principles and retain them during 4 to 6 months follow-up. However, there was not a difference between 2 teaching styles both in improvement and retention.

Conclusion: Simulation education, both deliberate and traditional, can be used to enhance teaching of key components in assessing children with sensory and communication barriers, including those with autism spectrum disorder when presenting with acute illness.

Objective: Wearable technology has potential benefits for clinical measurement with children who have neurodevelopmental disorders (NDDs). However, this cohort may experience sensory processing disorder, behavioral dysregulation, and cognitive challenges. For effective and considerate implementation, the experiences and views of parents of children with NDDs on this topic need in-depth investigation.

Method: This qualitative semi-structured interview study used purposeful sampling of families with experience with wearable technology in a research setting. The cohort included 12 parents of 14 children with a diagnosis of Fragile X (n = 6), Prader-Willi (n = 4), or Angelman (n = 4) syndromes. The data were processed using NVivo software (QSR International Ltd. 1999-2013). Data analysis was conducted using reflexive thematic analysis.

Results: Theme 1: Parents are willing to use wearable technology in the home or community if it is feasible. Aspects of feasibility were the ease of embedding technology into existing routines, device robustness, and device invasiveness. Theme 2: Parents are guided by previous healthcare and research experiences. Wearables were considered low burden in the context of everything else their child experiences through health care. Theme 3: Early engagement with families in the design and research process of new technologies is important. Parents had strong views on how to introduce a wearable to their child. In this article, parents stressed that the child's behavioral phenotype needs to be considered early in the design and rollout phases.

Conclusion: A shared decision-making approach between researchers and parents will improve the uptake and success of NDD-focused research adopting wearable technology approaches for clinical measurement.

Objective: Behavioral or conduct problems (BCPs) are common co-occurring conditions in children with special health care needs (CSHCNs), affecting their developmental and functional milestones. The role of family resilience in mitigating BCPs among these children and how adverse childhood experiences (ACEs) affect this dynamic remain largely unclear. The aim of the study was to disentangle the complex interplay between family resilience, ACEs, and BCPs by examining how ACEs moderate the relationship between family resilience and BCPs.

Methods: The study included 19,922 CSHCNs aged 3 to 17 years from the 2020-2021 National Survey of Children's Health. Weighted analysis was conducted using the Rao-Scott χ2 test and multivariable logistic regression to account for the complex survey design.

Results: Children from families with no and low resilience as compared with high-resilient families had 1.78 times (odds ratio [OR]: 1.78, 95% confidence interval [CI], 1.31-2.43) and 1.44 times (OR: 1.44, 95% CI, 1.18-1.76) higher odds of BCPs, respectively. While the odds of BCPs decreased in nonresilient families as ACEs increased from none to 1 ACE, 2 or more ACEs versus no ACE increased the odds of BCPs in low-resilient families from 1.42 times (OR: 1.42, 95% CI, 1.03-1.94) to 1.51 times (OR: 1.51, 95% CI, 1.13-2.02).

Conclusion: The findings suggest that family resilience is associated with a lower likelihood of BCPs in CSHCNs. ACEs have varying effects on the relationship between family resilience and BCPs across different levels of family resilience. These results highlight the importance of strengthening family resilience and addressing ACEs in interventions to reduce behavioral issues in CSHCNs.

Objective: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication differences and restricted interests. One proposed biologic mechanism underlying ASD is oxidative stress, leading to the clinical use of glutathione based on anecdotal reports of improved behavior in autistic children. In this pilot study, we tested this observation using a randomized clinical trial format to collect preliminary data on glutathione safety and efficacy.

Methods: Glutathione and glutathione in combination with vitamin C and N-acetylcysteine (Trio) were tested. Both treatments were administered in double-blind placebo-controlled randomized crossover studies. In total, 24 children between the ages of 5 and 16 years with ASD and severe behavior disorders were randomized to receive weekly intravenous injections of either placebo or 1 of the 2 interventions (glutathione or Trio) for 8 weeks. After a 1-week washout period, participants were crossed over for the subsequent 8 weeks. Behavioral measures and plasma levels of glutathione were obtained at baseline, during the washout period, and at the end of the study.

Results: No differences between treatment groups in behavioral or biologic measures were found. No significant adverse side effects attributable to the treatments were observed. Small improvements in specific glutathione and behavioral measures occurred over the study period for all groups.

Conclusion: Treatment with glutathione or glutathione in combination with vitamin C and N-acetylcysteine did not result in improvements in behavior or biologic measures. The positive trends over the course of the study were likely due to the placebo effect or decreased anxiety associated with the study routine.

Objective: To report on the feasibility and outcomes of universal language promotion intervention (Talk With Me Baby [TWMB]) embedded within routine well-child care for children from birth to 3-years old.

Methods: Across 2 primary care clinics, 29 health care team members participated in a 12-month trial to deliver TWMB within well-child care visits. Feasibility was based on clinician feedback during the trial, clinician knowledge assessments, and clinic data. Sixty-three parents and their infant/toddlers were enrolled to provide feedback on TWMB and to assess parent language promotion behaviors, specifically, parents' self-reported use of their language-building interactions during daily activities with their child.

Results: Clinician feedback and clinic data support TWMB as an acceptable and feasible intervention that can be used successfully within standard of care well-child visits by health care teams. Initial outcome data show positive changes for increasing parent-child language promoting interactions during daily activities.

Conclusion: Results support the promise of leveraging primary care as a low-cost, scalable way to deliver universal language promotion intervention to optimize the developmental potential of all young children.

Objective: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication differences and restricted interests. One proposed biologic mechanism underlying ASD is oxidative stress, leading to the clinical use of glutathione based on anecdotal reports of improved behavior in autistic children. In this pilot study, we tested this observation using a randomized clinical trial format to collect preliminary data on glutathione safety and efficacy.

Methods: Glutathione and glutathione in combination with vitamin C and N-acetylcysteine (Trio) were tested. Both treatments were administered in double-blind placebo-controlled randomized crossover studies. In total, 24 children between the ages of 5 and 16 years with ASD and severe behavior disorders were randomized to receive weekly intravenous injections of either placebo or 1 of the 2 interventions (glutathione or Trio) for 8 weeks. After a 1-week washout period, participants were crossed over for the subsequent 8 weeks. Behavioral measures and plasma levels of glutathione were obtained at baseline, during the washout period, and at the end of the study.

Results: No differences between treatment groups in behavioral or biologic measures were found. No significant adverse side effects attributable to the treatments were observed. Small improvements in specific glutathione and behavioral measures occurred over the study period for all groups.

Conclusion: Treatment with glutathione or glutathione in combination with vitamin C and N-acetylcysteine did not result in improvements in behavior or biologic measures. The positive trends over the course of the study were likely due to the placebo effect or decreased anxiety associated with the study routine.