Journal of Developmental and Behavioral Pediatrics最新文献

Objective: To explore the effects of the COVID-19 pandemic on early childhood development and identify areas of interest surrounding development.

Methods: A systematic literature review was performed to identify articles examining how the COVID-19 pandemic has affected early childhood development, and a meta-analysis was conducted from the results of those articles to examine the degree of the impact of the pandemic on the areas of childhood development.

Results: Ten articles from 6 countries were identified that met all inclusion and exclusion criteria. The multivariate meta-analysis showed no significant difference in overall development (pooled Cohen's d = 0.28, 95% CI, -0.33 to 0.88; p = 0.18) or odds for developmental delay (pooled odds ratio (OR) = 1.44, 95% CI, 0.77 to 2.67; p = 0.20) between pre-COVID-19 development and COVID-19 development. However, there was significantly more impairment (d = 0.46, p = 0.003) and greater odds (72%; OR = 1.72, p = 0.01) for developmental delay in the language and communication domain for COVID-19 children versus pre-COVID-19 children.

Conclusion: While exposure to the COVID-19 pandemic was not associated with global developmental delays, it had a significant impact on child development regarding language and communication. Further research monitoring effects of the COVID-19 pandemic is necessary, and parents and communities should focus on increasing early intervention and enriched curriculum to offset these delays.

Objective: Given the well-documented associations between excessive screen time (ST) and adverse health outcomes, this pilot study aimed to examine the applicability and effectiveness of a multicomponent intervention that combined strategies to enhance caregivers' screen-related parenting practices with efforts to create a supportive community environment to reduce children's ST in a county in China.

Methods: A 2-arm, cluster-randomized, wait-list controlled design was used. Eight communities and 336 caregivers of primary school-aged children were randomly assigned to intervention and control groups. Wilcoxon signed-rank tests and McNemar's χ2 tests were applied to evaluate within-group changes over time. A linear mixed model was used to assess intervention effects.

Results: The intervention significantly reduced children's daily average total ST and entertainment ST on weekends (β = -43.81; p < 0.05; β = -22.29, p < 0.05) and on a weekly basis (β = -30.32; p < 0.05; β = -14.40, p < 0.05). Moreover, it significantly reduced the odds of excessive entertainment ST on weekdays (β = -2.32, p < 0.05) weekly (β = -2.34, p < 0.05) and excessive academic ST weekly (β = -1.71, p < 0.05). No significant treatment effect was found for parenting practices and children's physical activities.

Conclusion: This study supports the feasibility of a multicomponent intervention and its effectiveness in reducing children's excessive ST, particularly in addressing entertainment ST.

Objective: It is becoming evident that the unique challenges faced by autistic drivers are contingent on the driving context and specific skills required. This meta-analysis examined the driving performance of both autistic and nonautistic drivers, aiming to clarify the reasons behind inconsistencies in published findings and identify the relative strengths and challenges faced by autistic drivers.

Method: This study was performed within a theoretical model of driving skills to break down the complex process of driving and identify specific strengths and challenges displayed by autistic drivers. Data were extracted from included studies, and a meta-analysis using random-effects models was conducted. Risk of bias was assessed, and sensitivity analyses were also conducted.

Results: The results from 16 studies suggested that autistic drivers show a small yet significant deficit in their overall driving performance compared with nonautistic drivers. Autistic drivers showed significant challenges and variation in performance at the operational level of driving compared with the tactical level of driving. Variation across driving performance was found to be related to licensure status but not age.

Conclusion: This paper was able to build upon prior work by clarifying strengths and challenges that are evident in autistic drivers and their driving performance. Notable differences were found to be most related to operational driving skills. These differences may subside with driving experience compared to nonautistic peers. Future studies should further assess potential reasonings for the variation seen across driving performance by examining the interplay of related factors.

Case: Thomas is a 12-year-old boy with Trisomy 21, hypothyroidism, and hearing loss. During a recent follow-up visit to the multidisciplinary Down syndrome clinic, his parents expressed concern regarding changes related to Thomas's overall functioning and increasing problematic self-talk behavior. Thomas's parents report that he has talked to "imaginary friends" (e.g., "no, don't do that" or "that's not nice") since he was in preschool. Previously, parents have been reassured that this behavior is likely externalized self-talk and have been advised to not be concerned by the behavior as it is fairly common in youth with Down syndrome.His parents shared that he has always been "in his own world," but over the past 6 months, the frequency of self-talk behavior has increased, and the content of self-talk has focused more on "bad men" (e.g., "bad men do bad things"). Thomas's parents have also noticed that it has become difficult to engage him in conversation or other tasks, including preferred activities, because of his preoccupation with "talking to imaginary friends." In addition, Thomas has begun picking at his skin to the point of bleeding, his artwork/drawings have become more rudimentary (now drawing stick figures), his sleep onset and maintenance have reduced, and he refuses to go into his bedroom because of "whispers in the walls."At school, Thomas's teachers have reported that his speech has become more difficult to understand, and he has been increasingly distracted by "talking to imaginary friends," including in the middle of class time. Classroom behavioral interventions (e.g., positive reinforcement program) have not been helpful.When asked about recent stressors, Thomas's parents shared that there was a string of car break-ins in the neighborhood around 7 months ago and have wondered if overhearing about this event could have affected Thomas in some way.Given this history, what would you consider in development of a differential diagnosis and what would be your next steps in providing care for Thomas?

Objective: Sleep problems are frequently reported and associated with externalizing behavior problems in young children, especially those with developmental delay (DD). Parent-child interaction therapy (PCIT) led to improved sleep in young children with DD, but research has not examined the effect of internet-delivered PCIT (iPCIT) on sleep quality or changes in bedtime resistance behaviors as a mediator. This study examined iPCIT's effect on sleep quality in young children with DD through its impact on bedtime resistance behaviors.

Method: Participants were from a previously completed randomized controlled trial and included 150 children with DD (M age = 36.2 months, SD = 1.0 months) and their caregivers who were randomized to iPCIT or referrals as usual (RAU). Path analyses examined links between treatment condition, post-treatment bedtime resistance, and sleep quality reported at 6-month follow-up.

Results: Treatment condition significantly influenced bedtime resistance behaviors (β = 0.17, 90% CI, [0.04, 0.29], p = 0.01), and these changes, in turn, significantly affected sleep quality reported at 6-month follow-up (β = 0.18, 90% CI, [0.03, 0.33], p = 0.02). Caregivers receiving iPCIT reported fewer bedtime resistance behaviors after treatment and improved child sleep quality at 6-month follow-up than caregivers receiving RAU.

Conclusion: Although effects were smaller than in other studies examining PCIT's effect on sleep, these results highlight how iPCIT led to improved sleep quality in children with DD through changes in bedtime resistance. Further research is needed to explore differences in the effectiveness of in-person versus iPCIT, as well as other mechanisms (such as parenting behaviors) through which iPCIT affects child sleep quality.

Objective: To determine whether the presence of integrated behavioral health care (IBH) in a pediatric practice is associated with improved implementation of Safe Environment for Every Kid (SEEK), an evidence-based approach to prevention of child maltreatment.

Methods: Pediatric primary care practices across the United States (n = 44) expressed interest in participating in a longitudinal multisite trial. Half of the practices included IBH. Semi-structured interviews were conducted at different points in time with 49 practice leaders, primary care professionals, behavioral health professionals, and nursing and administrative staff. Quantitative data on implementation stage and phase, proportion of activities completed at each stage, and length of time to complete each stage were collected by the Stages of Implementation Completion measure.

Results: Qualitative data revealed several instances in which IBH facilitated the adoption and implementation of SEEK and where SEEK supported IBH. However, apart from a longer duration devoted to program startup among IBH practices, none of the quantitative differences in rate of program startup, better completion of implementation activities, more tasks completed within each stage, and greater competency were statistically significant.

Conclusion: Integrated behavioral health care in pediatric primary care settings may help to facilitate the implementation of interventions like SEEK designed to address social determinants of health and reduce the risk of child maltreatment. However, the current study did not find evidence, based on quantitative analyses, that IBH significantly affected the uptake of Project SEEK and that more research may be warranted.

Background: Methylphenidate transdermal systems are a generally safe and effective treatment option for individuals with attention deficit hyperactivity disorder (ADHD).

Case presentation: A 9-year-old boy with a history of autism spectrum disorder, insomnia, ADHD combined type, and historical global developmental delays with high suspicion for intellectual disability presented to a developmental and behavioral pediatrics clinic for medication management related to his diagnosis of ADHD. Other pertinent medical history includes a history of pica, a branchial cleft cyst that has since been removed, intermittent constipation and early childhood trauma, resulting in permanent placement with his maternal grandparents. His birth history is notable for a presumed history of in utero exposure to marijuana. He has a family history of substance use disorder, depression, autism and ADHD. A chromosomal microarray and testing for Fragile X were completed in the past and unremarkable. Shortly after a first-time application of a starting dose methylphenidate transdermal system, he was noted to demonstrate involuntary lip puckering, tongue thrusting, and repetitive jaw opening and closing. Upon immediate discontinuation of the patch, the dyskinesia subsided with no persistent remaining symptoms.

Conclusion: To inform medication management for ADHD in children with comorbidities, it is valuable to define specific risk factors for adverse effects and intolerability of medication. Identifying if patient age, weight, comorbidities, previous antipsychotic or stimulant use, and concurrent medication use are demonstrable risk factors for dyskinesia can help practitioners develop a more individualized medication treatment plan for children with ADHD.

Introduction: Children with neurodevelopmental disorders and medical complexity experience care that is fragmented, costly, and ineffective, causing health disparities and harm. The Neurodevelopmental Disorders Care Coordination (NDD-CC) program addresses these issues by connecting families with support across medical and social services. While NDD-CC has improved outcomes in several areas, many families continue to experience challenges.

Objective: Using data from a longitudinal study, we investigated patterns of change across child health and behavior and caregiver stress during care coordination (CC).

Methods: We performed an exploratory analysis of prospectively collected data from 67 caregivers of children with a neurodevelopmental disorder aged 2 to 17 years referred for CC. We examined changes in child health states (EQ-5D-Y), care-related quality of life (CarerQoL), and parenting stress (Parental Stress Index-Short Form) to assess impacts of CC over time and within subgroups.

Results: Most caregivers who reported CarerQoL scores in the bottom half of the distribution at baseline saw improvements at 3 (89%) and 12 months (71%). Gains were strongly associated with improvements in mental health at both time points. Similarly, child health states in the bottom half of the distribution improved the most. The difficult child domain of the parenting stress index was the key contributor to clinically significant stress scores, and changes in the difficult child score were negatively associated with changes in CarerQoL, explaining 36% of the variance.

Conclusion: Findings show that CC has the most impact on those with the greatest need; yet clinically significant child behavior may prevent sustained improvements if left unaddressed.