Journal of Developmental and Behavioral Pediatrics最新文献

Case: Jaxon is a healthy 12-year-old boy who is referred to your clinic for medication management. He was diagnosed with ADHD using a validated questionnaire at age 9 years. He is currently prescribed OROS methylphenidate 54 mg capsules once daily in the morning, which he has taken for 3 years. This has generally worked well to improve his attention, focus, task persistence, and task completion. However, his parents now report increasing disruptive behaviors over the past 18 months, both at home and at school. There have been no major stressors over this period nor significant life changes or trauma in Jaxon's history.Jaxon's teachers report that although he remains in his seat, he constantly "squirms" and moves about. He also makes quick, jerky movements with his hands several times each class period. They report no specific trigger or activity for when this movement occurs, but report it being more intense when Jaxon is working hard to concentrate and stay focused. His mother also reports noticing the frequency increase if Jaxon thinks he is in trouble or when he is very excited (e.g., when he is playing video games). His parents share home videos to support these concerns.His teachers report problems with attention, fidgeting, and talking out of turn. They also report that his movements distract and disrupt the class. These reports are most often from his afternoon classes. Academically, he is doing well. He turns in most of his work, but his grades have dropped this semester. His teacher reports that he seems to lack the focus to complete his assignments and he rushes through them to go to the next activity.When you talk to Jaxon, he reports that he likes school, but he does not like how often he gets into trouble. He admits he gets embarrassed during quiet time when his hands randomly "move without me moving them."When observing Jaxon, you notice that he fidgets in his seat, often moving his hands over anything that is holding his attention (toys, papers). He is also verbally impulsive, interrupting the discussion with his mother multiple times during the visit. Twice, you witness a brisk single jerk of his right hand. It originates at the wrist and rotates away from his body with his hand closed. There was no accompanying vocalization with this movement.His parents are requesting a medication adjustment or change. What would you do?

Case: KM is an 11-year-old autistic boy followed by a developmental-behavioral pediatrician (DBP) practicing within a multidisciplinary autism center. He had been prescribed various attention-deficit hyperactivity disorder (ADHD) medications over the years, most recently dextroamphetamine-amphetamine extended-release capsule 10 mg daily.KM initially presented to the DBP for diagnostic confirmation of autism and ADHD at the age of 7 years. His school had conducted a detailed evaluation the year prior, indicating skills in the borderline range for cognitive, adaptive, and language functioning. Based on his developmental history, physical examination, review of school-based testing, and parent- and school-completed standardized questionnaires, he met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for autism spectrum disorder and ADHD with combined presentation.When KM was between the ages of 8 and 10 years, he trialed several medications, including methylphenidate (which led to emotional lability), dextroamphetamine sulfate oral solution (which caused irritability), and clonidine (which led to destructive behavior). Notably, KM's parents were divorced and had differing opinions and experiences surrounding the efficacy and tolerability of his medications, which made medication trials more complex. He eventually was stabilized on extended-release dextroamphetamine-amphetamine at the age of 9 years, which both parents agreed was helpful for improving attention, despite the medication triggering a new self-injurious behavior of punching himself.At the age of 10 years, after 1 year of stability on dextroamphetamine-amphetamine extended-release capsule 10 mg daily, his parents chose not to refill the medication, to see whether it was still helpful for him. They observed that he seemed much "happier" with improved mood and decreased anxiety when dextroamphetamine-amphetamine was withheld; however, they did note worsened hyperactivity. A few weeks later, he began demonstrating increased symptoms of anxiety such as somatization and externalizing behaviors. This included frustration, aggression, and oppositionality, especially in anticipation of and/or when confronting anxious stimuli.His neuropsychologist and DBP collaborated to create a behavior monitoring plan to help his parents clarify and track his symptoms across households, with the goal of monitoring symptom severity and differentiating ADHD from anxiety-related symptoms. Because of this, his parents identified hyperactivity and impulsivity as KM's most problematic symptoms; therefore, dextroamphetamine-amphetamine extended-release 10 mg daily was restarted. Although this was effective for his hyperactivity, ongoing monitoring suggested that his anxiety symptoms continued to be clinically significant. The DBP consulted a psychiatrist who advised a trial of escitalopram in conjunction with dextroamphetamine-amphetamine. Several weeks after sta

Abstract: Qualitative design can be an integral method for developmental and behavioral pediatric (DBP) researchers to understand and better comprehend participant experiences. Qualitative methods are meant to be flexible, iterative, and collaborative, allowing the research team to learn through the data collection process as they connect with and gain insight from participants, or those with lived experience of the phenomenon. Even so, guidance is unclear on how to rigorously and thoughtfully implement these methods within DBP. This article aims to use common qualitative reporting guidelines to advise early career researchers on how to use qualitative design from study conception to results dissemination through a study case example in DBP.

Abstract: Neurodevelopmental and behavioral problems (NBPs) such as attention-deficit hyperactivity disorder and autism spectrum disorder are highly prevalent in children and adolescents. Clinical care for NBPs is characterized by unwarranted variation, a limited number of systematic approaches to measuring outcomes and evidence-based treatments, and significant challenges to conducting large, longitudinal clinical research studies. Clinical documentation of care provided to children with NBPs can be lengthy and time-consuming, lacks standardization, and often does not include precise details about clinically and scientifically important information (e.g., diagnostic criteria, services provided, response to treatment). The lack of standardization and missing data limit the utility of clinical documentation to support clinical research and quality improvement.

Objective: The purpose of this study was to explore the genotypic and phenotypic presentation of males with MECP2 -related neurodevelopmental disorders. When variants in the MECP2 gene are discovered in patients, Rett syndrome becomes a possible diagnosis. Rett syndrome, however, does not encapsulate all phenotypic variations in MECP2 gene mutations, and specific diagnosis can become tricky especially in the male population as mutations in the gene were historically thought to affect females only. The authors present a rare case of a male with a previously unpublished genetic variant resulting in a distinct clinical presentation not meeting the criteria for typical or atypical Rett syndrome.

Methods: This patient's institutional electronic medical record was accessed, and information was reviewed.

Results: It was discovered that this patient had a maternally inherited variant in his MECP2 gene, resulting in a unique and previously undescribed form of MECP2 -related neurodevelopmental disorder, presenting with language regression followed by speech apraxia and motor discoordination.

Discussion/conclusion: Literature reports on various phenotypes associated with MECP2 gene mutations and elaborates on previously identified forms of typical and atypical Rett syndrome. Through this case report, the authors uncovered a pathogenic variant in MECP2 resulting in a rare phenotype of MECP2 -related neurodevelopmental disorder that has not previously been described. This should encourage clinicians to think more broadly when approaching diagnosis of children with developmental differences. This also reinforces that Rett syndrome or MECP2 mutations can often present on a spectrum, and it may be beneficial to modify diagnostic criteria to reflect this.

Objective: Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study aimed to adapt Customized Adherence Enhancement (CAE), a psychosocial intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD.

Methods: Phase 1 included focus groups with AYAs, caregivers, and health care providers who treat AYAs with ADHD (N = 19). Prompts included barriers and facilitators of medication adherence, impact of ADHD, and reasons treatment regimens may be difficult to maintain. Focus groups were recorded, transcribed, and thematically coded. Phase 2 included cognitive interviews with AYAs with ADHD to assess acceptability and usability of the intervention (N = 6).

Results: Main themes were AYAs' perception of ADHD and its negative impact on work, sports performance, and interpersonal relationships. Barriers of adhering to medication were limited access, physiological side effects, difficulty following medication routines, and having comorbidities. Facilitators to medication adherence were having more knowledge about ADHD, benefits from medication adherence, and using external prompts.

Conclusion: As untreated or undertreated ADHD negatively affects morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Results informed the adaptation of an existing intervention (CAE) to target AYAs with ADHD and can be applied to adherence interventions more broadly.

Objective: Internet access is critical for reaching most modern-day resources and systems. Yet many do not have consistent access, including people with disabilities. This can have an outsized impact on children, which COVID-19 lockdowns revealed in 2020 to 2021. However, internet access for parents with disabilities and their children is not well-studied. This study aims to fill that gap.

Methods: We used 2018 to 2022 American Community Survey data. Parents are defined as adults with a co-residing minor for whom they are presumed responsible, and are classified as with or without disabilities. Outcomes include presence of any home internet access and home high-speed internet access, and were analyzed by the presence of disability and type of disability.

Results: Results from modified Poisson regression analysis reveals that disabled parents are 1.79 times as likely as nondisabled parents to not have any home internet access (p < 0.001) and 1.40 times as likely to not have home high-speed internet access (p < 0.001). Adjustment for sociodemographic factors somewhat alleviated these disparities, but even after controlling for urbanicity, poverty, program participation, and family employment status, statistically significant disparities remained for most disability subtypes. Parents with hearing disabilities were most likely to lack home internet access.

Conclusion: Among US parents, disability status is associated with lacking any home internet access and lacking home high-speed internet access. Given the importance of internet access in nearly all aspects of modern society for children and families, continued and increased support for programs that assist parents with disabilities may be an avenue for improving access.

Objective: Given rising national rates of depression, anxiety, suicidality, and trauma, and with the associated rise in screening for mental health concerns in medical settings, medical and behavioral health clinicians increasingly identify and manage mental health crises during time-limited visits. Through 2 clinical case examples, this article introduces CARE-squared , a novel approach to teaching crisis management, grounded in client support and clinician self-care, that can be used in a variety of health care settings.

Method: This article describes the need for crisis management in health care settings, reviews literature on existing Psychological First-Aid frameworks, and highlights principles of trauma-informed care. The article then introduces CARE-squared , a four-step parallel-process model of crisis management, designed to guide health care trainees' support of clients in crises while simultaneously maintaining patient alliance, de-escalating, and managing clinician stress during a crisis.

Results: Two clinical cases highlight the applicability of CARE-squared to rapid crisis management during in-person and telehealth visits.

Conclusion: CARE-squared provides a novel, parallel-process approach to support patient care and clinician wellness. It has broad applicability to clinician training and practice and potential utility for a variety of presenting concerns and health care settings.