Journal of Developmental and Behavioral Pediatrics最新文献

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.

Objective: To determine the earliest developmental stage at which the association between unhealthy dietary patterns and depressive symptoms emerges, given that this relationship is well-documented in adolescents and adults but remains understudied in young children.

Methods: Children (N = 2360; mean age of 5.1[SD = 0.2] years; 48% female) enrolled in the CHILD birth cohort study were included. Parent-reported data on demographics, dietary intake, sleep, physical activity, mental health outcomes (Child Behavior Checklist [CBCL]), and family variables (parental education, household income, maternal depressive symptoms) were collected. Missing covariate data with <15% missingness were handled using multiple imputations by chained equations. Dietary patterns were derived using Principal Component Analysis with a varimax rotation to enhance interpretability. Multiple regression was used to test the association between dietary patterns and mental health outcomes while accounting for covariates.

Results: Three dietary patterns were identified: "Prudent" (high in vegetables, fruits, legumes, eggs, and fish); "Western-like" (high in fast foods, meats, and sugar-sweetened beverages); and "Refined Grain-Snack" (high in refined grains, dairy, and salty snacks). For the full sample, the mean CBCL subscale scores were as follows: Total Problems = 41.37[9.22], Internalizing Problems = 44.69[9.18], and Externalizing Problems = 39.78[9.65]. Greater adherence to the prudent pattern was associated with fewer Total Problems (β = -0.10, p = 0.003), Internalizing Problems (β = -0.10, p = 0.001), and Externalizing Problems (β = -0.08, p = 0.016 in fully adjusted models.

Conclusion: Findings suggest that the relationship between mental health and diet is observable in young children, highlighting a potential opportunity for preventive interventions. Longitudinal research is needed to determine the temporal association between dietary patterns and mental health symptoms.

Objective: Type 1 diabetes (T1DM) requires insulin administration, adjusting doses depending on multiple lifestyle factors. Studies show that personality traits influence glycemic management in patients with T1DM. The evidence regarding the relationship between conscientiousness, a personality trait associated with self-discipline, remains limited. The objective of this study was to investigate this relationship in children and adolescents with T1DM.

Methods: One hundred eighteen children and adolescents diagnosed with T1DM (42.4% girls, mean age 15.79 ± 1.98 years) were recruited for this study. Conscientiousness was measured using a 13-item shortened version of the Big Five Questionnaire. Glycemic management was evaluated with data obtained from intermittently scanned continuous glucose monitoring (isCGM).

Results: Higher levels of conscientiousness are associated with a better glycemic management and a greater adherence to isCGM usage in our study. Besides, greater adherence to isCGM correlates with a better glycemic management. We found a model where constant adherence to isCGM across the study period mediates the relationship between conscientiousness and glycemic management.

Conclusion: Our results highlight the importance of assessing personality traits and integrating this information into the therapeutic education of adolescents with T1DM to improve their glycemic management.

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: Problems with hearing feature prominently in autism spectrum disorder (ASD) but remain poorly characterized within population-based samples and according to symptom heterogeneity.

Method: We analyzed cross-sectional, caregiver-reported data from the National Survey of Children's Health (2016-2020). Our US-based sample included children with data on the presence/absence of "deafness or problems with hearing" (DPHs) and ASD (ages 3-17 years; n = 150,327). We used weighted logistic regression to examine the association between DPHs and (1) ASD diagnosis (no, yes), (2) ASD symptom severity (none, mild, moderate/severe), and (3) co-occurrences of ASD with intellectual disability (ID) (neither, ASD only, ID only, both) or attention deficit/hyperactivity disorder (ADHD) (neither, ADHD only, ADHD only, both). We also assessed effect modification by sex and preterm birth.

Results: Deafness or problems with hearing were associated with greater odds of ASD (OR = 2.7; 95% CI, 1.8-3.9), with 4% of children with ASD having DPHs versus 1% of children without ASD. Associations were stronger for: moderate/severe ASD symptoms (OR = 3.5; 95% CI, 2.1-5.7) versus mild symptoms (OR = 1.8; 95% CI, 1.1-3.1); children with co-occurring ID (OR = 5.0; 95% CI, 2.8-9.0) or ID only (OR = 8.6; 95% CI, 6.0-12.4); and children with co-occurring ADHD (OR = 4.3; 95% CI, 2.5-7.2) than for ASD only. Findings persisted after adjustment and were stronger for females versus males but were not modified by preterm birth.

Conclusion: Deafness or problems with hearing are associated with ASD, particularly-though not exclusively among children with more severe symptoms and co-occurring ID. Future research is needed to determine whether DPHs in ASD are driven by sensory, cognitive, and/or motivational processes or residual confounding (e.g., congenital anomalies).

Objective: This naturalistic, observational study aimed to assess the frequency and timing of new and recent suicidal ideation (SI) in youth with neurologic, developmental, and behavioral disorders (NDBDs) after an initial negative suicide risk screening within medical and behavioral health settings.

Method: A total of 5030 children aged 8 to 17 years were included, all of whom received at least 2 routine suicide risk screenings between July 2019 and February 2024 as part of their larger clinical care appointments (N = 20,177 total screenings). Screenings were conducted using the Ask Suicide-Screening Questions tool. Analyses examined the interval between an initial negative screening and the emergence of new SI, with stratification by clinic type and age group. Predictors of new onset of SI were also examined.

Results: Overall, a significant proportion of children screened positive for new SI after an initial negative screening (8.4%). Rates were higher in behavioral health clinics (11.3%) compared with medical clinics (5.4%), with a median interval of 5 to 6 months to the first positive screening for both settings. Females were more likely to report new SI, as were those in seen in behavioral health as compared with medical clinics.

Conclusion: The findings highlight the importance of repeated suicide risk screening in children with NDBDs as a significant proportion of new SI is reported in the months after an initial negative screening. Screening only annually appears likely to underdetect risk, underscoring the need for more frequent screening particularly within the first year of care to improve early detection and intervention opportunities.

Background: Musical hallucinations are a rare auditory phenomenon, with fewer than 50 pediatric cases reported in the literature. They are particularly uncommon in children without hearing impairment or psychosis.

Case presentation: A Thai girl with ADHD, diagnosed at age 5 years and treated with methylphenidate, presented with a 1-week history of bilateral musical hallucinations. The hallucinations consisted of instrumental music without lyrics, were nonpulsatile, occurred predictably during specific hours, and were emotionally distressing. Audiologic evaluation showed normal hearing bilaterally, and EEG showed normal background activity with no epileptiform changes during hallucination episodes. She also exhibited frequent eye blinking consistent with simple motor tics. Developmental assessment revealed some developmental delays, with a KBIT-2 composite IQ of 87, showing a moderate discrepancy between verbal (79) and nonverbal (98) domains, potentially reflecting both neurodevelopmental vulnerabilities and sociolinguistic factors. Initial nonpharmacological interventions including media restriction and behavioral techniques were unsuccessful. Low-dose risperidone (0.25 mg/day) led to complete resolution of hallucinations, tics, and associated emotional distress within 3 weeks. She remained symptom-free at the 3-month follow-up.

Conclusion: Musical hallucinations can occur in children with ADHD even in the absence of hearing impairment, epilepsy, or psychosis. Early recognition, comprehensive evaluation, and multidisciplinary management are essential. When symptoms cause significant distress, low-dose risperidone may be an effective treatment. Recognizing the structured and nonpsychotic nature of musical hallucination in neurodevelopmental contexts may help avoid misdiagnosis and guide appropriate intervention.

Objectives: For youth with gastrointestinal (GI) conditions, mental health symptoms can exacerbate GI symptoms. In a cyclical fashion, experiencing GI symptoms at school can contribute to depression, anxiety, and embarrassment. This study evaluated the impact of school instruction type on mental health and GI symptoms for youth with GI conditions during the COVID-19 pandemic.

Method: Data were collected from caregivers and patients aged 8 to 17 years with inflammatory bowel disease, celiac disease, and irritable bowel syndrome (N = 146) from September to December 2020. Patients completed measures of depression, anxiety, anger, and GI symptoms; caregivers provided their child's school instruction type (online, hybrid, or in-person). Analyses were conducted to examine the relations of mental health symptoms, GI symptoms, and school instruction type.

Results: Participants generally had mild levels of depressive symptoms (T = 55.50), and anxiety (T = 53.02) and anger (T = 49.92) symptoms were within normal limits. Anxiety and GI symptoms were positively related ( b = 0.14, p < 0.01), and if participants were attending school online, they had worse GI symptoms ( b = 0.46, p < 0.05). However, there was no significant interaction between anxiety and instruction type. Depression and anger were not significantly related to GI symptoms and there were no significant interactions.

Conclusion: For children with GI conditions during the pandemic, as their anxiety symptoms increased, so did their GI symptoms. Further research should examine the long-term effects of virtual learning for those with GI conditions.