Journal of Developmental and Behavioral Pediatrics最新文献

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.

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.