Journal of Developmental and Behavioral Pediatrics最新文献

Objective: A systematic review using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted to evaluate the potential adverse impacts on neurodevelopment associated with prenatal opiate exposure.

Method: After applying exclusion criteria to the identified collection of studies, 86 studies were included in this review. Each article was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. Results were grouped into 6 neurobehavioral function domains (executive, language, general development, motor, neurosensory, and socioemotional) and 1 neuroimaging domain.

Result: Risk difference analyses showed the neurosensory domain in children prenatally exposed to opioid had highest risk of impairment (76.9%), whereas the executive domain had lowest risk (44.8%). The meta-analysis of pooled estimates after statistical adjustments associated with the Egger's test results showed effect size (Hedge's g) was largest in the socioemotional domain (-1.14; 95% CI, -1.61 to -0.66) and smallest in the general development domain (-0.44; 95% CI, -0.70 to -0.18). Neuroimaging studies on prenatal exposure to opioid were limited and varied in the techniques and topographical focus in their approaches, resulting in a heterogenous body of literature.

Conclusion: Maternal opioid use during pregnancy can serve as a risk indicator for an at-risk child and the potential need for monitoring the child's neurodevelopmental growth. The conclusions related to the direct teratogenic effects of maternal opioid use, however, are often limited by poor experimental and statistical controls used to address other substances and social adversity that co-occur with opioid use.

Objectives: Most children exhibit preliteracy skills by preschool. Children who are deaf/hard of hearing (DHH) with a language gap are at risk for delayed preliteracy skills. Our study aimed to describe preliteracy skill development in preschool-aged DHH children and investigate associated factors.

Methods: Children, aged 3 to 5 years, were included in the analysis if enrolled in randomized trials of a language intervention using augmentative and alternative communication, shown to boost language skills. Evaluations using the Clinical Evaluations of Fundamentals-Preschool Preliteracy Rating Scale (PRS) were conducted at baseline, 24 weeks, and 48 weeks. Repeated-measures models assessed changes in total PRS scores and Early Reading and Early Writing subdomains. Results were presented as least square mean values with 95% confidence intervals.

Results: Forty-five children had completed pre-data and post-data. The mean nonverbal IQ was 99.3 (SD 14.3), and receptive and expressive language were 82.3 (14.9) and 76.8 (17.0), respectively. Significant ( p < 0.0001) skill growth was observed with all preliteracy outcomes, ranging from 11 to 15 points in the first 24 weeks. Increasing receptive and expressive language over time was significantly associated with increasing scores. Factors such as aided hearing thresholds, caregiver education level, and hearing device use were not significant in models.

Conclusion: Language is essential for literacy development. Language-enhancing interventions could facilitate literacy skills. Monitoring preliteracy skills in DHH children is crucial, given their increased risk for language delays. Further research is needed to support early literacy development in this population, ensuring they have the tools they need for future success.

Case: John is a 12-year-old African-American boy with a Specific Learning Disorder in Reading and Generalized Anxiety Disorder who you are seeing in follow-up at your clinic. Last fall, when John was having an escalation of his anxiety symptoms at school, he enacted the behavior intervention plan (BIP) that had been previously established by his educational team of informing his teacher that he needed to leave the classroom. He then paced the hallway outside of his classroom as a method of coping with the anxiety that he was experiencing. Approximately 3 months prior, John's teacher was unable to visualize him from her position in the classroom and subsequently called the School Resource Officer (SRO) to locate him. The SRO found John, who was in an emotionally dysregulated state. The SRO subsequently approached John who noted that he wanted to jump off a cliff. Rather than following the BIP which details the need to involve the school counselor and social worker when John is in an emotionally dysregulated state to perform a self-harm/threat assessment, the SRO bypassed this step and, instead, notified the emergency response team, who initiated a petition for psychiatric evaluation, thus temporarily limiting parental rights to make certain treatment decisions. This led to John being transported to the local Emergency Department (ED) in the backseat of a police vehicle.While in the ED, a urine toxicology assessment was performed which returned negative and John was subsequently evaluated by the child and adolescent psychiatrist on call who deemed that John was not an immediate threat to himself or others and discharged him home with his mother. Subsequent to this event, John exhibited refusal to return to school and would remain in his family's car for 30 to 60 minutes before entering the school in the morning. Once at school, he would go to an administrator's office where he felt safe, and his school work was brought to him. His long-standing therapist, who he had been seeing for management of anxiety, began providing Eye Movement Desensitization and Reprocessing therapy with John as a trauma-focused intervention to address the events he experienced at school.John continued to exhibit school avoidance and was placed on home-bound instruction by the school in the spring, which comprised 60 minutes of special education instruction in the home each week, without provision of general education instruction. John went from being an A/B student to earning Ds and Fs, and he was denied compensatory instructional services by the school in the summer.The family comes to your DBP clinic that summer asking for evaluation of his traumatic symptoms and to create a plan for the fall and returning to school.

Atypical antipsychotics are high-risk medications with serious side effects including weight gain, hyperlipidemia, and insulin resistance. Safe use in youth with autism spectrum disorder and other neurodevelopmental disorders is especially important due to inherent risks of high obesity rates and barriers to a healthy lifestyle. Metabolic monitoring rates are low in this population in part due to difficulties with obtaining labs and other vitals. In our Developmental and Behavioral Pediatrics clinic, 31% of patients had once-yearly metabolic monitoring parameters completed. We aimed to increase metabolic monitoring rates through multi-disciplinary interventions. A pharmacist provided educational presentations to staff, the pharmacist identified patients needing monitoring and provided recommendations to the medical provider, nursing staff notified families by phone if labs were needed, and child life support services were offered. Average once-yearly metabolic monitoring rates increased from 31% to 64% 1 year after beginning interventions. Three educational presentations were provided, 183 recommendations for monitoring were made on 141 patients, and nursing made 38 phone calls to families. Of the 141 patients identified as needing monitoring at the time of clinic visit, 72 (51%) obtained the monitoring parameters within 3 months. Abnormal metabolic labs requiring additional action were found in 31/72 (43%) patients. Patients with in-person visits were more likely to obtain labs overall and on the day of clinic visit than those with telehealth appointments. Using a multidisciplinary approach within a Developmental and Behavioral Pediatrics clinic, metabolic monitoring rates in patients taking atypical antipsychotics greatly improved.

Objectives: To examine recent trends and patterns in school-aged children's mental health and health care-related measures.

Methods: Data came from the 2016 to 2021 National Survey of Children's Health (n = 155,178). Adjusted logistic regression models were used to test for significant time trends and between-group differences. Measures included mental, emotional, behavioral conditions (MEB; depression, anxiety, behavioral/conduct problems), positive indicators of mental/emotional well-being, and mental health care access/utilization.

Results: In 2021, 20.4% of children aged 6 to 17 years (over 10 million) had at least 1 current MEB, up from 18.1% in 2016 (+13%; trend p < 0.001). Two-thirds (68.8%) of children with an MEB received treatment/counseling in the past year. Over half (53.6%) of children had difficulty getting mental health care, up from 44.0% in 2018 trend p < 0.001; 6.4% had unmet mental health care needs, up from 4.3% in 2016 (trend p = 0.01). Four of 5 positive indicators significantly decreased over time (range: -8% to -14%; trend p < 0.001). Across 2016 to 2021, access to mental health treatment was lower for publicly insured, uninsured, lower income, and racial/ethnic minority children.

Conclusion: An increasing burden of MEB conditions in children aged 6 to 17 years has been accompanied by stagnant rates of mental health treatment and increasing challenges in accessing services. Access to treatment varied across population subgroups, indicating gaps in access to prevention, diagnosis, and treatment.

Case: Marcus is a 4-year-old African-American boy with cerebral palsy, Gross Motor Function Classification System level 1, and attention-deficit hyperactivity disorder (ADHD), Combined Presentation who presents to Developmental-Behavioral Pediatrics clinic for evaluation because of preschool difficulties. He is very active, jumping up and down at circle time, bumping into classmates, and impulsively hitting other children when they take his toys. As a toddler, his cognitive and social-emotional skills were on track, and he received early intervention for language and motor delays. He qualified for an IEP and transitioned to a district-based inclusive preschool setting with speech therapy and adaptive physical education. Marcus spends the week with his grandparents, and they live in a school district that is well-resourced and has inclusive school and therapy settings. The teachers call parents or grandparents frequently to pick him up. In response to misbehavior, they also put him in a separate timeout area, away from the other children, with a 1:1 aide for the rest of the day. On 2 occasions, he was strapped into a therapy chair for nonambulatory children after biting or hitting another child. Because he does well with 1:1 support, the school has switched him to a special day class with smaller class size, comprised primarily of autistic preschoolers who are minimally verbal. Marcus' parents have just started parent training in behavior management for ADHD after struggling to find a therapist that was covered by their insurance. His mother noticed while volunteering in his original class that other children with similar behavior were not sent home or transferred to a special education class. They are upset with the transfer to the more restrictive environment, but they are worried if they speak up that the district will send him to a less resourced school in the district where the family, rather than grandparents, reside. How would you advise the family to proceed?

Objective: The introduction to complementary food is an important stage, particularly for preterm infants and their parents as they navigate a changing feeding relationship. Parental feeding strategies during this period can influence long-term feeding outcomes, but the influence of specific strategies on later feeding skills and feeding problem symptoms is unknown.

Method: Parents of preterm infants completed surveys about their infant's feeding at regular intervals from 1 to 12 months of age. At each time point, parents reported on their use of feeding strategies and their infants' feeding skills (Child Oral and Motor Proficiency Scale) and feeding problem symptoms (Pediatric Eating Assessment Tool). Patterns of parental strategy use across the early complementary feeding period were examined and associations with feeding skills and problems at 12 months corrected age was assessed.

Results: Seventy-four parents completed the surveys. Frequency and type of strategies used changed over time. Four patterns of parental strategy use emerged: low-moderate, schedule dominant, dual dominant, and modification dominant. Parental use of 2 or more types of strategies at relatively high levels was associated with more feeding problem symptoms at 12 months but not feeding skills.

Conclusion: Parents of preterm infants use different strategies during the complementary feeding period to navigate their infant's feeding, with potential implications for later feeding problems. Future research should explore causal mechanism behind parental strategy use and feeding problem symptoms through longitudinal analyses and investigate how parental perceptions and decision-making regarding mealtime strategy use evolve over the first year of life.

Objective: Maternal 15q11-q13 duplication syndrome (Dup15q) has been associated with 0.5% of all cases of autism spectrum disorder (ASD). There is no established protocol for the neuropsychiatric evaluation of individuals with this syndrome. This study aims to define a protocol incorporating gold standard assessments.

Methods: Six individuals with Dup15q underwent assessment of cognitive and adaptive functioning (Leiter-3, Adaptive Behavior Assessment System-Second Edition), autistic traits (Autism Diagnostic Observation Schedule-2 [ADOS-2], Autism Diagnostic Interview-Revised [ADI-R], Social Communication Questionnaire, Social Responsiveness Scale, Repetitive Behaviors Scale-R), co-occurring psychopathology (Kiddie Schedule for Affective Disorders and Schizophrenia, Child Behavior Checklist, Swanson, Nolan, and Pelham-Forth Edition, Sleep Disturbance Scale for Children), and family functioning (Parenting Stress Index-Short Form, PedsQL). Parents were required to fill the Symptom Checklist 90 (SCL-90) and Autism-Spectrum Quotient (AQ) to gather information about their psychiatric co-occurrences and autistic traits. A molecular analysis was performed to confirm the genetic alteration.

Results: Two siblings inherited the duplication through maternal transmission, whereas 4 individuals had a de novo maternal duplication. No participant exhibited preserved cognitive abilities; 4 of 5 showed below average adaptive functioning and 2 of 6 received a diagnosis of ASD. ADOS-2 revealed greater difficulties in the Social Affect domain compared with the Repetitive and Restricted Behaviors domain (p < 0.05), findings confirmed by ADI-R (p < 0.05). K-SADS indicated clinical scores in 5 individuals, with anxiety disorder in 3 participants. High levels of parental stress and a poor quality of life were reported. The mother carrier of the duplication showed clinical scores on the "Positive Symptom Total" of the SCL-90 and on the AQ.

Conclusion: Individuals with an in tandem 15q-11q13 duplication seems to exhibit cognitive and adaptive difficulties along with psychiatric co-occurrences and autistic traits. Parents, with or without the duplication, may experience psychopathological difficulties and impaired family functioning.

Objective: To estimate the frequency of suspected neurodevelopmental delays (NDD) and to investigate the measurement properties and usability of the Survey of Well-Being of Young Children-Brazilian version (SWYC-BR).

Methods: We conducted a cross-sectional study in Basic Health care Units in Northeastern Brazil. The participants were 645 mothers/caregivers of children between 2 and 65 months of age who completed the SWYC-BR and a socioeconomic questionnaire. We estimated the frequency of suspected NDD using the SWYC-BR, assessed the respondents' experience with the questionnaire, and examined test-retest reliability and internal consistency of the SWYC-BR items, as well as the construct validity of the Developmental Milestones questionnaire (DM-SWYC).

Results: The sample consisted primarily of families residing in urban areas and belonging to very low socioeconomic classes. The frequency of suspected NDD was 37.9%. The internal consistency of the SWYC-BR ranged from 0.56 to 0.97, and the test-retest reliability of the items was high (>0.75). Significant associations with risk factors for developmental delays confirmed the construct validity of the DM-SWYC. Most mothers/caregivers found the SWYC-BR easy to respond (85.7%) and enjoyed responding to the questions (95.8%).

Conclusion: The high frequency of suspected NDD highlights the need for special attention to early child development. The SWYC-BR was well accepted, and its measurement properties were confirmed, demonstrating its feasibility in identifying children requiring closer primary health care monitoring.