Journal of Developmental and Behavioral Pediatrics最新文献

Objective: Within an evolving and increasingly complex pediatric context, little is known about how developmental pediatricians experience their interactions with families within nuanced clinical practices that demand flexibility and a tolerance for ambiguity. To address this gap, this study explored the perspectives and experiences of developmental pediatricians regarding their communications and interactions with children and families.

Method: A qualitative exploratory design informed by phenomenology was used. Individual semi-structured interviews were conducted with 12 developmental pediatricians across Canada. Issues involving children's agency and their right to participate in shared decision-making were examined.

Results: Developmental pediatrics emerged as an inherently relational practice that involves building strong long-term relationships with caregivers through a strength-based, humble, and self-reflexive approach. "Keeping the door open" and "planting the seed" arose as metaphorical representations of developmental pediatricians' commitment to ensuring caregivers feel supported and understood. Moreover, challenges associated with involving children in decision-making processes, as well as managing caregivers' understandings and desires for their child's diagnosis were evident.

Conclusion: The findings generated by this study elucidate the clinical approaches and communication styles of developmental pediatricians. Despite participants' strong family-centered approach to care, future clinical considerations should accentuate the promotion of children's autonomy and rights in developmental pediatrics.

Case: A 5-year-old girl with a history of autism spectrum disorder was admitted to inpatient rehabilitation after extensive accidental burns requiring skin grafts to her upper body. During her admission, she had increasingly aggressive behaviors toward staff, hyperactivity, impulsivity, and refusal to participate in therapies. She resisted transitions between activities, hit her bed rails, and eloped from her room. Goals during physical therapy sessions included stretching and strengthening her scarred extremities to increase mobility. Her behavior increased her risk of healing complications and became a significant barrier to progress in her rehabilitation. The medical team consulted developmental and behavioral pediatrics to recommend medications for oppositional behaviors not responding to behavioral strategies.A developmental and behavioral pediatrics consulting team of physicians and nurses met the patient, gathered history, and observed the child in the hospital. The patient's developmental history was significant for expressive language delay and autism spectrum disorder. At home, she preferred solitary play and spinning objects and had an intense interest in horses. In the school setting, she was supported with an individualized education plan and special education services. In crowded areas, she wore noise-canceling headphones to accommodate auditory sensory hypersensitivity. Her mother reported maintaining a strict schedule at home around mealtimes, bath time, and bedtime, which provided comfort and limited tantrums. She had never needed medication to manage behaviors at home or at school in the past.When the developmental pediatrics team observed her in the hospital, she eloped from a physical therapy session in the gym and refused to participate in a hospital school session. Therapies occurred at variable times throughout the day, and she resisted transitions between therapies. She frequently complained of itching from healing burn sites and had developed new daytime urinary incontinence. During examination, she engaged in back-and-forth ball play and sought reassurance from her parent. Therapists, nurses, and behavioral health providers were interested to hear any ideas to support her. What should the developmental and behavioral pediatrics team recommend?

Case: Noah is an 18-month-old boy with Rubinstein-Taybi syndrome, diagnosed at 3 months through genetic testing that revealed a cyclic adenosine monophosphate response element-binding protein (CREBBP) variant. At 7 months, Noah was socially engaged, smiling and responding to familiar caregivers, but his motor differences were evident: limited head control, frequent fisting of his hands, difficulty grasping objects because of syndactyly, the need for assistance with rolling, and difficulty tolerating time on his stomach.By 9 months, Noah was referred to Part C Early Intervention services and began occupational and physical therapy. With support, he was developing postural control and reaching skills. Still, his opportunities for exploration and communication remained largely dependent on adult facilitation. At this point, Noah did not have independent or reliable ways to move across his environment or consistent methods for communication to share his wants, needs, or make choices.The central challenge in this case: How can pediatric clinicians and therapists partner to bring assistive technology into the lives of children, like Noah, at the right time?

Objective: Positive childhood experiences (PCEs) are protective events against the impact of childhood trauma. Previous research has found that children and youth with special health care needs (CYSHCN) are more likely to experience adverse childhood experiences, but the prevalence of PCEs among this population has not been examined. Therefore, this study seeks to evaluate the prevalence of PCEs among CYSHCN.

Methods: Cross-sectional data from the 2021 to 2022 National Survey of Children's Health (n = 47,207) was used to evaluate differences in the prevalence of PCEs between CYSHCN and non-CYSHCN, and to evaluate predictors of PCE exposure among CYSHCN. Rao-Scott χ2 test and multivariable logistic regression, using appropriate survey weights, were used.

Results: Compared with non-CYSHCN, CYSHCN had lower odds of having at least one PCE (adjusted odds ratio [aOR]: 0.35, 95% Confidence Intervals [CIs]: 0.15‒0.83), and having specific types of PCEs: having constructive social engagement (aOR: 0.24, 95% CIs: 0.21‒0.27), having nurturing and supportive relationships (aOR: 0.80, 95% CIs: 0.72‒0.89), living in a safe, stable, and equitable environment (aOR: 0.75, 95% CIs: 0.68‒0.82), and creating social and emotional competency (aOR: 0.62, 95% CIs: 0.56‒0.69). Among CYSHCN, children of color, those with greater poverty, and those with more complex needs have lower odds of experiencing most PCEs.

Conclusion: The results of this study indicate a need for programs aimed at fostering resilience among CYSHCN. There is also a need for additional research creating better measures of evaluating PCEs among CYSHCN and examining how PCEs mitigate the effects of adverse childhood experiences in this population.

Objective: To examine whether self-control in first grade predicts later parenting.

Method: Participants were first graders enrolled in a universal preventive intervention trial in 1993 to improve behavior and school achievement. By 2023, n = 221 participants were parents of children aged 4 to 15 years. Pre-intervention, self-control was assessed using the Teacher Observation of Classroom Adaptation-Revised. Latent profile analysis identified 3 profiles of childhood self-control: high (n = 101, 45.7%), inattentive (n = 87, 39.4%), and inattentive/hyperactive (n = 33, 14.9%). The association between self-control profiles and later parent-rated discipline consistency and enjoyment of parenting from the Structured Interview of Parent Management Skills and Practices was evaluated using latent profile regression. The association between self-control and observed parent sensitivity, intrusiveness, and positive/negative regard for the child was explored in a subset (n = 81).

Results: The high and inattentive childhood self-control profiles were more likely to discipline consistently versus the inattentive/hyperactive profile (Wald(2) = 8.55, p = 0.01). Self-control did not predict enjoyment of parenting (Wald(2) = 3.30, p = 0.19). Compared with the high profile, the inattentive/hyperactive and inattentive profiles exhibited greater positive regard for the child (Wald(2) = 11.03, p = 0.004).

Conclusion: Childhood self-control may provide a foundation for discipline consistency as a parent. Individual differences in regulatory functioning that pose challenges in childhood might confer unexpected parenting benefits, underscoring the need for a life course perspective.

Objective: This study examined whether irritability and sensory over-responsivity (SOR) mediate the relationship between anxiety disorders and sleep problems in preschool-aged children. Although previous research has demonstrated a link between anxiety and sleep disturbances, the specific contributions of irritability and SOR remain unclear.

Methods: The sample included 45 preschool children (24-72 months, 44.4% male) diagnosed with anxiety disorders and 85 healthy controls (24-72 months, 50.6% male). Diagnoses were determined using the Preschool Age Psychiatric Assessment, a structured DSM-5-based clinical interview. Parents completed the Child Behavior Checklist 1.5 to 5 to assess behavioral and emotional symptoms, including sleep problems and irritability.

Results: Children with anxiety disorders showed significantly higher levels of irritability (p = 0.003) and SOR (p < 0.05) compared with controls. Sleep problems were more frequent in the anxiety group compared with the controls (p = 0.003). Multiple regression analyses revealed that irritability and SOR significantly mediated the relationship between anxiety and sleep problems (p < 0.001).

Conclusion: The irritability and SOR seem to play key mediating roles in the development of sleep problems among preschoolers with anxiety disorders. These findings highlight the importance of addressing regulatory and sensory-emotional functioning in the assessment and treatment of young children with anxiety and sleep difficulties.

Objective: There is a growing need for autism evaluations in young children. Wait times to evaluation are long due to the limited specialty workforce. Primary care autism evaluations are 1 solution, but many providers lack training and confidence in autism care. Literature highlights the need for improvement in developmental and behavioral pediatrics training among pediatric residents. This study evaluates resident confidence in autism care after participation in a novel autism evaluation pathway in a primary care pediatric resident continuity clinic.

Methods: Pediatric residents led a primary care autism evaluation with a trained pediatrician in their continuity clinic. Residents were provided with enhanced autism education which included neurodiversity-affirming strategies and training on the use of an autism assessment tool. Presurveys and postsurveys were used to assess resident confidence in autism care before and after the educational intervention. Survey data were compared using Mann-Whitney U tests appropriate for ordinal, nonpaired data.

Results: Thirty resident-led autism evaluations were conducted during the study period. There was statistically significant improvement in resident confidence in autism screening, use of assessment tools, evaluation, diagnosis, treatment recommendations, sharing resources, understanding of neurodiversity, and use of a strength-based approach after participation.

Conclusion: Providing autism education and hands-on primary care autism evaluation training opportunities for residents in pediatric continuity clinic improves confidence in autism care. This model is 1 way to enhance autism education and training during pediatric residency which may have a positive impact on the care provided to autistic patients.

Objective: To (1) identify distinct profiles (i.e., subgroups) of screen time (ST) and outdoor play (OP) in a sample of preschool children, and (2) examine the mean differences in specific domains of cognitive and social-emotional development between these profiles.

Method: Baseline data from the Technology and Development in Early Childhood study were used. Participants were 352 preschool children (3-4 years) and their parents living in Western Canada. ST (television [TV]/video viewing and video/computer games) and OP for both weekdays and weekend days were parent-reported. Social-emotional development outcomes (emotional, cognitive, and behavioral self-regulation) and demographic covariates were assessed by questionnaire. Cognitive development outcomes (language, response inhibition, working memory, and self-control) was assessed by 4 short games played during a recorded virtual meeting. Latent profile analysis was conducted.

Results: Four profiles were identified: (1) low ST/medium-high OP, (2) high TV/high OP, (3) medium ST/low OP, and (4) high ST/medium-high OP. Profile 1 was selected as the reference group. For response inhibition, the medium ST/low OP (M = 10.3, SE = 2.0; p = 0.03) and high ST/medium-high OP (M = 2.8, SE = 3.7; p < 0.01) profiles scored significantly lower than the reference group (M = 15.3, SE = 1.0). For self-control, the high TV/high OP (M = 65.5, SE = 3.2; p = 0.03) and medium ST/low OP (M = 63.8, SE = 4.8; p < 0.05) profiles scored significantly lower than the reference group (M = 74.2, SE = 2.1). For behavioral self-regulation, the high TV/high OP (M = 3.6, SE = 0.1; p < 0.01) profile scored significantly lower than the reference group (M = 3.9, SE = 0.04).

Conclusion: Children with the combination of lower ST and higher OP had more advanced cognitive and social-emotional development for some outcomes.

Purpose: Some individuals with autism spectrum disorder (ASD) demonstrate marked behavioral improvements during febrile episodes, which is called febrile effect. This study aimed to investigate the prevalence and characteristics of the febrile effect in children with ASD in China.

Methods: One hundred fifty-seven patients diagnosed with ASD were recruited to participate in the study; the parents completed a self-compiled questionnaire regarding the febrile effect. Children who reportedly improved with fever (Improve Group) were compared with those who reportedly did not improve (No Improve Group) on the core symptoms and developmental status.

Results: Parent reports of 16.56% of children exhibited behavioral improvements during fever. Improvements included reduced problem behaviors, enhanced cognitive or learning abilities, increased social interaction, and decreased stereotypical behaviors. The Improve Group scored higher in Autism Diagnostic Observation Schedule, Second Edition and Social Responsiveness Scale. There were no significant differences in the incidence of infectious diseases during pregnancy among mothers in the 2 groups; however, a marked disparity was observed in the frequency of febrile episodes within the preceding year. The duration of the febrile effect varied, with 76.92% being temporary and 23.08% showing sustained improvements postfever. Children with sustained improvements had more severe social deficits.

Conclusion: The febrile effect is observed in a subset of ASD children and may be associated with more severe social deficits. The heterogeneity in the duration of the febrile effect suggests the need for further research to elucidate the underlying mechanisms and potential therapeutic applications.