Journal of Developmental and Behavioral Pediatrics最新文献

Objective: To determine whether mothers' depressive symptoms with or without exposure to selective serotonin reuptake inhibitor (SSRI) antidepressant treatments during pregnancy were associated with executive functions (EFs) in offspring at 6 and 12 years of age.

Methods: A prospective cohort of 191 mothers and their children participated in the study. Clinician-rated reports of mothers' depressive symptoms were obtained spanning the third trimester during pregnancy to 12 years later. Children's EFs were measured using 2 computer-based tasks (Flanker/Reverse Flanker, Hearts and Flowers [HF]) and mothers' reports of EFs using the Behavior Rating Inventory of Executive Function (BRIEF) when the child was 6 and 12 years old.

Results: Longitudinal analyses showed that all children were both faster and more accurate on both Flanker/Reverse Flanker and HF with age. Fewer maternal prenatal depressive symptoms were associated with better accuracy on HF in children at 6 years of age and better EF skills as measured by the BRIEF at 6 and 12 years. Mothers' ratings of their children at 12 years indicated more executive dysfunction in children with prenatal SSRI exposure than for children without prenatal SSRI exposure, but this was no longer significant once prenatal depressive symptoms were taken into account.

Conclusion: Prenatal and later depressive symptoms, not prenatal SSRI exposure, seems to affect offspring that continues into preadolescence, highlighting the importance of long-term mental health follow-up in mothers to ensure optimal development of children's EFs and hence their optimal development in school, in social relations, and in life generally.

Objective: The Research Units in Behavioral Intervention (RUBI) Autism Network Parent Training Program is an effective behavioral parent training program for reducing child externalizing behavior and parenting stress in families of children with autism spectrum disorder (ASD). The present study examined the effectiveness, feasibility, and acceptability of a time-limited (i.e., 6-10 sessions), telehealth delivered, and community-based adaptation of the RUBI program for families of children with suspected or diagnosed ASD.

Method: Twenty-six parents started treatment, and 18 were considered treatment completers (i.e., completed a minimum of 6 sessions). To assess effectiveness, the Aberrant Behavior Checklist, Parenting Stress Index-Short Form (PSI-4-SF), and Clinical Global Impression-Improvement (CGI-I) were used. Feasibility was evaluated through therapist fidelity, Therapist-Reported Parent Objectives, session attendance, and homework completion. Parent satisfaction was measured via a post-treatment questionnaire.

Results: No significant differences were found from pretreatment to post-treatment on the ABC-2; however, there were significant reductions in the PSI-4-SF Parent-Child Dysfunctional Interaction subscale ( p < 0.05) along with reductions in the PSI-4-SF Total Stress score ( p < 0.05). Half of the treatment completers showed clinically significant improvement on the CGI-I. Overall, there were high therapist treatment fidelity, parent completed objectives, attendance, and homework completion. Furthermore, there were high approval ratings across several satisfaction categories.

Conclusion: Results provide support for the continued research and use of brief, flexible, telehealth intervention formats in community settings for children suspected of or diagnosed with ASD diagnosis and their families.

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?

Objective: Associations between perinatal posttraumatic stress disorder (PTSD) and the mother-infant relationship are increasingly recognized as a serious concern with implications for maternal and infant health; however, the existing body of literature has yet to be systematically mapped, leaving questions about current gaps and areas for future research.

Methods: Studies that included pregnant and/or postpartum (i.e., up to 12 months following delivery) individuals who reported PTSD symptoms and/or diagnosis and were assessed for at least 1 mother-infant relationship outcome during the perinatal period were considered eligible. A comprehensive search of PubMed, Scopus, Embase, CINAHL, PsychINFO, and Google Scholar was conducted. The search included studies published in English at any time before January 2024. Data extraction was performed using a standardized form developed and tested by the research team. Finally, data were summarized to address the review's research questions.

Results: The 57 included studies examined the relationship between PTSD and at least 1 dyadic process related to the mother-infant relationship during the perinatal period. Studies originated primarily from the United States, used quantitative, cross-sectional, nonexperimental methodologies, and sampled predominantly White and highly educated birthing persons. Most studies indicated an association between perinatal PTSD and the mother-infant relationship, such that women with more significant PTSD symptoms demonstrated greater mother-infant relationship difficulties.

Discussion: Findings highlight the need for longitudinal, multimethod research that integrates diverse samples and culturally informed methodologies to enhance maternal-infant relationships and mitigate intergenerational trauma.

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.