Journal of Developmental and Behavioral Pediatrics最新文献

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.

Background: Sleep disordered breathing (SDB) is more prevalent in children with Down syndrome (DS), and polysomnography (PSG) is routinely performed by 4 years of age. However, application of sensors to the scalp and midface is often poorly tolerated in this population because of behavioral and sensory sensitivities, resulting in failed studies and incomplete data.

Objective: This study aimed to explore caregiver experiences and perspectives of contactless sleep monitoring using Sonomat as an alternative to PSG.

Methods: This was a cohort study of children with DS undergoing PSG for evaluation of SDB. Caregivers completed study-specific questionnaires on their child's experiences with PSG and Sonomat (in-hospital, home). Descriptive statistics of responses are reported.

Results: Fifty-six children underwent simultaneous Sonomat and PSG monitoring, with 28 continuing home monitoring. Airflow sensors were poorly tolerated during PSG, with 30% of children unable to tolerate both nasal prongs and oronasal thermistor. All caregivers who used the Sonomat at home rated the experience positively; however, only 56% preferred it over in-lab PSG, indicating mixed preferences. Most caregivers found Sonomat easy to use, and a majority reported typical sleep patterns during home monitoring.

Conclusion: The Sonomat represents a promising contactless tool for screening sleep disordered breathing in children with Down syndrome, particularly in cases where standard PSG is not tolerated. Its ease of use and acceptability suggest value in complementing traditional diagnostics, especially in home settings.

Objective: To describe changes in household food security status among families with young children before and during the COVID-19 pandemic, when many families experienced changes in food security status because of pandemic disruptions and relief programs, and to investigate the association between household food insecurity (FI) before and/or during the pandemic and developmental milestone attainment.

Method: We used an interrupted time series design to evaluate the association between household FI and developmental milestone attainment before and during the pandemic. Our sample included US children 0 to 5 years with FI and developmental screenings prepandemic (June 2017 to February 2020) and intrapandemic (May 2020 to May 2022) in the Comprehensive Health and Decision Information System. Children with no food insecurity were compared to children with only intrapandemic (new), only prepandemic (resolved), or both intrapandemic and prepandemic (persistent) FI.

Results: We found lower developmental milestone attainment only in the persistent FI group, with significantly lower communication (adjusted difference = -0.17; 95% CI, -0.33 to -0.01) and personal-social (adjusted difference = -0.15; 95% CI, -0.30 to -0.01) scores, versus children with no FI. There were no differences in developmental milestone attainment in any domains for children with new or resolved FI compared to children with no FI.

Conclusion: Using the pandemic as a natural experiment to study how changes in household food security status are associated with development, we found that persistent, but not transient, household FI is associated with suboptimal early childhood development. To promote healthy development, pediatricians should promptly intervene to address FI and advocate for governmental programs that promote food security.

Objective: Feeding problems in typically developing children (TDCs) are quite common in early childhood and are of great concern for parents, as they significantly impact nutritional intake and overall health. This study aimed to evaluate the prevalence of feeding difficulties in typically developing children from India aged 1 to 5 years using the Kannada version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS).

Method: Data were gathered from 253 parents of typically developing children via a purposive sampling method. The parents completed a self-reported demographic questionnaire and a Kannada version of the BPFAS.

Results: The survey analyzed the responses of 124 (49%) male and 129 (51%) female children. According to the BPFAS cutoff scores, the prevalence of feeding difficulties among TDCs in the study was 28.9% (n = 73) (TFS >84) and 18.2% (n = 46) (TPS >9). Even though a higher percentage of children exhibited negative feeding behaviors, very few parents considered these behaviors problematic for them. Furthermore, analysis revealed a weak negative correlation between BMI and TFS and TPS scores (Pearson r values of -0.027 [ p = 0.669] for the TFS score and -0.049 [ p = 0.436] for the TPS score).

Conclusion: The present study reveals a higher prevalence of parent-perceived feeding issues in young, typically developing children from India. This highlights the necessity of educating Indian parents about feeding issues in young children, their potential long-term consequences, and the need for early intervention.

Objective: Neural development differs between in-utero and ex-utero environments. Length of gestational age (GA) is associated with brain development and early life neurodevelopmental outcomes, affecting both preterm and term infants. This study aimed to examine a wide range of GA and provide a more comprehensive understanding of its effects on various developmental domains.

Method: Four hundred fifty-four infants who were born at 24 to 41 weeks of GA were included in this analysis. Cognitive, language, and motor development between 8 and 30 months of age were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Associations between GA and outcomes were analyzed using linear and logistic mixed-effects models.

Results: GA was positively associated with all examined developmental domains with a small-sized effect (Pearson's correlation coefficients: 0.08-0.15; p < 0.05). After adjusting for covariates, linear mixed-effect models estimated that each additional week of GA was associated with an increase in Bayley III composite scores: cognitive (0.6 points), language (0.6 points), and motor (0.62 points). Logistic mixed-effect models showed that after adjusting for the covariates, each additional week of GA reduced the adjusted odds ratio of delay in 1 of the language subdomains (i.e., receptive communication) by 13%.

Conclusion: We found a small impact of GA on cognitive, language, and motor development across a wide range of GA. Language and its subdomains seem particularly sensitive to the effects of prematurity. Thus, regular monitoring and parent-based early intervention, especially in the language domain, are warranted for early-term and preterm infants.

Purpose: To determine whether caregiver expectation and symptoms of attention deficit/hyperactivity disorder (ADHD) were significantly associated with self-management behavior in a sample of youth and young adults with spina bifida (SB), while accounting for several other condition-related and sociodemographic factors.

Methods: Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2022 and 2023. Participants included 52 youth and young adults younger than 21 years diagnosed with SB. Caregiver report of youth and young adult self-management behavior and caregiver expectation were obtained using the Kennedy Krieger Independence Scales-Spina Bifida Version (KKIS-SB). Caregiver report of youth and young adult ADHD symptoms were obtained using the National Institute for Children's Health Quality Vanderbilt Assessment Scale-Parent Version.

Results: Caregiver expectation and symptoms of ADHD were significantly associated with self-management behaviors in youth and young adults with SB, including the ability to initiate daily self-care and home living routines independently and the ability to use prospective memory to complete tasks that are needed for good health. More ADHD symptoms were associated with poorer ratings of self-management behavior and higher caregiver expectation was associated with better ratings of self-management behavior.

Conclusion: The findings of this study suggest that caregiver expectations and co-occurring neurocognitive challenges may be influential when considering self-management behaviors in youth and young adults with SB. Family-based interventions that target caregiver perceptions and behaviors and provide psychoeducation about neurocognitive challenges as they relate to self-management behaviors may be an important target for future research.