Journal of Developmental and Behavioral Pediatrics最新文献

Case: Andrew is a 12-year-old boy living in Southeast Asia with autism spectrum disorder (minimally verbal), who first presented with new symptoms of low mood and anhedonia during the COVID pandemic. This was associated with loss of appetite, which culminated in him eventually refusing to eat any food or swallow any liquids (including saliva). He would hold his saliva in his mouth in the daytime and refused to swallow. He would spit out the saliva when instructed to do so. Because of his worries about swallowing his saliva involuntarily during sleep, he also experienced insomnia. If he managed to fall asleep, he would involuntarily swallow his saliva.Three months from his initial symptoms, he was relocated by his family, to another southeast Asian country for specialty care. At this time, he also refused to speak. He went from intermittently accepting some foods, to being completely averse to any food or fluid intake. He was diagnosed with avoidant restrictive food intake disorder. Because of his acute refusal to eat or drink, a nasogastric tube was inserted and subsequently a gastrostomy tube for enteral nutrition. With this intervention, he was able to maintain good weight and nutrition.Simultaneously, he began treatment in a multidisciplinary feeding and nutrition program. Genetic testing done for concerns of neurological regression yielded a variant of unknown significance. He also began an anti-depressant and sleep medication.During this period, he returned to his country of origin and was no longer able to receive direct in-person specialty feeding support, but did have a dedicated caregiver. He was seen once every few months either in-person or by telehealth by the multidisciplinary feeding and nutrition clinic in the second country. His caregiver was taught to implement behavior strategies with a goal of him resuming oral food intake eventually.What factors should be considered when evaluating a child with co-existing neurodevelopmental and psychiatric conditions, who completely stops eating or drinking in the midst of a global pandemic? What feeding approach would be helpful in managing a complex case like this? What feeding interventions can be actualized at home to reintroduce solids? How did the pandemic impact access to services?

Objective: Suicide is the second leading cause of death for adolescents. Children in surgical clinics have diagnoses that may predispose mental health challenges. This study explored associations between demographics, diagnoses, and suicide risk screenings in the outpatient pediatric surgical setting.

Methods: A database of suicide risk screenings administered across a pediatric surgical health care system from 2019 to 2023 was analyzed. Demographic variables and diagnoses were collected, and multilevel logistic regression models calculated odds ratio (OR) and 95% confidence interval (CI) for the relationships.

Results: In total, 79,384 suicide risk screenings were collected for 50,796 patients. 5.6% (n = 4476) were positive for suicidal thoughts. Asians were less likely to screen positive (OR, 0.65; 95% CI, 0.56-0.76), and females were more likely (OR, 1.92; CI, 1.80-2.05). Patients with Medicaid or uninsured were more likely to screen positive (OR, 1.47; CI, 1.38-1.57 and OR, 1.17, CI, 1.002-1.36, respectively). As affluence increased, there was decreased likelihood of positive screens (OR, 0.93; CI, 0.91-0.96). The diagnosis most associated with increased risk was mental, behavioral, and neurodevelopmental disorders (OR, 3.41; CI, 2.92-3.97), followed by pain (OR, 1.88; CI, 1.71-2.05), burns (OR, 1.43; CI, 1.21-1.69), and scoliosis (OR, 1.10; CI, 1.02-1.17).

Conclusion: When screening for suicide risk in outpatient pediatric surgical subspecialty clinics, females and patients with Medicaid or uninsured have increased risk of screening positive for suicidal ideations. Youth with mental, behavioral, and neurodevelopmental disorders were most at risk, followed by pain, burns, and scoliosis. It is important to understand how these factors influence mental health to aid in providing resources for at-risk patients.

Objective: The aim of this study was to determine the effect of fathers' participation in complementary feeding on the occurrence of parent-reported behavioral feeding problems in infants.

Method: Both parents in the intervention group and mothers in the control group were trained for 20 minutes in accordance with the national complementary feeding guideline. Behavioral feeding status were evaluated by Behavioral Pediatrics Feeding Assessment Scale.

Results: The frequency of fathers engaged in infant feeding increased in the intervention group compared with in the control group at the follow-ups ( p < 0.05), respectively. The frequency of behavioral feeding problems at 9th and 12th months in the intervention group was 44.7% and 18.8%, respectively, compared with 79.5% and 65% in the control group ( p < 0.05). Problems related to the attitudes of fathers during feeding in the intervention group were lower than the control group. The Behavioral Pediatrics Feeding Assessment Scale scores in the intervention group were 54.36 ± 6.82 and 53.31 ± 6.62 for fathers, while they were 62.54 ± 6.69 and 61.28 ± 7.73 for fathers in the control group, at the 9th and 12th months, respectively ( p < 0.01).

Conclusion: Training and engaging fathers on complementary feeding positively affects the feeding attitudes and behaviors of parents and reduces early behavioral feeding problems in infants.

Objective: Children with higher adverse childhood experiences (ACEs) experience more severe parent-reported attention-deficit/hyperactivity disorder (ADHD). Positive childhood experiences (PCEs) help to build resilience and mitigate the impact of ACEs on ADHD. Prior studies have measured the 2 constructs as independent factors, but no research has examined their combined influence on children with ADHD. The first aim was to categorize children with different levels of parent-reported ADHD severity into classes based on shared characteristics of ACE and PCE promoters. The second aim was to examine the relationship between the classes and ADHD severity.

Methods: Participants included children 6 to 17 years with data on the 2019 National Survey of Children's Health ADHD severity questionnaire (n = 19,715; weighted n = 49,149,269). Latent class analysis (LCA) identified subgroups of children experiencing patterns among PCE promoters and ACEs, which were measured as independent variables in an adjusted ordinal regression model to estimate their composite effects on ADHD severity.

Results: Using LCA, one class belonging to children with low ACEs and high PCE promoters (class 1) and another belonging to children with high ACEs and low PCE promoters (class 2) were identified. Class 2 was 2.2 times more likely to have more severe ADHD (aOR 2.2; 95% confidence interval, 1.8-2.6).

Conclusion: Findings suggest ACEs and PCE promoters do not operate independently; children with high ACEs had low PCE promoters and had more severe parent-reported ADHD. Clinicians should consider actively screening for the presence of ACEs and PCEs in all children, especially those with high ADHD severity, and build strong alliances with families.

Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and a common presenting concern in primary and developmental pediatric care. However, objective diagnostic tools are currently not available, leading to delayed and missed diagnoses. The current systematic review aimed to determine whether objective indices can serve as diagnostic markers for pediatric ADHD.

Method: We conducted a systematic review of objective behavioral, neurobiological, and genetic biomarkers that could inform a precision medicine approach to diagnosis of pediatric ADHD. Following the PRISMA guidelines, we searched three major databases (MEDLINE, PsycInfo, and Scopus) for articles published between 2012 and 2024 that evaluated diagnostic biomarkers with a translational aim.

Results: A total of 111 studies met inclusion criteria, including 42 behavioral, 44 neuroimaging, and 25 genetic studies. Among behavioral studies, measures of physical activity achieved discriminant validity in the good to excellent range. Neuroimaging biomarkers were strongest when machine learning and multiple-features models were used. A particularly promising direction involved task-based NIRS paradigms targeting cognitive control. The results of the genetic studies underscored the complexity of the genetic architecture of ADHD, implicating rare and common variants, as well as epigenetic mechanisms. MicroRNA and methylation profiles demonstrated the strongest accuracy, overall.

Conclusion: Our systematic review identified promising candidate diagnostic markers for ADHD across behavioral, neuroimaging, and genetic methods. Multimethod approaches are likely to yield the strongest diagnostic accuracy. The complexity and cost of these approaches limits potential for implementation of a precision medicine approach to pediatric ADHD diagnosis in primary care settings.

Objective: The current study assesses the impact of an educational program designed to train primary care clinicians (PCCs) to diagnose children between age 18 and 36 months at high risk for autism spectrum disorder (ASD).

Methods: Two cohorts of PCCs completed an 8-session training over a 9-month period. Clinicians were surveyed at baseline and 3 months after training completion. Information was collected regarding PCCs knowledge of ASD, their diagnostic beliefs, and perceived comfort and competence regarding all aspects of an ASD diagnostic evaluation.

Results: A total of 35 participants completed training, and 29 (82%) completed presurvey and postsurvey. At baseline, 89% of PCCs reported no additional training in developmental behavioral pediatrics or diagnosing children with ASD, although 31% had diagnosed a child with ASD in the past year. After training, PCCs reported significantly greater comfort diagnosing ASD in children between age 18 and 36 months with mild ASD (2.31 vs 3.02, p < 0.0001), moderate ASD (3.03 vs 3.83, p < 0.001), and severe ASD (3.45 vs 4.34, p < 0.0001). PCCs also reported a significant increase in their knowledge and perceived competence in completing an autism evaluation, including taking an autism history, completing a structured observation, scoring the Childhood Autism Rating Scale-Second Edition, writing a letter of medical necessity, and discussing findings with families.

Conclusion: After training, PCCs reported a significant improvement in their knowledge, comfort, and competence regarding all aspects of diagnosing young children 18 to 36 months of age at high risk of ASD. PCCs can help to improve access to services for young children at risk for ASD.

Objective: Identify training priorities for primary care clinicians who commit to a minimum of 300 hours of training in developmental-behavioral pediatrics (DBP mini-fellows).

Methods: Eight mini-fellows from 13 DBP fellowship training programs funded by the Health Resources and Services Administration participated in a focus group discussion of training priorities (round 1) resulting in 105 potential priorities. One faculty member from each funded program (13 faculty) and all 14 mini-fellows in Spring, 2024 were invited to complete a survey to rate the importance of each of 105 suggested priorities on a 9-point Likert scale (round 2). Training priorities rated as 6 or higher by 60% of mini-fellows and/or faculty were retained for the round 3 survey, which included the mean score on the item from mini-fellows and faculty and asked the group to rate the items on the 9-point Likert scale considering the round 2 ratings. Items in round 3 with a median score of at least 7 and a 25th percentile score of at least 6 were categorized as consensus training priorities.

Results: In round 2, 68 of 105 items met criteria to advance. In round 3, 46 of these 68 qualified as consensus training priorities. Many priorities related to care for children with autism spectrum disorder, attention-deficit hyperactivity disorder, and/or systems-based practice. Seven items not rated as consensus priorities by the full group, did meet criteria among mini-fellows.

Conclusion: This study identified high priority topics for training mini-fellows that can provide foundational guidance for developing mini-fellow training curricula.

Objective: The purpose of this study was to explore developmental behavioral clinicians' (DBP) perspectives on transitions between education programs for children age 8 and younger with developmental disabilities.

Method: We used a qualitative descriptive design to systematically gather and analyze DBP clinicians' perspectives. Most of the 25 participants were members of the Society for Developmental and Behavioral Pediatrics (SDBP). Interviews were conducted between June and October, 2022. Audio recordings of the interviews were transcribed. We used MAXQDA software for thematic analysis.

Results: We organized categories regarding barriers and facilitators of educational transitions according to the child and family and broader community levels and identified four major themes: (1) acknowledging that families play critical roles in education transitions; (2) communicating effectively at the intersections of the families and education and health care systems; (3) helping families navigate health and education systems and make education transitions; and (4) overcoming systems-level issue.

Conclusion: Organizational and systemic barriers often impede DBP clinicians' ability to be involved with education transition activities. Education transitions often exacerbate underlying inequities in access to assessment, care, and outcomes among children with developmental disabilities from historically minoritized populations. Our data prompted us to propose a new framework that features the intersections among child and family, health care, and education teams. We found innovative ways for coordinating education transitions by cultivating relationships among children and families and professionals in health care and education systems.