Journal of Developmental and Behavioral Pediatrics最新文献

Objectives: We sought to examine differences in caregiver-reported adverse childhood experiences (ACEs) in adolescents with and without autism and explore associations between ACEs and behavioral and emotional problems in those with ACEs.

Methods: Children were classified as having autism, another developmental disability (DD), or population comparison (POP) after a comprehensive evaluation in the Study to Explore Early Development (SEED) between 2 to 5 years of age. Caregivers of these same children completed the SEED Teen survey and answered questions about ACEs and current behavioral and emotional problems at 12 to 16 years of age.

Results: Adolescents with autism (n = 198) and other DD (n = 330) were more likely than POP (n = 330) to experience income insufficiency (29.8%, 25.2%, and 12.2%, respectively) and parental divorce (29.3%, 25.7%, and 18.4%, respectively) (all p < 0.05). Living with someone with an alcohol or drug problem was associated with conduct problems only in adolescents with autism; living in a family that received financial assistance was associated with hyperactivity problems only in adolescents with other DD. Living with anyone experiencing mental illness, suicidality, or severe depression was associated with conduct and emotional problems in all 3 study groups.

Conclusion: Families of children with atypical development may need more financial and emotional/marital support than others. Moreover, adolescents with autism and other DD could benefit from behavioral supports in response to a few specific ACEs while addressing household mental health problems could have widespread benefits that improve pediatric health. These findings can be used to encourage evidence-based programs and practices to prevent ACEs and offer supports when needed.

Objective: Health professionals participating in learning health networks collect data for informing clinical decision-making, research, and quality improvement (QI). To optimize the collection and use of clinical and Parent Reported Outcome (PRO) data for these purposes, it is important to understand the priorities of patient registry "end users" (clinicians, researchers, and patients/families).

Methods: The analysis used a sequential mixed-methods approach with parent (n = 93) and clinician (n = 167) surveys followed by targeted interviews (parent n = 9, clinician/researcher n = 7) completed at Autism Care Network (ACNet) sites to better understand current use of registry data and parent/clinician priorities.

Results: Sixty percent of parents reported receiving behavioral data regarding their child from their health provider in the past, and 90% felt these data would help them understand their child's behavior. Among data access options parents preferred an online portal (72%) and/or the clinic's electronic medical record (59%). Parents indicated willingness to complete surveys longitudinally if the assessments correlated with their child's specific areas of difficulty. Priorities for clinicians included easy access to the data (84%), meaningful connection to clinical outcomes (81%), and measures that can demonstrate change in symptoms over time (76%) and that are easy for families to complete (80%). Both groups recommend assessing parenting stress and social determinants of health.

Conclusion: Consideration of end-user priorities can improve patient registry data collection, analysis, and utilization. Families may be more willing to participate if they can receive direct benefit by accessing their own data and clinicians use this data to optimize clinical care.

Objective: To determine the performance of autism screeners at 12 and 15 months of age.

Methods: Children were screened either at 12- (n = 1473) or 15-month (n = 1227) primary care visits. Children were screened with both the Infant/Toddler Checklist (ITC) and the First Year Inventory-Lite (FYI-L) at 12 months and FYI-L and the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) at 15 months. After a positive screen and/or clinical concern, families were offered a no-cost diagnostic evaluation.

Results: Of the 1473 toddlers screened at 12 months, 223 screened positive and 107 attended a diagnostic evaluation. Of the 1227 children screened at 15 months, 252 screened positive and 94 attended the evaluation. Overall, specificity for autism was high (>0.94) for all screeners at 12 and 15 months. At 12-month screening, sensitivity for autism was low on the ITC (0.26) and moderate on the FYI-L (0.67). Positive predictive value (PPV) was low for both screeners (0.24 for ITC and FYI-L). At 15 months, both the FYI-L and the M-CHAT-R/F demonstrated moderate sensitivity (0.61 for FYI-L and 0.60 for the M-CHAT-R/F) and low PPV (0.16 for FYI-L and 0.31 for M-CHAT-R/F).

Conclusion: Although data do not support universal screening at younger ages, the study identifies tools that can be used at 12 and 15 months. Importantly, screening at these ages does not identify all cases of autism, and repeat screening at 18 months and beyond is essential to support autism detection as early as possible.

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?