Journal of Developmental and Behavioral Pediatrics最新文献

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.

Objective: Although active involvement of the caregiver is crucial in early intervention for toddlers at risk for developmental language disorders (DLD), challenges in accessing and participating in these programs often exist. Telepractice offers a potential solution to address this issue. This study aims to examine the effectiveness of an Integrated Caregiver Language Intervention Program via Telepractice (ICLIP-T).

Methods: A quasi-experimental model with a pretest-posttest format and matched control groups was used. The ICLIP-T, comprising basic language modelling strategies and environmental arrangements, was developed. The session protocol included a video analysis of strategies from previous sessions, a discussion of new strategies, and a question-answer segment. The ICLIP-T intervention was conducted with 21 dyads (study group) over a 12-week period, with each session lasting 45 minutes. The outcomes were analyzed for both caregivers and toddlers and compared with those of the 21 dyads in the control group.

Results: Significant differences were observed between the pretest and posttest language scores of toddlers in the study group, and in comparison with those of the control group. Furthermore, the study group revealed significant differences in caregivers' strategies between the pretest and posttest assessments.

Conclusion: These results suggest that the language scores of toddlers at risk for DLD improved after the implementation of ICLIP-T by caregivers. Therefore, ICLIP-T should be conducted with larger cohorts and in toddlers with varying severities of DLD to confirm its utility.

Objective: Exposure to child maltreatment is highly prevalent and associated with a myriad of adverse physical and mental health outcomes, including disordered eating (DE). However, most of this work has been limited to adults with eating disorders, and the association between maltreatment and DE specifically among youth has yet to be systematically quantified. This systematic review and meta-analysis aimed to quantify the association between child maltreatment and indicators of DE among children and adolescents.

Method: Electronic databases were searched to identify original, peer-reviewed articles. Effect sizes were calculated to quantify the association between child maltreatment (physical, sexual, emotional abuse, or neglect) and DE among youth.

Results: Across 13 studies, the odds of engaging in DE among youth who experienced child maltreatment were significantly greater than the odds of engaging in DE among youth who had never experienced child maltreatment (odds ratio = 2.16; 95% CI, 1.77-2.63; p < 0.001).

Conclusion: These meta-analytic findings indicate that youth who experience maltreatment may be vulnerable to patterns of DE during childhood/adolescence. Notable methodological limitations of these findings are discussed, and this broader field of research would benefit from methodologically rigorous future studies.

Objective: This study investigated prevalence of positive tests for COVID-19 infection and difficulties with mitigation strategies among young children with autism spectrum disorder (ASD) and other developmental disabilities (DD) compared with children from the general population (population comparison group [POP]).

Methods: Before the pandemic, children aged 2 to 5 years in the Study to Explore Early Development (SEED) completed a developmental assessment assigning them to a study group (ASD, other DD, or POP). Caregivers were recontacted in 2021 to complete a questionnaire assessing the impact of the pandemic in 2020 when children were aged 3 to 8 years. Modified Poisson regression models assessed the relationship between study group and difficulty with mitigation strategies and nasal swabbing.

Results: Caregivers of 1027 SEED participants completed the survey. Prevalence of having 1 or more positive COVID-19 tests was 3 times higher for children in the ASD and DD groups versus the POP group. In adjusted models, children in the ASD group were more likely to have difficulty with all 3 mitigation strategies and nasal swabbing compared with children in the POP group. The DD group were more likely than the POP group to experience difficulty with handwashing and physical distancing.

Conclusion: Compared with the general population, youth with ASD and DD were more likely to have at least 1 positive COVID-19 test and difficulty following mitigation strategies. These findings underscore the importance of supporting youth with ASD and DDs in anticipation of future public health emergencies and the annual respiratory disease season.

Objective: To compare a sample of pediatric primary care patients diagnosed with autism spectrum disorder (ASD) with the general clinic population, as well as associations of child and caregiver characteristics with age of diagnosis.

Method: Cross-sectional data for patients from 2 large, urban primary care practices diagnosed with ASD between March 1, 2018, and February 28, 2022, were collected from the medical record through extraction and chart review. The sample was compared with the total primary care population using χ 2 analysis. Unadjusted bivariate linear regression and multivariate linear regression were used to evaluate associations of each variable with age of diagnosis.

Results: Patients diagnosed with ASD were more likely to be male, Hispanic, publicly insured and medically complex than the general clinic population. There was also a higher maternal education level in the autism group. In unadjusted linear regression analyses, language delay, connection with Early Intervention (EI), earlier age of parental concern, earlier age of referral, having an M-CHAT completed, higher M-CHAT scores, and having a first-degree relative with ASD were associated with earlier age of diagnosis. In multivariate linear regression analysis, connection with EI, better continuity of care, higher M-CHAT scores and having commercial insurance were associated with earlier diagnosis. Race/ethnicity, language, and Social Vulnerability Index ≥ 90%ile were not significantly associated with age of ASD diagnosis.

Conclusion: This study reflects shifting prevalence patterns of ASD, but a persistent disparity in age of diagnosis among publicly insured children. It highlights the importance of developmental monitoring, continuity of care, and navigation support to help families obtain ASD diagnoses promptly.

Objective: Sleep quality and quantity are critical for preschoolers' physical, cognitive, social, and emotional development. This study examined the individual and environmental factors associated with preschoolers' sleep problems. Specifically, we investigated the direct effects of maternal parenting behavior and the indirect effects mediated by preschoolers' effortful control.

Method: A total of 774 mothers with preschool-aged children (aged 3-6 years) participated in this study. They completed a questionnaire assessing their parenting behavior, as well as their children's effortful control and sleep problems.

Results: Our analysis yielded 3 major findings. First, we found that rejecting and chaotic maternal parenting behaviors were directly associated with sleep problems in preschoolers. Second, preschoolers' effortful control mediated the relationship between positive maternal parenting behavior and preschoolers' sleep problems. Third, among the 3 dimensions of negative maternal parenting behavior, the mediating effect of effortful control was observed only in the context of chaotic parenting.

Conclusion: These results suggest that maternal negative and positive parenting behaviors may be differentially related to preschoolers' sleep problems, with the former exhibiting a more proximal association and the latter potentially linked through mediated processes. Furthermore, when home environments are unpredictable or inconsistent, preschoolers may struggle to develop appropriate behavioral regulation, which can contribute to sleep problems.

Objective: There is growing literature emphasizing the importance of early and tailored parental disclosure of an autism diagnosis to their children. While there are barriers to disclosure, most parents agree that children have a right to know of their diagnosis, with early disclosure being associated with a better quality of life and self-image. Within the literature, however, there is scarcity of populations from the United States represented in qualitative disclosure studies. With the impact of culture and location on language, this study aims to address this gap.

Method: Caregivers of children with prior diagnosis of ASD (n = 16) were recruited to participate in semistructured interviews. Blinded transcripts of interviews were used to individually create codes that were formed into themes based on consensus of the researchers through thematic analysis.

Results: Of the 16 caregivers interviewed, 14 were White and all 16 were female. Twelve caregivers reported working or volunteering in areas with high exposure to the autism community. Thematic analysis yielded 4 themes relating to diagnosis disclosure: (1) Language of Disclosure, (2) Disclosure as a Journey, (3) Purpose of Disclosure, and (4) Process of Disclosure.

Conclusion: This exploratory, qualitative study examines caregiver's perspectives on the disclosure process, strengthening the consensus with emerging literature surrounding the process of disclosure and highlighting the role language plays in the disclosure process. More specifically, the metaphors used by parents to describe autism change from generally positive euphemisms to more well-balanced and realistic metaphors that encapsulate both triumphs and struggles that accompany an autism diagnosis.