Journal of Developmental and Behavioral Pediatrics最新文献

Objective: To describe clinician attitudes and practices regarding discussions about race-related topics with families of children aged 0 to 5 years.

Methods: The authors distributed a survey to the Reach Out and Read (ROR) medical provider network to assess clinicians' prior education, attitudes and clinical practice discussing the impact of racism on child health, racial identity formation, and development of ethnic-racial pride. The authors report item response frequencies with a sub-analysis of respondent race, ethnicity, level of training, and practice region and setting.

Results: Six hundred fifty-two surveys with 80% or more completion rate were analyzed. Over 90% of respondents agreed that racism affects child health. Although most agreed that clinicians have a role in discussing the impact of racism on a child's health, racial identity formation, and development of ethnic-racial pride with families, the majority did not regularly do so. Barriers included lack of time and education, clinician discomfort, and fear of damaging the therapeutic relationship. Many agreed that receiving education about these topics was very important, but fewer than 25% had prior education or knew of resources. Nearly 90% agreed that books and ROR can support these discussions; 79% were interested in additional ROR training.

Conclusion: Although surveyed clinicians agree that they have a role in discussing race-related topics with families with infants and young children, they do not feel equipped to have these discussions. Pediatricians are interested in incorporating culturally diverse, developmentally appropriate books, and ROR to discuss issues related to race.

Objective: Describe the engagement of opioid-exposed infants (OEI) with recommended developmental surveillance and supports in the first year of life.

Methods: We conducted a single-site retrospective cohort study of OEI delivered between 2016 and 2021, linking birth hospitalization, developmental follow-up (DFU) clinic, and early intervention (EI) records. Primary outcomes were attendance at DFU clinic and evaluation by EI. We used multivariable modified Poisson regression to examine how birthing parent-, infant-, and clinic-level factors are associated with service engagement.

Results: Of 256 OEI, 75% engaged in at least 1 developmental service. Referral and attendance rates at the DFU clinic were 69% and 33%, respectively. Ninety-three percent were referred to EI, 73% evaluated and 58% enrolled in services. EI evaluation was positively associated with prolonged infant hospitalization (adjusted risk ratio [aRR] 1.01; CI, 1.002-1.01) and exposure to antidepressants (aRR 1.23; CI, 1.02-1.49) and cocaine (aRR 1.28; CI, 1.09-1.50). Probability of attendance at DFU was higher for infants born to parents receiving care at an integrated perinatal substance use clinic (aRR 2.13; CI, 1.07-4.24) and exposed to antipsychotics (aRR 1.73; CI, 1.12-2.67), whereas those remaining in parental custody had lower probability of engagement (aRR 0.62; CI, 0.39-0.97).

Conclusion: Three-quarters of the OEI engaged in developmental surveillance services in the first year of life. Factors relating to disease severity, location of birthing parent care, birthing parent co-exposures, and parental custody were associated with engagement. Efforts to improve engagement in recommended follow-up should elicit the perspectives of caregivers to better understand the mechanisms that drive these differences.

Objective: Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

Methods: Data were extracted from patient medical records of a primary care clinic for children in foster care between January 1, 2018, and December 31, 2021. Cox proportional hazards regression generated hazard of positive developmental delay screening using the Ages and Stages Questionnaire-3 among those who with and without PSE controlling for sex, race, ethnicity, prematurity, caregiver type, as well as interaction between PSE and prematurity and PSE and race.

Results: The sample included 975 patients. 60.4% had PSE, and 62.6% had a positive developmental delay screening at least once. 52.9% were male, and 45.5% were White. Those who had PSE but were nonpremature had 1.14 (95% confidence interval, 1.01-1.29) times the hazard of positive developmental delay screening compared with those without PSE and prematurity. However, those with PSE and prematurity had 2.01 times the hazard of positive developmental delay screening than those without either condition.

Conclusion: Children in foster care with PSE are at risk for positive developmental delay screening compared with those without; however, those with both PSE and prematurity are at extra risk. This interaction should be considered when making inferences regarding developmental delay screening in this population.

Objective: The authors aimed to understand the experience of parents and caregivers during COVID-19, including the challenges they faced and what helped them cope using the Strengthening Families (SF) Approach and Protective Factors Framework's five factors: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children.

Methods: The Family Snapshot Survey was developed to assess the impact of COVID-19 on family life, including items for quantitative analysis and 2 open-ended responses. This national survey of 9000 parents recruited from an opt-in internet panel was conducted in 3 waves of 3000 in November 2020, February 2021, and July 2021 using the online YouGov platform. The 2 open-ended responses are analyzed here using qualitative thematic analysis based on the SF Approach and Protective Factors Framework for caregivers with children aged 0 to 5 years.

Results: The SF factors were used to classify 770 responses, with many responses identified as containing multiple factors, representing their interrelated nature. A lack of concrete support was the most frequent challenge, and parental resilience was the most frequent support.

Conclusion: Access or lack of access to concrete support in times of need underscored many of the strengths and challenges, respectively. Participants described interactions between individual protective factors that allowed for safety, stability, or positive experiences. In future community policy creation, policymakers may look at how programs interact and allow families to access multiple protective factors at once, with a critical need for providing these concrete supports.

Objective: This study focused on in-home use of a tele-assessment tool for autism diagnosis in young children, the TELE-ASD-PEDS (TAP). Psychometric properties, caregiver experiences, and perceptions of feasibility were examined among families likely to experience barriers to in-person evaluation.

Methods: One hundred eighty-two children between 18 and 42 months of age were recruited because of positive screening, primary care concerns, or early intervention referral. All participants completed initial tele-assessment including the TAP. Approximately 2 weeks later, a second visit was conducted: 92 were randomized to a repeat TAP administration by telehealth and 90 were randomized to an in-person evaluation. Caregivers completed surveys regarding challenges with technology and satisfaction with telehealth assessment.

Results: Overall, 77% of the sample was diagnosed with autism spectrum disorder (n = 140). There were few diagnostic disagreements (n = 10, 6%) between initial and second evaluations, with disagreements equally distributed between second visit type. Diagnostic outcomes (autism vs no autism) agreed between telehealth and in-person evaluation for 94% of cases, kappa = 0.82. Outcomes agreed between 2 telehealth visits for 94% of cases, kappa = 0.84. Test-retest reliability of total TAP scores across 2 administrations was strong, intraclass correlation coefficient = 0.85. Very few caregivers reported challenges with technology during telehealth appointments (<6%); 92% reported that there was nothing they would change about the telehealth visit. Examiners also reported high satisfaction with telehealth assessments.

Conclusion: In-home use of the TAP is valid, reliable, feasible, and acceptable to caregivers. Findings support the continued use of telehealth assessment for autism in toddlers, which can reduce disparities in access to timely diagnostic services.

Objective: This study aimed to investigate the relationship between infants' negative affect and problem-solving skills, along with the moderating role of mothers' perceived social support.

Methods: The sample consisted of 110 infants (49% females) and their mothers, who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study at 2 time points: T1 (peripartum period, from late second trimester to 6 months postpartum) and T2 (when the infants were 8-10 months old). We used the Face-to-Face Still-Face (FFSF) procedure as an observational task to assess infant negative affect (T2) and maternal reports of their perceived social support (T1 and T2) and infants' problem-solving skills (T2). Spearman correlations and moderation analysis with PROCESS macro were performed in SPSS, controlling for maternal education, maternal age, maternal mental health (depression and anxiety at T1 and T2), and child sex.

Results: We found that infant negative affect was positively ( b = 1.88, p = 0.045) associated with problem-solving after controlling for other variables, whereas there was no evidence for a relationship with mothers' perceived social support ( b = 0.73, p = ns). Notably, in testing the interaction between negative affect during FFSF and social support ( b = 1.13, p = 0.001), the findings reveal more optimal problem-solving skills in infants whose mothers reported at T1 moderate ( b = 2.98, p = 0.003) or high ( b = 4.11, p = 0.001) social support. There was no evidence of a moderating role of mothers' perceived social support at T2 ( b = 0.32, p = ns).

Conclusion: Results show that infant negative affect may reflect their capacity for problem-solving and that bolstering social support for perinatal women may enhance their infants' problem-solving abilities. Findings highlight that children's negative affect in stressful situations, such as the FFSF context, may serve as a coping mechanism and offer new insights into the intergenerational transmission of resilience.

Case: Jaxon is a healthy 12-year-old boy who is referred to your clinic for medication management. He was diagnosed with ADHD using a validated questionnaire at age 9 years. He is currently prescribed OROS methylphenidate 54 mg capsules once daily in the morning, which he has taken for 3 years. This has generally worked well to improve his attention, focus, task persistence, and task completion. However, his parents now report increasing disruptive behaviors over the past 18 months, both at home and at school. There have been no major stressors over this period nor significant life changes or trauma in Jaxon's history.Jaxon's teachers report that although he remains in his seat, he constantly "squirms" and moves about. He also makes quick, jerky movements with his hands several times each class period. They report no specific trigger or activity for when this movement occurs, but report it being more intense when Jaxon is working hard to concentrate and stay focused. His mother also reports noticing the frequency increase if Jaxon thinks he is in trouble or when he is very excited (e.g., when he is playing video games). His parents share home videos to support these concerns.His teachers report problems with attention, fidgeting, and talking out of turn. They also report that his movements distract and disrupt the class. These reports are most often from his afternoon classes. Academically, he is doing well. He turns in most of his work, but his grades have dropped this semester. His teacher reports that he seems to lack the focus to complete his assignments and he rushes through them to go to the next activity.When you talk to Jaxon, he reports that he likes school, but he does not like how often he gets into trouble. He admits he gets embarrassed during quiet time when his hands randomly "move without me moving them."When observing Jaxon, you notice that he fidgets in his seat, often moving his hands over anything that is holding his attention (toys, papers). He is also verbally impulsive, interrupting the discussion with his mother multiple times during the visit. Twice, you witness a brisk single jerk of his right hand. It originates at the wrist and rotates away from his body with his hand closed. There was no accompanying vocalization with this movement.His parents are requesting a medication adjustment or change. What would you do?

Case: KM is an 11-year-old autistic boy followed by a developmental-behavioral pediatrician (DBP) practicing within a multidisciplinary autism center. He had been prescribed various attention-deficit hyperactivity disorder (ADHD) medications over the years, most recently dextroamphetamine-amphetamine extended-release capsule 10 mg daily.KM initially presented to the DBP for diagnostic confirmation of autism and ADHD at the age of 7 years. His school had conducted a detailed evaluation the year prior, indicating skills in the borderline range for cognitive, adaptive, and language functioning. Based on his developmental history, physical examination, review of school-based testing, and parent- and school-completed standardized questionnaires, he met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for autism spectrum disorder and ADHD with combined presentation.When KM was between the ages of 8 and 10 years, he trialed several medications, including methylphenidate (which led to emotional lability), dextroamphetamine sulfate oral solution (which caused irritability), and clonidine (which led to destructive behavior). Notably, KM's parents were divorced and had differing opinions and experiences surrounding the efficacy and tolerability of his medications, which made medication trials more complex. He eventually was stabilized on extended-release dextroamphetamine-amphetamine at the age of 9 years, which both parents agreed was helpful for improving attention, despite the medication triggering a new self-injurious behavior of punching himself.At the age of 10 years, after 1 year of stability on dextroamphetamine-amphetamine extended-release capsule 10 mg daily, his parents chose not to refill the medication, to see whether it was still helpful for him. They observed that he seemed much "happier" with improved mood and decreased anxiety when dextroamphetamine-amphetamine was withheld; however, they did note worsened hyperactivity. A few weeks later, he began demonstrating increased symptoms of anxiety such as somatization and externalizing behaviors. This included frustration, aggression, and oppositionality, especially in anticipation of and/or when confronting anxious stimuli.His neuropsychologist and DBP collaborated to create a behavior monitoring plan to help his parents clarify and track his symptoms across households, with the goal of monitoring symptom severity and differentiating ADHD from anxiety-related symptoms. Because of this, his parents identified hyperactivity and impulsivity as KM's most problematic symptoms; therefore, dextroamphetamine-amphetamine extended-release 10 mg daily was restarted. Although this was effective for his hyperactivity, ongoing monitoring suggested that his anxiety symptoms continued to be clinically significant. The DBP consulted a psychiatrist who advised a trial of escitalopram in conjunction with dextroamphetamine-amphetamine. Several weeks after sta

Abstract: Qualitative design can be an integral method for developmental and behavioral pediatric (DBP) researchers to understand and better comprehend participant experiences. Qualitative methods are meant to be flexible, iterative, and collaborative, allowing the research team to learn through the data collection process as they connect with and gain insight from participants, or those with lived experience of the phenomenon. Even so, guidance is unclear on how to rigorously and thoughtfully implement these methods within DBP. This article aims to use common qualitative reporting guidelines to advise early career researchers on how to use qualitative design from study conception to results dissemination through a study case example in DBP.