To evaluate whether autonomic nervous system (ANS) reactivity modifies the relation between family stress, and physical and mental health, and functional impairment for children with sickle cell disease.
Thirty-eight 5-to 8-year old children with sickle cell disease completed a 20-minute ANS reactivity protocol measuring respiratory sinus arrhythmia and pre-ejection period during comparison and challenge tasks in social, cognitive, sensory, and emotion domains. Domain-specific reactivity was calculated as the difference between challenge and comparison tasks; overall reactivity was calculated across domains as the mean of the difference scores. ANS profile scores combined the overall respiratory sinus arrhythmia and pre-ejection period reactivity scores. Caregivers completed measures of family stress, child physical and mental health symptoms, and functional impairment.
Family stress was associated with child functional impairment whereas overall and cognitive ANS reactivity was associated with co-morbid internalizing and externalizing mental health symptoms. Interaction models showed that children with the classic ANS profile (parasympathetic inhibition and sympathetic activation) in the cognitive and emotion domains were most vulnerable to the effects of stress, with more functional impairment and injuries when family stress was high, controlling for age, sex, and parent education.
The costs to patients and families in diminished quality of life and to the health care system could be reduced by further exploration of strategies to identify children with sickle cell disease who are most vulnerable under conditions of high family stress and heightened psychobiologic reactivity.
stress reactivity; autonomic nervous system; sickle cell disease; pediatric chronic condition; child functional impairment; hemoglobinopathies
Sensory over-responsivity (SOR) refers to an exaggerated, intense, or prolonged behavioral response to ordinary sensory stimuli. The relationship of SOR to psychiatric disorders remains poorly understood. The current study examined the SOR construct within typically developing children with clinically significant anxiety, including the prevalence and course of SOR symptoms and relationship between SOR symptoms, demographic factors, and psychopathology.
Children presenting at an anxiety specialty clinic (n = 88) completed a psychiatric diagnostic assessment, which included parent-report measures of SOR, anxiety, obsessive-compulsive disorder (OCD), and global behavior and child-report measures of anxiety, depression, and OCD.
SOR symptoms were very common: 93.2% were bothered by at least one tactile or auditory sensation, and the mean number of bothersome sensations was 9.2 (SD = 7.4). SOR symptoms were reported to be “moderately bothersome” on average and to onset at an early age. Sensory Over-Responsivity Inventory (SensOR) scores did not differ by psychiatric disorder diagnosis, but SensOR scores significantly correlated with measures of obsessive compulsive disorder (OCD) and depression. Higher SensOR scores were associated with greater global impairment.
A high rate of SOR symptom occurrence was observed in this sample of children seeking anxiety treatment, suggesting that SOR may not be entirely independent of anxiety and may be closely associated with OCD. Future research on the validity and nosology of SOR using psychiatric samples is warranted.
sensory; anxiety; obsessive compulsive disorder; depression; psychopathology
Caregiver involvement is critical to ensuring optimal adolescent asthma management. The study investigated whether Multisystemic Therapy (MST), an intensive, home-based family therapy, was superior to family support for changing beliefs regarding asthma-related positive parenting among caregivers of African-American youth with poorly controlled asthma. The relationship between parenting beliefs and asthma management at the conclusion of the intervention was also assessed.
A randomized controlled trial was conducted with 167 adolescents with moderate to severe persistent, poorly controlled asthma and their primary caregivers. Families were randomly assigned to MST or FS, a home-based family support condition. Data were collected at baseline and seven month post-test. Changes in caregiver ratings of importance and confidence for engaging in asthma-related positive parenting were assessed via questionnaire. Illness management was assessed by the Family Asthma Management System Scale (FAMSS).
Participation in MST was associated with more change in caregiver beliefs as compared to FS for both importance (t =2.39, p=.02) and confidence (t =2.04, p=.04). Caregiver beliefs were also significantly related to youth controller medication adherence at the conclusion of treatment (importance: r=.21, p=.01; confidence: r=.23, p=.004).
Results support the effectiveness of MST for increasing parental beliefs in the value of asthma-related positive parenting behaviors and parental self-efficacy for these behaviors among families of minority adolescents with poorly controlled asthma.
Asthma; Self-Management; Adolescents
To evaluate the effectiveness of the PLAY Project Home Consultation (PLAY) model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASD) compared to CS only.
Children (N=128) with autism or PDD-NOS (DSM IV criteria), 2 years-8 months to 5 years-11 months, recruited from five disability agencies in four U.S. states, were randomized in two one-year cohorts. Using videotape and written feedback within a developmental framework, PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/language and occupational therapy and public education services. Primary outcomes included change in: parent and child interactions; language and development; and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression; and home consultant fidelity. Data were collected pre and post intervention.
Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group though functional development improved significantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers’ stress did not increase; depressive symptomatology decreased. Home Consultants administered the intervention with fidelity.
PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parent stress/depression. ADOS findings must be interpreted cautiously as results do not align with clinical experience. PLAY offers communities a relatively inexpensive, effective intervention for children with ASD and their parents.
developmental outcomes; early intervention; parent-child relationship; parent-mediated intervention
Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non-Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis.
We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typically-developing Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an ASD diagnosis. Focus groups and interviews were audio-recorded, transcribed and independently coded. Coded data were analyzed using thematic analysis.
Many Latino families in the study had not heard of ASD or had little information about it. Families sometimes assumed ASD red flags were normal or could be attributed to family dysfunction. Families also had concerns about provider communication and access to language services. Having a child with a developmental delay was associated with embarrassment, rejection, and family burden, making it difficult for parents to raise developmental concerns with providers.
Pediatric providers should not assume that Latino parents have heard of ASD or know its symptoms. Providers should be aware that parents may be reluctant to mention concerns due to cultural factors. The health care system needs to improve resources for Latino parents with limited English proficiency. Policies should encourage the use of developmental screening in primary care.
Autism Spectrum Disorder; Delayed Diagnosis; Hispanic Americans; Health services accessibility; Qualitative Research
Only one-third of U.S. adolescents with depression obtain treatment for depression. Teen and parent barriers differ, but both contribute to low treatment rates. Primary care providers (PCPs) may be able to elicit and address such barriers, but little is known about their perceptions of teen and parent barriers, and whether they recognize these differences.
We administered a survey to 58 PCPs assessing their perceptions of the importance of specific barriers to depression care for teens and parents using McNemar’s test to examine differences.
Most PCPs believed barriers for parents included difficulty making appointments, worry about what others would think, and cost. PCPs believed barriers for teens included not wanting treatment and worry about what others would think. PCPs believed parents and teens differed in the extent to which they would perceive cost, difficulty making appointments, and not wanting care as a barrier (ps<.001).
PCPs recognize teens and parents have different barriers to care, but may have discordant perceptions of the importance of certain barriers for teens and their parents. PCPs may need to probe parents and teens individually about barriers which impede depression care to enhance shared decision making and treatment uptake.
primary health care; depressive disorder; adolescent
To assess self-perceptions of social behavior among children treated for a
brain tumor and comparison children. To investigate group differences in the accuracy of
children’s self-perceptions as measured by discrepancies between self and peer
reports of social behavior and to understand if these phenomena differ by gender.
Self and peer report of social behavior were obtained in the classrooms of 116
children who were treated for an intracranial tumor. Social behaviors were assessed
utilizing the Revised Class Play (RCP) which generates indices for 5 behavioral
subscales: Leadership-popularity, Prosocial, Aggressive-disruptive, Sensitive-isolated,
and Victimization. A child matched for gender, race, and age, was selected from each
survivor’s classroom to serve as a comparison. Abbreviated IQ scores were
obtained in participants’ homes.
Relative to comparison children, those who had undergone treatment for a brain
tumor overestimated their level of Leadership-popularity and underestimated levels of
Sensitive-isolated behaviors and Victimization by peers. Female survivors were more
likely to underestimate Sensitive-isolated behaviors and Victimization than male
Following treatment for a brain tumor, children (particularly girls) may be
more likely to underestimate peer relationship difficulties than healthy children. These
discrepancies should be considered when obtaining self-report from survivors and
developing interventions to improve social functioning.
pediatric; brain tumor; self-perception; self-report; social behavior
Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. These children are considered to have achieved ‘optimal outcomes’ (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA)
The current study examined intervention histories in 34 individuals with OO and 44 individuals with HFA (currently ages 8-21), who did not differ on age, sex, nonverbal IQ or family income. Intervention history was collected through detailed parent questionnaires.
Children in the OO group had earlier parent concern, received earlier referrals to specialists, and earlier and more intensive intervention than those in the HFA group. Substantially more OO children received Applied Behavior Analysis (ABA) therapy than HFA children, although the intensity of ABA did not vary between groups. Children in the HFA group were more likely to have received medication, especially anti-psychotics and anti-depressants. There were no group differences in the percent of children receiving special diets or supplements.
These data suggest that OO individuals generally receive earlier, more intense interventions and more ABA, while HFA individuals receive more pharmacologic treatments. While the use of retrospective data is a clear limitation to the current study, the substantial differences in reported provision of early intervention, and ABA in particular, are highly suggestive and should be replicated in prospective studies.
autism spectrum disorder; optimal outcomes; intervention history; medication
Past research is inconsistent in the stability of autism spectrum disorder (ASD) diagnoses. The authors therefore sought to examine the proportion of children identified from a population-based surveillance system that had a change in classification from ASD to non-ASD and factors associated with such changes.
Children with a documented age of first ASD diagnosis noted in surveillance records by a community professional (n = 1392) were identified from the Autism and Developmental Disabilities Monitoring Network. Children were considered to have a change in classification if an ASD was excluded after the age of first recorded ASD diagnosis. Child and surveillance factors were entered into a multivariable regression model to determine factors associated with diagnostic change.
Only 4% of our sample had a change in classification from ASD to non-ASD noted in evaluation records. Factors associated with change in classification from ASD to non-ASD were timing of first ASD diagnosis at 30 months or younger, onset other than developmental regression, presence of specific developmental delays, and participation in a special needs classroom other than autism at 8 years of age.
Our results found that children with ASDs are likely to retain an ASD diagnosis, which underscores the need for continued services. Children diagnosed at 30 months or younger are more likely to experience a change in classification from ASD to non-ASD than children diagnosed at 31 months or older, suggesting earlier identification of ASD symptoms may be associated with response to intervention efforts or increased likelihood for overdiagnosis.
autism; diagnostic stability; screening
To provide recent estimates of the prevalence of Tourette Syndrome among a nationally representative sample of US children, and to describe the association of Tourette Syndrome with indicators of health and functioning.
Data on 65,540 US children aged 6–17 years from the 2011–2012 National Survey of Children s Health were analyzed. Parents reported whether a health care provider had ever told them their child had Tourette Syndrome or other neurobehavioral or chronic health conditions, and whether their child had current Tourette Syndrome.
Based on parent report, 0.19% of US children had Tourette Syndrome; the average age of diagnosis was 8.1 years. Children with Tourette Syndrome, compared to those without, were more likely to have co-occurring neurobehavioral and other health conditions, meet criteria for designation as having a special health care need, receive mental health treatment, have unmet mental health care needs and have parents with high parenting aggravation and parents who were contacted about school problems; they were less likely to receive effective care coordination or have a medical home. After controlling for co-occurring neurobehavioral conditions, the findings on parents being contacted about school problems and children having unmet mental health care needs were no longer significant.
TS is characterized by co-occurring neurobehavioral and other health conditions, and poorer health, education and family relationships. The findings support previous recommendations to consider co-occurring conditions in the diagnosis and treatment of Tourette Syndrome. Future research may explore whether having a medical home improves outcomes among children with Tourette Syndrome.
Epidemiology; prevalence; health care; comorbidity; parenting
This article has supplementary material on the Web site: www.jdbp.org.
Most infants become settled at night by 3 months of age, whereas infants not settled by 5 months are likely to have long-term sleep-waking problems. We assessed whether normal infant development in the first 3 months involves increasing sleep-period length or the ability to resettle autonomously after waking in the night.
One hundred one infants were assessed at 5 weeks and 3 months of age using nighttime infrared video recordings and parental questionnaires.
The clearest development was in sleep length; 45% of infants slept continuously for ≥5 hours at night at 3 months compared with 10% at 5 weeks. In addition, around a quarter of infants woke and resettled themselves back to sleep in the night at each age. Autonomous resettling at 5 weeks predicted prolonged sleeping at 3 months suggesting it may be a developmental precursor. Infants reported by parents to sleep for a period of 5 hours or more included infants who resettled themselves and those with long sleeps. Three-month olds fed solely breast milk were as likely to self-resettle or have long sleep bouts as infants fed formula or mixed breast and formula milk.
Infants are capable of resettling themselves back to sleep in the first 3 months of age; both autonomous resettling and prolonged sleeping are involved in “sleeping through the night” at an early age. Findings indicate the need for physiological studies of how arousal, waking, and resettling develop into sustained sleeping and of how environmental factors support these endogenous and behavioral processes.
infant sleeping; infant crying; settling; parenting
To determine (a) how child age relates to parent concerns about child behavior and (b) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments.
Data were obtained from Rhode Island’s Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income, diverse families. Children 9 months to 8 years were eligible for the study if they had a scheduled screening well child visit in 2010 (N = 1,451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment.
For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children over 5 years were 2.61 times more likely to attend than children less than 5. When examining parent behavioral concerns and child age jointly, only concerns remained significant.
Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally-based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.
Mental health consultation; screening; integrated care; primary care; early childhood
To investigate the role of executive function (EF) skills, measured by parent-rating and performance-based instruments, as mediators of the effects of gestational age on functional outcomes and behavior symptoms in preterm and full term preschoolers.
Patients and methods
Children born preterm (n=70; mean gestational age 29.6 weeks and mean birth weight 1365g) were compared to children born full term (n=79) on composite measures of EF (using the Behavior Rating Inventory of Executive Function and a performance-based EF battery), adaptive function, prereading skills, and behavior symptoms. For the entire sample, mediation analyses examined the effect of gestational age on outcomes with EF as mediator.
Compared to children born full term, children born preterm had significantly higher parent-rated EF scores and lower performance-based EF scores, both indicating more problems; further, children born preterm had lower adaptive function and prereading scores and more problematic behavior. Gestational age contributed to adaptive function, prereading skills, and behavior symptoms for all children. EF acted as a mediator of gestational age for all three outcomes; different patterns emerged for parent-rated and performance-based EF evaluations. For adaptive function, both EF measures significantly mediated effects of gestational age; for prereading skills, only performance-based EF was significant; for behavior symptoms, only parent-rated EF was significant.
We propose standard assessment of EF, using both parent-rating and performance-based EF measures, in young preterm children and other children at risk of EF impairments. EF skills are measurable, mediate important functional outcomes, and may serve as intervention targets.
premature birth; preterm; executive function; adaptive function; reading; behavior; mediation
This study examined a multivariate model of the relationship between caregiver strain and adolescent diabetes illness outcomes in a sample of caregivers of adolescents in chronically poor metabolic control (Hba1c ≥ 8.0% at enrollment and for previous 12 months). Caregiver mental health symptoms were hypothesized to mediate the relationship between caregiver strain and adolescent illness management behavior and metabolic control. Caregivers’ perceptions of social support and their level of responsibility for diabetes care tasks were hypothesized to be directly related to caregiver strain and indirectly to caregiver mental health symptoms.
One hundred forty-six caregiver-adolescent dyads completed baseline measures of caregiver strain, responsibility for diabetes care, social support, mental health symptoms, and illness management behavior. Adolescent metabolic control was also assessed.
Findings from structural equation modeling suggested that caregiver strain was directly and positively associated with caregiver mental health symptoms which mediated the relationship to adolescent diabetes management behavior and metabolic control. Caregivers’ responsibility for diabetes care tasks was directly related to caregiver strain and indirectly to caregiver mental health, but caregiver perceptions of social support was not.
These findings suggest that caregiver strain is an important dimension of the caregiving context of diabetes. Clinicians and researchers should consider how caregiving strain, responsibility for illness management, and mental health symptoms might be impacting children’s diabetes care behavior and diabetes health when working with and designing interventions for adolescents with diabetes.
The authors performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. Ninety-three Latino children (51 VIP, 42 control) at risk of developmental delay on the basis of poverty and low maternal education (none had completed high school) were assessed for cognitive and language development at age 21 months. Results differed depending on the level of maternal education; the VIP was found to have a moderate impact on children whose mothers had between seventh and 11th grade education (approximately 0.75 SD for cognitive development, 0.5 SD for expressive language) but little impact on children whose mothers had sixth grade or lower education.
child development; parent–child interaction; randomized; controlled trial
We assessed the prevalence of autism spectrum disorders (ASD) and screening test characteristics in children with Down syndrome.
Eligible children born in a defined geographic area between January 1, 1996, and December 31, 2003, were recruited through a population-based birth defects registry and community outreach, then screened with the modified checklist for autism in toddlers or social communication questionnaire, as appropriate. Screen-positive children and a random sample of screen-negative children underwent developmental evaluation.
We screened 123 children (27.8% of the birth cohort). Mean age was 73.4 months (range, 31–142). Compared to screen-negative children, screen-positive children had similar sociodemo-graphic characteristics but a lower mean developmental quotient (mean difference: 11.0; 95% confidence interval: 4.8–17.3). Weighted prevalences of autistic disorder and total ASD were 6.4% (95% confidence interval [CI]: 2.6%–11.6%) and 18.2% (95% CI: 9.7%–26.8%), respectively. The estimated minimum ASD prevalence, accounting for unscreened children, is 5.1% (95% CI: 3.3%–7.4%). ASD prevalence increased with greater cognitive impairment. Screening test sensitivity was 87.5% (95% CI: 66.6%–97.7%); specificity was 49.9% (95% CI: 37.0%–61.4%).
The prevalence of ASD among children with Down syndrome aged 2 to 11 years is substantially higher than in the general population. The modified checklist for autism in toddlers and social communication questionnaire were highly sensitive in children with Down syndrome but could result in many false positive tests if universal screening were implemented using current algorithms. Research needs include development of specific ASD screening algorithms and improved diagnostic discrimination in children with Down syndrome. Timely identification of these co-occurring diagnoses is essential so appropriate interventions can be provided.
Down syndrome; Autism spectrum disorders; prevalence; test characteristics; Modified Checklist for Autism in Toddlers; Social Communication Questionnaire
To compare the health problems, preventive care utilization, and medical costs of child family members (CFMs) of adults diagnosed with alcohol or drug dependence (AODD) to CFMs of adults diagnosed with diabetes or asthma.
Child family members of adults diagnosed with AODD between 2002 and 2005 and CFMs of matched adults diagnosed with diabetes or asthma were followed up to 7 years after diagnosis of the index adult. Logistic regression was used to determine whether the CFMs of AODD adults were more likely to be diagnosed with medical conditions, or get preventive care, than the CFMs of adults with asthma or diabetes. Children’s health services use was compared using multivariate models.
In Year 5 after index date, CFMs of adults with AODD were more likely to be diagnosed with depression and AODD than CFMs of adults with asthma or diabetes and were less likely to be diagnosed with asthma, otitis media, and pneumonia than CFMs of adults with asthma. CFMs of AODD adults were less likely than CFMs of adult asthmatic patients to have annual well-child visits. CFMs of AODD adults had similar mean annual total health care costs to CFMs of adults with asthma but higher total costs ($159/yr higher, confidence interval, $56–$253) than CFMs of adult diabetic patients. CFMs of adults with AODD had higher emergency department, higher outpatient alcohol and drug program, higher outpatient psychiatry, and lower primary care costs than CFMs of either adult asthmatic patients or diabetic patients.
Children in families with an alcohol- or drug-dependent adult have unique patterns of health conditions, and differences in the types of health services used, compared to children in families with an adult asthmatic or diabetic family member. However, overall cost and utilization for health care services is similar or only somewhat higher. This is the first study of its kind, and the results have implications for the reduction of parental alcohol or drug dependence stigma by health care providers, clearly an important issue in this era of health reform.
alcohol; drug; costs; family
Pediatricians are frequently asked to address parents’ behavioral concerns. Time out (TO) is one of the few discipline strategies with empirical support and is recommended by the American Academy of Pediatrics. However, correctly performed, TO can be a complex procedure requiring training difficult to provide in clinic due to time and cost constraints. The Internet may be a resource for parents to supplement information provided by pediatricians. The present study included evaluation of information on TO contained in websites frequently accessed by parents. It was hypothesized that significant differences exist between the empirically supported parameters of TO and website-based information.
Predefined search terms were entered into commonly used search engines. The information contained in each webpage (n = 102) was evaluated for completeness and accuracy based on research on TO. Data were also collected on the consistency of information about TO on the Internet.
None of the pages reviewed included accurate information about all empirically supported TO parameters. Only 1 parameter was accurately recommended by a majority of webpages. Inconsistent information was found within 29% of the pages. The use of TO to decrease problem behavior was inaccurately portrayed as possibly or wholly ineffective on 30% of webpages.
A parent searching for information about TO on the Internet will find largely incomplete, inaccurate, and inconsistent information. Since nonadherence to any 1 parameter will decrease the efficacy of TO, it is not recommended that pediatricians suggest the Internet as a resource for supplemental information on TO. Alternative recommendations for pediatricians are provided.
child discipline; parenting; internet; time out; behavior problems
To explore correspondences between the trajectories of symptoms and impairments in youth with attention-deficit hyperactivity disorder (ADHD) being treated by in primary care settings.
Parents of youth (n = 1976) rated their child's symptoms of inattention and hyperactivity/impulsivity, and impairment across a variety of domains. Multilevel models were estimated to characterize the trajectories of symptoms and impairment and to determine whether changes in symptom dimension trajectories corresponded to changes in impairment trajectories over time.
Results indicated that symptom dimensions initially improved, then leveled off, and then decreased minimally. However, impairment domains remained largely stable (i.e., neither improved nor worsened). Improvement in inattention symptoms were associated with improved ratings of writing impairment, and improved ratings of hyperactivity/impulsivity symptoms were associated with improved relationship with peers.
Youths with ADHD who are treated by their community pediatrician tend to initially improve in their symptom presentation, although this symptom reduction plateaus and is not associated with corresponding improvements in most areas of impairment.
ADHD; community-delivered treatment; primary care setting; symptom-impairment correspondence
Routine, standardized screening for ASD has been hypothesized to reduce known racial/ethnic and socioeconomic status (SES) disparities in age of first diagnosis. This study explored demographic differences in toddlers’ age and performance on developmental measures at the time of ASD assessment.
Toddlers (16-39 months at evaluation) who screened at-risk for developmental delay on the Modified Checklist for Autism in Toddlers (M-CHAT) or M-CHAT-Revised (M-CHAT-R) and follow-up interview participated in a diagnostic assessment. Of these, 44.7% were racial/ethnic minorities and 53.5% were non-minorities. Child race/ethnicity, years of maternal education (MEd), and household yearly income (YI) were parent-reported.
Small but significant correlations were observed between MEd or YI and evaluation age and adaptive communication, socialization, and motor scores. Controlling for MEd and YI, minority racial/ethnic group did not predict child’s performance on most measures and did not predict likelihood of ASD diagnosis. Differences in age at evaluation and receptive language skills were small effects.
Significant but small effects emerged for SES and minority status on toddlers’ age at evaluation and parent-reported adaptive skills, but these did not predict ASD diagnosis. The small magnitude of these effects suggests that routine, standardized screening for ASD in toddlers and timely access to diagnostic evaluation can reduce disparities in age at diagnosis and possibly reduce racial/ethnic disparities in access to services for ASD and other developmental delays.
M-CHAT; autism screening; socioeconomic status
The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.
Patient Protection and Affordable Care Act; children; health services; health care reform; Children and Youth with Special Health Care Needs; disabilities
The use of harsh discipline is a risk factor for child maltreatment and is more common among families in which mothers have previously experienced trauma. We sought to understand the stressors experienced by low-income traumatized mothers and the perceived impact of those stressors on their discipline approaches.
We conducted 30 in-depth qualitative interviews with low-income mothers with a history of trauma. We triangulated the results with experts in behavioral health, and with a subset of the informants themselves, to ensure data reliability.
We identified the following themes: 1. Repetitive child behaviors are the most stressful. 2. Mothers commonly cope by taking time away; this can result in prolonged unsupervised periods for children. 3. Harsh discipline is used deliberately to prevent future behavior problems. 4. Mothers relate their children’s negative behaviors to their own past experiences; in particular, those who have suffered domestic violence fear that their children will be violent adults.
Our findings suggest that trauma-informed interventions to promote positive discipline and prevent child maltreatment should help mothers predict and plan for stressful parent-child interactions; identify supports that will allow them to cope with stress without leaving their children for prolonged periods; and explicitly address long-term goals for their children and the impact of different discipline approaches.
Trauma; Discipline; Ethnographic interviews; Qualitative research
Early TV viewing has been linked with maternal depression and has adverse health effects in children. However it is not known how early TV viewing occurs. We evaluated the prevalence at which parents report television (TV) viewing for their children if asked in the first two years of life and whether TV viewing is associated with maternal depression symptoms.
Using a cross-sectional design, we evaluated TV viewing in children 0 – 2 years of age in 4 pediatric clinics in Indianapolis, IN between January 2011 and April 2012. Families were screened for any parental report of depression symptoms (0 – 15 months) and for parental report of TV viewing (before 2 years of age) using a computerized clinical decision support system (CDSS) linked to the patient’s electronic health record (EHR).
There were 3,254 children in the study. By parent report 50% of children view TV by 2 months of age, 75% by 4 months of age and 90% by 2 years of age. Complete data for both TV viewing and maternal depression symptoms were available for 2,397 (74%) of children. In regression models, the odds of parental report of TV viewing increased by 27% for each additional month of child’s age (OR: 1.27, CI: 1.25 – 1.30, p < 0.001). The odds of TV viewing increased by almost half with parental report of depression symptoms (OR: 1.47, CI: 1.07 – 2.00, p = 0.016). Publicly insured children had three times the odds of TV viewing compared to children with private insurance (OR: 3.00, CI: 1.60 – 5.63, p = 0.001). Black children had almost four times the odds (OR: 3.75, CI: 2.70 – 5.21, p < 0.001) and White children had one and a half times the odds (OR: 1.55, CI: 1.04 – 2.30, p = 0.032) of TV viewing when compared to Latino children.
By parental report TV viewing occurs at a very young age in infancy, usually between 0 to 3 months and varies by insurance and race/ethnicity. Children whose parents report depression symptoms are especially at risk for early TV viewing. Like maternal depression, TV viewing poses added risks for reduced interpersonal interactions to stimulate infant development. This work suggests the need to develop early targeted developmental interventions.
Preventive services guidelines; CHICA; screening; Television; TV; Maternal Depression