Objective

To describe responses to the questions “Do you have concerns about your child’s behavior? Development? Learning?” among parents seeking pediatric care, and to analyze their correspondence to formal screening questionnaires.

Methods

Of 465 parents of children ages 3–65 months recruited at pediatric primary care practices in greater Boston, 451 provided complete data for analysis. After completing a questionnaire that asked if they had any or all of these concerns parents filled out a developmental screener (Ages and Stages Questionnaire-3) and a behavioral screener (Ages and Stages Questionnaire-Social/Emotional).

Results

108 parents (24%) reported having at least one concern about their child. Greater child age, male gender, and lower family income were associated with more concerns about development, behavior, and learning. Moderate agreement was found between parents’ concerns and their responses on screening instruments. Compared to children who were not identified on either screener, parents of children identified only on the behavioral screener were more likely to have concerns about behavior and parents of children identified on both screeners were more likely to have noted concerns about both behavior and development. No type of concern was associated with identification on the developmental screener alone. Among parents who identified no concerns, 18% were identified as at risk on one or both screening tests.

Conclusion

Parents’ self-report of concerns showed moderate agreement with the results of developmental and behavioral screening instruments. Agreement was higher for behavioral concerns than for developmental concerns.

Objective

To investigate risk for language impairment in children perinatally infected or exposed to HIV.

Methods

We evaluated the prevalence of language impairment (LI) in 7–16 year old children with perinatal HIV infection (HIV+) compared to children HIV-exposed and uninfected (HEU), using a comprehensive standardized language test (CELF-4). LI was classified as primary LI (Pri-LI) (monolingual English exposure and no cognitive or hearing impairment), concurrent LI (Con-LI) (cognitive or hearing impairment), or no LI. Associations of demographic, caregiver, HIV disease and antiretroviral treatment (ART) factors with LI category were evaluated using univariate and multivariable logistic regression models.

Results

Of 468 children with language assessments, 184 (39%) had LI. No difference was observed by HIV infection status for overall LI or for Pri-LI or Con-LI; mean (SD) CELF-4 scores were 88.5 (18.4) for HIV+ vs 87.5 (17.9) for HEU. After adjustment, Black children had higher odds of Pri-LI vs no LI (aOR=2.43, p=0.03). Children who were Black, Hispanic, had a caregiver with low education or low IQ, or a non-biological parent as caregiver had higher odds of Con-LI vs no LI. Among HIV+ children, viral load >400 copies/ml (aOR=3.04, p<0.001), CDC Class C (aOR=2.19, p=0.02) and ART initiation <6 months of age (aOR=2.12, p=0.02) were associated with higher odds of Con-LI vs. no LI.

Conclusions

Children perinatally exposed to HIV are at high risk for LI, but such risk was not increased for youth with HIV. Risk factors differed for Pri-LI and Con-LI.

Objective

To assess the effect of maternal prenatal and past-year cocaine use on mother-child interactions across the preschool years.

Methods

The sample is drawn from the Miami Prenatal Cocaine Study (MPCS), a longitudinal follow-up of prenatal cocaine exposure (PCE) in a large cohort of African-American infants prospectively enrolled at birth. Analyses are based on the 366 children (168 PCE and 198 NCE) in the care of their biological mothers and with completed mother-child interaction measures at the 3- and/or 5-year assessments. Videotaped interactions were coded using a modified Egeland Teaching Task scheme. GLM/GEE models were used to evaluate the effect of PCE on the overall quality of maternal-child interaction, measured by the Egeland total score at both study visits, and on the individual Egeland subscales at the 5-year visit, while adjusting for other suspected influences on interactions.

Results

PCE dyads demonstrated less optimal overall mother-child interactions compared to NCE dyads. The estimated PCE-associated difference did not shift appreciably with statistical adjustment for child sex, child age at exam or other birth covariates. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared to children with neither exposure. In subscale analyses, PCE was most strongly associated with greater maternal intrusiveness and boundary dissolution at the 5-year visit.

Conclusions

Prenatal and past-year maternal cocaine use appear to be associated with poorer quality in mother-child interaction during early childhood. These dynamics should be considered when examining the association between prenatal cocaine exposure and child cognitive, behavioral, and academic outcomes.

Objective

Cross-sectional research indicates high rates of mental health concerns among youth with perinatal HIV infection (PHIV), but few studies have examined emerging psychiatric symptoms over time.

Methods

Youth with PHIV and peer comparisons who were HIV-exposed but uninfected or living in house-holds with HIV-infected family members (HIV-affected) and primary caregivers participated in a prospective, multisite, longitudinal cohort study. Groups were compared for differences in the incidence of emerging psychiatric symptoms during 2 years of follow-up and for differences in psychotropic drug therapy. Logistic regression models were used to evaluate the association of emerging symptoms with HIV status and psychosocial risk factors.

Results

Of 573 youth with study entry assessments, 92% attended at least 1 annual follow-up visit (PHIV: 296; comparisons: 229). A substantial percentage of youth who did not meet symptom criteria for a psychiatric disorder at study entry did so during follow-up (PHIV = 36%; comparisons = 42%). In addition, those who met criteria at study entry often met criteria during follow-up (PHIV = 41%; comparisons = 43%). Asymptomatic youth with PHIV were significantly more likely to receive psychotropic medication during follow-up than comparisons. Youth with greater HIV disease severity (entry CD4% <25% vs 25% or more) had higher probability of depression symptoms (19% vs 8%, respectively).

Conclusions

Many youth in families affected by HIV are at risk for development of psychiatric symptoms.

Objective

To examine what contributes to resiliency in children living with Duchenne muscular dystrophy (DMD), a chronic, progressive neuromuscular disorder that also influences cognitive ability. We hypothesized that family and social support will moderate the effects of individual symptoms of illness severity and influence positive adjustment in boys with DMD.

Method

146 boys with DMD were included. Child adjustment, as determined by parent ratings of their son’s behavior using the Total Behavior score from the Child Behavior Checklist (CBCL), was examined as an outcome measure. The contributions of individual variables (including age (which serves also as a proxy for degree of physical disability), wheelchair use, and estimated verbal IQ), family variables (the Parental Distress score from the Parent Stress Index), and social environment variables (the Social Competence score from the CBCL) on child adjustment were examined in a linear regression analysis.

Results

Both family and social environment variables significantly contributed to the variance in the CBCL total behavior score. In contrast, individual factors that are related to illness severity (age, degree of physical involvement and estimated verbal IQ) were not associated with child adjustment.

Conclusion

Increased children’s social networks and decreased parents’ stress levels positively contributed to good child adjustment, whereas degree of individual clinical severity did not. Thus, emphasis on providing opportunities for friendships and social support and on parents’ adjustment will aid in children’s resilience, ensuring they can live well, even while living with the significant burdens associated with DMD.

Objective

To (1) describe type and source of social support perceived by obese youth and examine associations with sociodemographic/anthropometric characteristics, and (2) examine relationships between social support and obesity-specific health-related quality of life (HRQOL).

Methods

Seventy-four obese youth and their primary caregivers participated. Youth completed the Child and Adolescent Social Support Scale and an obesity-specific HRQOL measure, Sizing Me Up.

Results

Close friends and parents provided the most social support and were rated most important, except for teacher informational support. Classmates and schools provided the least social support. Body mass index z-score was correlated with teacher support frequency (r=−.26, p < .05) and minority youth reported more parent support (t(72)=−2.21, p < .05). Compared with other support providers, classmate support significantly predicted most HRQOL scales (p<.001).

Conclusions

Close friends, parents, and teachers are significant sources of support to youth with obesity; however, classmates play a unique role in the HRQOL of obese youth.

Depressive syndromes represent a disabling comorbidity for many children with autism spectrum disorders (ASD), however the ascertainment of depression can be complicated by phenotypic overlap between the two conditions, by ways in which autistic symptomatology can mask cardinal features of depression, and by atypical manifestations of depression in children with ASD. These issues have contributed to wide variation in the estimation of prevalence rates of depression in individuals with ASD, and invoke the need for new approaches to the specific detection of depression and other neuropsychiatric comorbidities that aggregate in children affected by ASD. We review the scientific literature relevant to the occurrence of depression in ASD, and consider important parameters of risk, including psychosocial factors such as insight into affectation status, as well as biological factors such as the aggregation of depressive syndromes in certain families affected by autism, which has suggested possible overlap in genetic influences underlying the two conditions. Variability in the manifestations of depression across environmental contexts provides important clues to intervention, and underscores the potential importance of involving multiple informants in ascertaining depression in children and adolescents with ASD. A practical strategy for evaluating the presence of depression in youth with ASD is synthesized from the available data and discussed.

Objective

Sleep disruption has been linked to numerous neural regulatory problems and problems with social emotional and behavioral functioning, and researchers have shown that sleep disruption is prominent in children with symptoms of attention-deficit hyperactivity disorder. These issues are germane to foster children, who have numerous disparities in areas of self-regulation and psychopathology but for whom there has been very little examination of sleep quality or the associations between poor sleep quality and physiological/behavioral dysregulation.

Method

Actigraphy measures were used to examine associations between sleep duration/quality and inattentive/hyperactive problem behavior in a sample of 79 children (ages 5–7 years): 32 foster children and 47 nonmaltreated community children.

Results

Of the sleep variables examined, only sleep duration was significantly associated with inattentive/hyperactive problem behavior. These associations were more significant in foster children compared to community children and in boys compared to girls.

Conclusion

The results have several implications for prevention and intervention research.

Objective

The aim of this research study was to examine the relationship between four sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents’ diabetes outcomes (illness management behavior and health status) using a diverse sample of urban adolescents.

Method

One hundred forty-one adolescents with insulin-managed diabetes and their primary caregivers completed questionnaires assessing social support and illness management behavior. Glucose meters were downloaded and hemoglobin A1c assays were obtained. Structural equation modeling (SEM) was used to test a model social support informed by social ecological theory.

Results

The results of the SEM indicated that support for the caregiver from another adult was directly and positively related to support for the adolescent from family and indirectly related to better illness management. Support for the adolescent was directly related to better diabetes management and, through better management, to better diabetes health. Neither support to the family from the health care provider or support to the adolescent from friends were related to support for the adolescent or illness management.

Conclusion

This study identifies a novel target for social support intervention to improve adolescents’ illness management behavior – the caregivers of adolescents with diabetes. By enhancing the social support caregivers receive from other adults in their lives, caregivers’ ability to support their adolescent children with diabetes might also be improved and, in turn, adolescents’ illness outcomes.

Objective

This study examined the role of demographic characteristics, psychological factors, and family functioning on attendance in a randomized controlled trial of a family-based pediatric obesity program.

Method

Participants included 155 children between the ages of 4 and 7 years (M age = 5.77, 57.4% female, 73.6% African-American, M BMI = 25.5) and their primary caregivers who were randomized to the treatment group. Three groups of participants were created based on their patterns of attendance during the program: 1) noncompleters, 2) partial completers, and 3) completers.

Results

Results indicated no differences among the attendance groups in child gender, child BMI, or child psychological functioning. Significant group differences were found with respect to race/ethnicity, parent marital status, and family income, such that noncompleters were more likely to be racial/ethnic minorities, to living in single parent households, and to have lower incomes than partial completers and completers. After controlling for the effects these socio-demographic risk factors, noncompleters and partial completers reported more family dysfunction characterized by high levels of disengagement than completers.

Conclusion

Adapting existing weight management programs to include a focus on family engagement in the early stages of treatment may help to improve participation in family-based obesity interventions targeting high risk, socio-economically disadvantaged youth.

Objective

To quantify racial differences in receipt of early intervention (EI) services among children ages birth to three.

Methods

We conducted multivariable analyses of a nationally representative sample of children eligible for EI services using data from the Early Child Longitudinal Study, Birth Cohort. Birthweight <1000 grams, genetic and medical conditions associated with developmental delay, or low scores on a standardized measure of developmental performance defined EI eligibility. Receipt of EI services was ascertained from parent self-report. The effect of race on receipt of EI services was examined in main effect models and models stratified by EI qualifying condition, which was defined as either established medical condition or developmental delay in the absence of an underlying medical diagnosis.

Results

At 9 months of age, among the 1000 children eligible for EI services, 9% of children received services; there were no Black-white racial differences in receipt of services. At 24 months of age, among the 1000 children eligible for EI services, 12% received services; Black children were 5 times less likely to receive services than white children (aOR 0.19; 95% CI 0.09, 0.39). In models stratified by qualifying condition, Black children who qualified for services at 24 months based on developmental delay alone were less likely to receive services (aOR 0.09; 95% CI 0.02, 0.39); there were no differences by race among children who qualified based on established medical conditions (aOR 0.56; 95% CI 0.18, 1.72).

Conclusions

Racial disparities in EI service receipt, which were not present during infancy, emerged as children became toddlers. These disparities were found most consistently among children who qualified for services based on developmental delay alone.

Objective

Adult caregivers provide children living with HIV with varying amounts and types of information about their health status that may affect their coping and health care behaviors. We aimed to describe patterns of information-sharing with children and thoughts around disclosure among caregivers in the Democratic Republic of the Congo.

Methods

259 primary caregivers of children 5–17 years old in an HIV pediatric care and treatment program were screened; 8 adult caregivers (3%) had informed their child of the child’s HIV status. We conducted structured interviews with 201 caregivers whose children had not yet been told their HIV status.

Results

Nearly 50% of caregivers provided no information to their child about their health; 15% had given partial information without mentioning HIV, and 33% provided information that deflected attention from HIV, whether deliberately so or otherwise. Almost all caregivers said that the child should be told their status some day, and three-fourths reported having ever thought about what might lead them to tell. However, nearly one-third of caregivers saw no benefits to informing the child of her/his HIV status. A majority of caregivers felt that they themselves were the best to eventually disclose to the child, but some wanted support from health care providers.

Conclusion

HIV-infected children are given limited information about their health. Health care providers may serve as important sources of support to caregivers as they decide when and how to talk candidly with their children about their health.

Objective

Accurate assessment of racial disparities in attention-deficit/hyperactivity disorder (ADHD) depends on measurement that is equally valid for all groups. This study examines differences among African American and white children in ADHD measurement with a widely used parental report instrument, the Diagnostic Interview Schedule for Children (DISC).

Methods

Data come from 1070 children in the Fast Track Project, a longitudinal study of predominantly low-income children at risk of emotional and/or behavioral problems. Item Response Theory (IRT) methodology is used to determine whether ADHD screening items provide comparable information for African American and white children or whether differential item function (DIF) exists. IRT scores and race/ethnicity are entered in logistic regression models predicting use of ADHD medication.

Results

Seven of 39 DISC items performed differently among African Americans and whites. In most cases, parents of white children were more likely to endorse these items than were parents of African American children at comparable underlying levels of children’s hyperactivity. When items exhibiting differential functioning were deleted, race disparities predicting underlying need as indicated by ADHD medication use decreased and were no longer statistically significant.

Conclusions

Perceptions of ADHD-related symptoms among parents of African American children appear to differ in important ways from those of parents of white children, and screening instruments relying on parent report may yield different results for African American and white children with similar underlying treatment needs. Gathering information from additional sources including teachers and school counselors can provide a more complete picture of the behavioral functioning and therapeutic needs of children in all race/ethnic groups.

Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and treatment of deformational plagiocephaly (DP). Though considered a medically benign condition, preliminary reports suggest that DP may be associated with developmental problems. However, mechanisms to account for this association have not been hypothesized or empirically tested. Although treatment justifications often center on prevention of atypical appearance, little is known about the cosmetic outcomes of treated and untreated children. In this review we hypothesize different etiological pathways linking DP with neurodevelopment (e.g., environmental positioning limitations with and without underlying CNS pathology). We outline directions for research on incidence and prevalence, developmental outcomes, sex differences, determinants of treatment participation, and craniofacial appearance. Despite the paucity of existing research, preliminary findings suggest that children with this condition should be screened and monitored for developmental delays or deficits, as we await more conclusive information from future studies.

Within the medical home, understanding the family and community context in which children live is critical to optimally promoting children’s health and development. How to best identify psychosocial issues likely to have an impact on children’s development is uncertain. Professional guidelines encourage pediatricians to incorporate family psychosocial screening within the context of primary care, yet few providers routinely screen for these issues. We propose applying the core principles of surveillance and screening, as applied to children’s development and behavior, to also address family psychosocial issues during health supervision services. Integrating psychosocial surveillance and screening into the medical home requires changes in professional training, provider practice, and public policy. The potential of family psychosocial surveillance and screening to promote children’s optimal development justifies such changes.

Objective

To ascertain whether level of intrauterine cocaine exposure (IUCE) is associated with early adolescent delinquent behavior, after accounting for prenatal exposures to other psychoactive substances and relevant psychosocial factors.

Methods

Ninety-three early adolescents (12.5–14.5 years old) participating since birth in a longitudinal study of IUCE reported delinquent acts via an audio computer assisted self interview (ACASI). Level of IUCE and exposure to cigarettes, alcohol, and marijuana were determined by maternal report, maternal and infant urine assays, and infant meconium assays at birth. Participants reported their exposure to violence on the Violence Exposure Scale for Children – Revised (VEX-R) at ages 8.5, 9.5, 11 years and during early adolescence, and the strictness of supervision by their caregivers during early adolescence.

Results

Of the 93 participants, 24 (26%) reported ≥3 delinquent behaviors during early adolescence. In the final multivariate model (including level of IUCE and cigarette exposure, childhood exposure to violence, and caregiver strictness/supervision) ≥ 3 delinquent behaviors were not significantly associated with level of IUCE but were significantly associated with intrauterine exposure to half a pack or more of cigarettes per day and higher levels of childhood exposure to violence, effects substantially unchanged after control for early adolescent violence exposure.

Conclusions

In this cohort, prospectively ascertained prenatal exposure to cigarettes and childhood exposure to violence are associated with self-reported delinquent behaviors during early adolescence. Contrary to initial popular predictions, intrauterine cocaine is not a strong predictor of adolescent delinquent behaviors in this cohort.

Objective

Attentional problems, hyperactivity, and impulsivity have been described as behavioral features associated with sex chromosome aneuploidy (SCA). In this study, the authors compare attention-deficit hyperactivity disorder (ADHD) symptoms in 167 participants aged 6 to 20 years with 4 types of SCA (XXY n = 56, XYY n = 33, XXX n = 25, and XXYY n = 53). They also evaluate factors associated with ADHD symptomatology (cognitive and adaptive scores, prenatal vs postnatal ascertainment) and describe the clinical response to psychopharmacologic medications in a subset of patients treated for ADHD.

Methods

Evaluation included medical and developmental history, cognitive and adaptive functioning assessment, and parent and teacher ADHD questionnaires containing DSM-IV criteria.

Results

In the total study group, 58% (96/167) met DSM-IV criteria for ADHD on parent-report questionnaires (36% in XXY, 52% in XXX, 76% in XYY, and 72% in XXYY). The Inattentive subtype was most common in XXY and XXX, whereas the XYY and XXYY groups were more likely to also have hyperactive/impulsive symptoms. There were no significant differences in Verbal, Performance, or Full Scale IQ between children with symptom scores in the ADHD range compared with those below the ADHD range. However, adaptive functioning scores were significantly lower in the group whose scores in the ADHD range were compared with those of the group who did not meet ADHD DSMIV criteria. Those with a prenatal diagnosis of XXY were less likely to meet criteria for ADHD compared with the postnatally diagnosed group. Psychopharmacologic treatment with stimulants was effective in 78.6% (66/84).

Conclusions

Children and adolescents with SCA are at increased risk for ADHD symptoms. Recommendations for ADHD evaluation and treatment in consideration of other aspects of the SCA medical and behavioral phenotype are provided.

This study investigated associations between child temperament and DSM-IV disorders in children. A total of 156 probands (97 boys, 59 girls; mean age = 10.78 years) and 154 randomly selected siblings were assessed using the Junior Temperament and Character Inventory (JTCI) and a structured DSM-IV interview. Subjects were placed in nonoverlapping groups of (1) attention-deficit hyperactivity disorder (ADHD) only, (2) disruptive behavior disorders (DBD) only, (3) DBD plus an affective and/or anxiety disorder (DBD+Int), and (4) controls with no diagnosis. Many JTCI scales were found to differ between diagnostic groups and controls. Regression analyses showed independent associations between low persistence and ADHD-only group membership, high novelty seeking (NS), and the DBD-only group and between high harm avoidance (HA) and DBD+Int group membership. The interaction NS × HA was related to the ADHD-only group. Future research is needed to determine the mechanism of these association.

Successful development during the first year of life is dependent on the infant’s ability to regulate behavioral and physiological state in response to unpredictable environmental challenges. While most infants develop skills to self-soothe and regulate behavior, a subset lacks these skills and develops regulatory disorders (RD).

Objectives

To evaluate the component features of RD by determining if infants with RD differ from typically developing infants on measures of temperament, respiratory sinus arrhythmia, heart rate, and mother-infant interactions.

Methods

Parents of 50 9-month old infants completed behavioral questionnaires that provided information necessary to complete the Regulatory Disorders Checklist, which evaluates for difficulties in self-regulation and hypersensitivities. Infants with difficulties in both domains were assigned to the RD group. Mothers and their infants were videotaped interacting for 10 minutes. Infant heart rate was monitored before and during the mental development test.

Results

The RD group (n=10) was more temperamentally difficult and exhibited atypical physiological regulation relative to infants with difficulties in either self-regulation or hypersensitivity (n=25) or infants with no difficulties (n=15). During the mother-infant interactions, the RD group exhibited more high-level withdrawal behaviors, including verbal and physical protests, although there were no differences in the quantity and quality of the maternal approaches.

Conclusion

Infants with RD have both temperamental and physiological regulation difficulties, and may be in a physiologically state that makes it difficult to moderate behavior in response to social demands. Mothers of RD infants might be taught to modify their behavior to help their infants regulate behavioral and physiological state.

Objective

To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure.

Method

The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared to an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1,081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled.

Results

Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco pre- and post-natally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes.

Conclusion

Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.

Objective

The goals of the review are threefold; a) to highlight the educational and employment consequences of poorly developed mathematical competencies; b) overview the characteristics of the children with persistently low achievement in mathematics; and c) provide a primer on cognitive science research that is aimed at identifying the cognitive mechanisms underlying these learning disabilities and associated cognitive interventions.

Method

Literatures on the educational and economic consequences of poor mathematics achievement were reviewed and integrated with reviews of epidemiological, behavioral genetic, and cognitive science studies of poor mathematics achievement.

Results

Poor mathematical competencies are common among adults and result in employment difficulties and difficulties in many common day-to-day activities. Among students, about 7% of children and adolescents have a mathematical learning disability (MLD) and another 10% show persistent low achievement (LA) in mathematics despite average abilities in most other areas. Children with MLD and their LA peers have deficits in understanding and representing numerical magnitude, difficulties retrieving basic arithmetic facts from long-term memory, and delays in learning mathematical procedures. These deficits and delays cannot be attributed to intelligence, but are related to working memory deficits for children with MLD, but not LA children. Interventions that target these cognitive deficits are in development and preliminary results are promising.

Conclusion

Mathematical learning disabilities and learning difficulties associated with persistent low achievement in mathematics are common and not attributable to intelligence. These individuals have identifiable number and memory delays and deficits that appear to be specific to mathematics learning. The most promising interventions are those that target these specific deficits and, in addition, for children with MLD interventions that target their low working memory capacity.

Objective

To compare the characteristics of children with ADHD who have high IQ versus normal and low IQ through long-term follow-up of children with ADHD from a population-based birth cohort.

Methods

Subjects included children with research-identified ADHD (N=379) from a birth cohort (N=5,718). Full scale IQ scores obtained between ages 6 –18 years were used to categorize children into three groups: Low (IQ<80), Normal (80≤IQ<120) and High IQ (IQ≥120). Subjects were retrospectively followed from birth until emigration, death, or high school graduation/dropout. The groups were compared on demographic characteristics, age at which ADHD case criteria were met, co-morbidities, treatment, and school outcomes.

Results

There were no significant differences among children with high (N=34), normal (N=276) or low IQ (N=21) and ADHD in numerous characteristics, including median age at which ADHD criteria were fulfilled (9.5, 9.7, and 9.8 years); rates of co-morbid learning disorders (85.3%, 78.3%, 76.2%), psychiatric disorders (47.1%, 50.4%, 47.6%), and substance abuse (17.6%, 23.6%, 19.0%); and rates of stimulant treatment (79%, 75%, 90%). In comparison to children with normal or low IQ, those with high IQ had mothers with higher educational levels (e.g., college graduation rates 44.1%, 11.6%, 14.3%), and higher reading achievement (median national percentiles on standardized reading tests 77.0, 42.0, 29.0, p<0.001).

Conclusions

These findings suggest that ADHD is similar among children with high, normal and low IQ, although high IQ may favorably mediate some outcomes such as reading achievement. Diagnosis and treatment of ADHD are important for all children, regardless of cognitive ability.

Objective

This study examined the role that easy infant temperament and cumulative environmental risk play in predicting cognitive, language and behavioral outcomes in 3 year-old children at high social risk.

Methods

Subjects were 412 mother-infant dyads, recruited at birth, participating in a longitudinal study examining the effects of prenatal methamphetamine (MA) on child development. This analysis includes a subsample (n=290) of the study with a completed 3 year visit. Temperament was assessed by the Infant Behavior Questionnaire at 12 mos. Factor analysis from well-validated measures generated “easy” and “difficult” temperament profiles, and a profile for high risk environment. Caretaker receptive vocabulary served as a proxy for IQ. Outcomes at 3 years included motor and mental development, behavior problems, and language. Linear regression and hierarchical linear modeling examined the effects of temperament, high risk environment and caregiver receptive language on outcomes adjusting for maternal drug use, demographic, and socioeconomic covariates.

Results

Internalizing and externalizing behaviors were lower in children with easy temperament and higher with increased environmental risk. Easy temperament attenuated behavioral problems only in the setting of lower environmental risk. Caregiver receptive language was associated with lower internalizing scores High risk environment and temperament factors were not related to cognitive or motor outcomes. Prenatal MA exposure was not associated with 3 year-old outcomes, nor did it alter the protective effects of an easier temperament on child behavior.

Conclusions

Children growing up in adverse social environments had increased behavioral problems and compromised language development. Conversely, an easy temperament acts as a protective factor for social-emotional development and could be related to resilience.

Objective

To determine the relationship between napping and cognitive function in preschool-aged children.

Methods

Daytime napping, nighttime sleep and cognitive function were assessed in fifty-nine typically developing children ages 3-5 years, who were enrolled in full-time childcare. Participants wore an actigraphy watch for 7 days to measure sleep and napping patterns, and completed neuropsychological testing emphasizing attention, response control, and vocabulary. Parents of participants completed behavior ratings and sleep logs during the study. Sleep/wake cycles were scored with the Sadeh algorithm.

Results

Children who napped more on weekdays were also more likely to nap during weekends. Weekday napping and nighttime sleep were inversely correlated, such that those who napped more slept less at night, while total weekday sleep remained relatively constant. Weekday napping was significantly (negatively) correlated with vocabulary and auditory attention span, and weekday nighttime sleep was positively correlated with vocabulary. Nighttime sleep was also significantly negatively correlated with performance, such that those who slept less at night made more impulsive errors on a computerized go/no-go test.

Conclusions

Daytime napping is actually negatively correlated with neurocognitive function in preschoolers. Nighttime sleep appears to be more critical for development of cognitive performance. Cessation of napping may serve as a developmental milestone of brain maturation. Children who nap less do not appear to be sleep deprived, especially if they compensate with increased nighttime sleep. An alternative explanation is that children who sleep less at night are sleep deprived and require a nap. A randomized trial of nap restriction would be the next step in understanding the relationship between napping and neurocognitive performance.