The Food and Drug Administration has approved the use of antipsychotic medications in some children and adolescents with severe emotional and behavioral disorders. However, recent national data show a dramatic rise in off-label and Food and Drug Administration–approved uses of these medications. Of particular note is a twofold to fivefold increase in the use of antipsychotic medications in preschool children, despite little information on their long-term effects. This article describes the trend in pediatric antipsychotic medication use, possible explanations for the increase, implications for children’s health, and recommendations for pediatric providers who work with parents of children and adolescents who seek or receive antipsychotic medication treatments.
Child mental illness; antipsychotics in children; prescribing trends
Recent health reforms will expand US children’s insurance coverage. Yet, disparities persist in access to pediatric care, even among the insured. We investigated the separate and combined effects of having health insurance and a usual source of care (USC) on children’s receipt of health care services.
We conducted secondary analysis of the nationally-representative 2002-2007 Medical Expenditure Panel Survey data from children (aged ≤18 years) who had at least one health care visit and needed any additional care, tests, or treatment in the preceding year (n=20,817).
Approximately 88.1% of the study population had both a USC and insurance; 1.1% had neither one; 7.6% had a USC only, and 3.2% had insurance only. Children with both insurance and a USC had the fewest unmet needs. Among insured children, those with no USC had higher rates of unmet needs than those with a USC.
Expansions in health insurance are essential; however, it is also important for every child to have a USC. New models of practice could help to concurrently achieve these goals.
child health; health insurance; usual source of care; access to health care; health care disparities; health policy; health care reform
Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff.
Structured individual interviews were conducted with the entire Prime Time program staff (N=7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy recruited from school and community clinics.
Program staff described different capacities of adolescents to engage with the program (easy, middle and difficult connecting adolescents) and provided specific recommendations for working with different connectors.
Findings from this study support the notion that preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers, nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations and supports needed for healthy behavior change.
Adolescents; Pregnancy Prevention; Intervention
This study explored the relationship between depression, stigma, and risk behaviors in a multisite study of high risk youth living with HIV (YLH) in the United States.
All youth met screening criteria for either problem level substance use, current sexual risk and/or suboptimal HIV medication adherence. Problem level substance use behavior was assessed with the CRAFFT, a 6-item adolescent screener. A single item was used to screen for current sexual risk and for a HIV medication adherence problem. Stigma and depression were measured via standard self-report measures.
Multiple regression analysis revealed that behavioral infection, older age, more problem behaviors, and greater stigma each contributed to the prediction of higher depression scores in YLH. Associations between depression, stigma, and problem behaviors are discussed. More than half of the youth in this study scored at or above the clinical cut-off for depression. Results highlight the need for depression focused risk reduction interventions that address stigma in YLH.
Study outcomes suggest that interventions are needed to address stigma and depression not only among youth living with HIV but in the communities in which they live.
HIV/AIDS; Stigma; Depression
Congenital cataract; leukocoria; nuclear cataract; amblyopia; aphakia
Migrant; mothers; health promotion; nutrition
Descriptive study compared adolescent mothers’ subjective perceptions of their children’s development with objective developmental assessments.
Volunteer sample of mother/child pairs was recruited from urban high school. Thirty-three mothers completed Ages and Stages Questionnaire (A&SQ). Children were administered Bayley Scales of Infant Development (BSID).
On the BSID, group mean scores all fell within the normal range. However, almost 20% of individual children had one or more delays. Almost 73% of mothers accurately assessed their children’s development on the (A&SQ) when compared to BSID results. Eighteen percent of mothers suspected delays when there were none objectively identified. A single mother identified delay in a different domain than that identified on the BSID.
Findings that almost 20% of these children had developmental delays support other research that children of adolescent mothers are at risk for delays. Findings that teen mothers varied in their abilities to assess their children’s development reinforce the need for education of teen mothers about child development. Further study needed to determine the best models of this education in school and community settings.
To assess health-related quality of life (HRQOL) in children and adolescents with sickle cell disease (SCD).
Design, Setting, and Participants
The PedsQL™ 4.0 Generic Scales, a multidimensional self-report instrument that has been shown to be valid and reliable for use in children and adolescents with chronic illness, consists of 23 items that assess physical, emotional, social, and school functioning. Questionnaires were administered to 124 children and adolescents (aged 8-18 years, child self-report) with SCD (100 sickle cell anemia [SS], 24 sickle beta zero thalassemia [Sβ0thal]) and their parents (parent-proxy report). Summary scores for children’s and parents’ ratings of overall HRQOL and psychosocial health and subscale scores for physical, emotional, social, and school functioning were compared to published data for healthy children. Both summary and subscale scores for children with SCD were also compared to those of their parents.
Children with SCD and their parents rated overall HRQOL and all sub-domains of HRQOL lower than ratings of healthy children and their parents (p < .001). Children with SCD rated their own HRQOL significantly better than their parents for overall HRQOL and all sub-domains (p <.001) except emotional functioning (p = .06).
Children with SCD and their parents perceived overall HRQOL and all HRQOL sub-domains to be lower than scores reported in healthy children. Therefore, successful therapeutic efforts to improve HRQOL could represent important advances in the health of children with SCD.
Quality of Life; Health Related Quality of Life; Sickle Cell Disease; Chronic Illness; Children and Adolescents
The purpose of this paper is to describe components of a health coaching intervention based on coping skills training delivered via telephone. This intervention was provided to urban adolescents at risk for type 2 diabetes mellitus (T2DM), reinforcing a school-based curriculum designed to promote a healthy lifestyle and prevent T2DM.
Health coaching via telephone was provided to at-risk, urban youth enrolled in a study of an intervention to reduce risk for T2DM. Vignettes are used to describe the use of several coping skills in this high risk youth population.
A variety of vignettes illustrate how telephone health coaching reinforced lifestyle changes in students by incorporating coping skills training.
Given the benefits and the challenges of the telephone health coaching intervention, several suggestions for others who plan to use a similar method are described.
Injection site rotation is an important component of insulin administration and helpful in preventing lipodystrophy in type 1 diabetes (T1DM). We examined the number of injection/infusion sites (sites) used by youth with T1DM and their perceived barriers to using new sites for insulin.
Two hundred-one youth with T1DM completed a 24-item survey about site rotation practices and barriers to site rotation during a routine diabetes appointment.
Fifteen percent of youth reported using at least four distinct sites in their rotation plan, while 22% reported using only one site. A negative correlation was found between number of sites used and the number of perceived barriers endorsed by youth on multiple daily injections. Fear of pain was the most common barrier endorsed by youth.
Many youth with T1DM may not adhere to an adequate site rotation plan. Regular assessment of insulin sites and counseling regarding adequate site rotation is needed when managing diabetes in youth. Relaxation and distraction may help to reduce youths’ fear of pain when rotating to new insulin sites.
Type 1 diabetes; youth; insulin; adherence
The purpose of this article is to review attachment theory and relate the attachment perspective to adolescent mothers and their children. Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world. With respect to cognitive, social, and behavioral domains, securely attached infants tend to have more favorable long-term outcomes, while insecurely attached infants are more likely to have adverse outcomes. Adolescent parenthood can disrupt normal adolescent development, and this disruption influences development of the emotional and cognitive capacities necessary for maternal behaviors that foster secure attachment. However, it appears that if specialized supports are in place to facilitate the process of developing attachment, infants of adolescent mothers can obtain higher rates of secure attachment than normative samples in this population.
To explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood.
Fourteen parents of eleven T1DM children diagnosed at ≤5 years participated in semi-structured interviews. Data were analyzed using content analysis.
Significant themes were: Diagnostic Experiences: Frustrations, fears and doubts: Parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and sometimes delayed diagnosis. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. Adapting to Diabetes: Parents described isolation in caring for their child’s T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers’ isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision-making was shared. All parents reported never mastering diabetes management. Negotiating Developmental Transitions: Normative childhood events were stressful requiring that parents balance concerns to foster child participation.
Pediatric providers can improve diagnostic and treatment experiences for parents of T1DM children by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.
parenting; type 1 diabetes; teamwork; qualitative
Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services.
This exploratory study included 126 adolescents with asthma, aged between 13–20 years. Subjects were classified as having inaccurate symptom perception (IG), well controlled, accurate symptom perception (WCA), and poorly-controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization including emergency department (ED) visits, hospitalization and office visits and school absenteeism in the past 3 months.
More adolescents in the inaccurate group had at least one hospitalization compared to adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6% respectively). A similar trend was seen for emergency department visits. Compared to WCA group, adolescents in the inaccurate group were nearly 9 times more likely to have been hospitalized, 3.4 times more likely to have visited an emergency department (ED), and 4 times more likely to have missed school days.
Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school as compared to those with accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to assure appropriate care.
This study provides preliminary data about a parenting intervention for families of preschoolers with early ADHD/ODD symptoms carried out in two diverse primary care pediatric offices.
Parents of toddlers completed behavioral screening questionnaires at well-child visits. Eligible parents participated in a 10-week parenting education group using the Incredible Years Program. Mothers completed several outcome measures at three time points - before participating in the group, immediately after the group ended, and six months thereafter. These measures assessed changes in parenting practices, parenting stress, and child symptoms. Parent and provider satisfaction were also assessed.
Mothers reported improvements in parenting skills and decreases in stress. They also reported decreases in child aggression and increases in compliance. Mothers and providers reported high levels of satisfaction.
Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.
pediatrics; intervention; parenting; parenting education; disruptive behavior; ADHD; ODD
Nurse practitioners have the power to detect suicide risk and prevent suicide, a problem plaguing rural areas of the United States. Suicide risk assessment can be completed using the HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality and depression) interview instrument. The purpose of this study was to determine if HEADSS is appropriate for guiding suicide risk assessment of rural adolescents.
High school students in Southwestern Pennsylvania completed qualitative questions from the Child Behavior Checklist and Coping Response Inventory as part of the Intervention to Promote Mental Health in Rural Youth. Qualitative content analysis was performed.
Prominent themes identified by participants included academic performance, relationships, dislikes about school, friends, death, mental health, and the future. Several minor themes concerned safety. Most known risk factors for suicide were concerns of participants.
The expansion of HEADSS to include death and safety should be considered. The modified version—HEADDSSS— can be used to guide suicide risk assessment of youth in rural Pennsylvania, ensuring both thoroughness of assessment and safety.
This study tested the addition of a cognitive-behavioral skill-building component called Positive Adolescent Life Skills (PALS) training to an existing intervention for urban adolescents to enhance resiliency. In previous pilot work with the existing intervention, called “Teen Club,” it was found that participants in group meetings and intensive case management reported an enhanced ability to connect with positive resources.
Sixteen adolescents aged 12 to 16 years (10 boys and 6 girls) attending an urban secondary school were randomly assigned to Teen Club or Teen Club plus PALS. Boys and girls met separately in one of the two conditions for 30 weeks. The Problem-Oriented Screening Instrument for Teenagers (POSIT) subscale scores were measured at baseline and at the completion of the program.
The sample consisted of 11 Black and five Hispanic teens. Between-group differences in the POSIT subscale scores were not significantly different in this small sample. Group interviews conducted at the conclusion of the intervention revealed that participants found the PALS intervention to be relevant and useful.
Results suggest that the PALS component strengthened the existing intervention and lend preliminary support for the continuation of this combination of interventions. Future research with larger numbers is needed.
This study examines risks for high blood pressure (BP) among undiagnosed African American (AA) mothers and daughters, because AA children are at risk for hypertension due to familial influences.
This study was cross-sectional in design and included 70 AA mother and daughter participants from the Detroit metropolitan area.
BP readings clinically diagnostic of hypertension were found for mothers (25.7%) and daughters (54.3%), although they were undiagnosed. Many participants with BP readings in pre-hypertension or hypertension categories were overweight or obese (mothers, 90.9%; daughters, 50.2%). Fewer underweight or normal weight mothers (25.0%) and daughters (64.3%) had BP readings indicative of hypertension. Lower diastolic BP was associated with higher body mass index (BMI) among mothers (r = −.34, p = .045). Higher systolic blood pressure was positively related to potassium consumption among daughters and total AAs (r = .55, p = .005 and r = .41, p = .003 respectively).
Early screening for hypertension is needed to improve health among AAs. Health providers should use American Academy of Pediatrics (AAP) guidelines for determining hypertension in children. Research on familial and environment influences on BP among children is recommended to determine early risk for hypertension development.
children; blood pressure; African American; risks
Representing 1 in 6 children in the United States, Latino children incur disproportionate exposures to air pollutants, pesticides, and toxic industrial chemicals, as well as lead and mercury from candy, traditional folk remedies, religious practices, and other sources. Latino children also have higher rates of asthma, lead and mercury poisoning, behavioral and developmental disorders, and certain cancers. Concurrent exposure to multiple pollutants, pre-existing disease, poor nutrition, substandard housing, limited access to health care, and other factors related to their lower socioeconomic status increase Latino children's susceptibility to environmental contaminants. Targeted research, education, prevention and intervention efforts, and economic development initiatives are needed.
Asthma control requires assessment of nighttime symptoms and sleep disruption. Cognitive and emotional development enables most school age children to report nocturnal problems but providers often rely only on parental report potentially limiting the comprehensiveness of their assessments and their ability to support the child’s emerging efforts at shared management of their illness. This study investigated parent-child concordance in report of nighttime respiratory symptoms, sleep disruption and quality of sleep in a sample of 9–11 year old children with asthma. Secondarily, similar concordance patterns in an equal number of dyads where the child was asthma free were examined, to illustrate the potential influence of asthma.
Parents and children completed one-week diaries in their homes without confiding in one another. The probability of knowing the child’s report on a specific item if the parent’s report was known was assessed using contingency tables.
Within the asthma group, parent-child reports differed significantly across all symptoms and sleep parameters. Parents most often reported fewer symptoms and awakenings and better quality of sleep than their child. Concordance rates were lowest for morning perceptions of tiredness, sleepiness and alertness in both asthma and non-asthma groups.
Both parents and school age children with asthma need to be asked about nighttime asthma symptoms, sleep and morning perceptions when attempting to evaluate asthma control. Assessment of sleep in all children should include parent and child reports and would benefit by the addition of objective measures.
Understanding cardiovascular disease (CVD) risk factors among Chinese American children would allow us to target individuals in this group who are at the greatest risk for developing CVD early in life. The purpose of this study is to examine cardiovascular risk factors (increased blood pressure [BP], total cholesterol, low-density lipoproteins, triglycerides, decreased high-density lipoproteins, and increased body mass index [BMI]) in Chinese American children.
A cross-sectional design was used. A total number of 65 children, aged 8 to 10 years, and their mothers participated in the study. Measurements of the children’s weight, height, BP, blood sample, level of physical fitness, activity level, and dietary intake were collected. Mothers completed questionnaires regarding family history of CVD and level of acculturation.
A low level of physical activity and high paternal BMI were associated with higher systolic BP in the children. A low level of physical activity was also found to be a risk factor for higher LDL and systolic BP in the children. A high birth weight and lower parental acculturation level were risk factors for higher BMI in the children.
The findings suggest that a low level of physical activity and high BMI are associated with increased risk of CVD in Chinese American children. The development of culturally appropriate programs that promote an active lifestyle and reduce weight is critical in CVD prevention in Chinese American populations.
The purpose of this paper is to describe the language ability and school functioning of early adolescents with perinatal HIV/AIDS.
Participants included 43 youths, 9–15 years, and their primary caregivers. Youths completed the Peabody Picture Vocabulary Test (PPVT) and the Reading Subtest of the Wide Range Achievement Test (WRAT3), and were interviewed regarding their future educational aspirations and parental supervision and involvement with homework. Caregivers were interviewed regarding the child’s school achievement, parental supervision and monitoring, and educational aspirations for their child.
Fifty-four percent of youths scored below average (<25th percentile) on the PPVT, and 29% scored <10th percentile; 40% scored below average (<25th percentile) on the WRAT3, and 24% scored <10th percentile. Scores were associated with parental monitoring and educational aspirations.
Youths performed poorly on tests of verbal and reading ability, although not dissimilar to other samples of inner-city youths. Future research should attempt to isolate the impact of HIV disease on intellectual and school functioning of HIV+ youths.
perinatal HIV infection; verbal ability; reading ability
Birth weight often is used to predict how preterm infants will grow, but scant attention has been paid to the effect of neonatal morbidities on growth trajectories. We investigated birth weight and neonatal morbidity in preterm infants' growth to age 12 years.
A five-group, prospective, longitudinal study was conducted with 194 infants: 46 full term; 29 healthy preterm without morbidity; 56 preterm with medical illness (MPT); 34 preterm with neurologic illness; and 29 preterm small for gestational age (SGA). Height, weight, and body mass index were measured at six ages.
The full-term group had greater height than the preterm groups to age 8 years, when healthy preterm and MPT groups caught up. Only the SGA group had smaller height at age 12 years. The MPT, preterm with neurologic illness, and SGA groups had lower weight through age 12 years. Body mass index was appropriate for preterm groups by age 4 years. Across time, neonatal morbidity had a significant effect on height and weight trajectories. Birth weight was significant for weight trajectories only.
With variation in growth trajectories, details of neonatal morbidity in health history interviews will inform child health assessments.
Limited clinical and research data are available on early renal and cardiovascular complications in youth with diabetes. The possible associations of elevated microalbuminuria to creatinine (MC) ratios with heart rate variability (HRV) were explored in adolescents with type 1 (T1DM) or type 2 (T2DM) diabetes.
A descriptive study was conducted with 41 adolescents with diabetes (n = 31 T1DM vs. n = 10 T2DM). Twenty-four hour Holter recordings for determining HRV, urine spot checks for MC ratio, and the most recent measures of glycosylated hemoglobin (A1c) were obtained.
HRV was significantly lower in the T2DM group, while BMI percentile, triglycerides and diastolic blood pressure were significantly higher. For the T1DM group, clinical case examples provided evidence of elevated MC ratios (> 30μg/mg) occurring in two females who also had decreased HRV measures.
Although HRV was not significantly associated with MC ratios for the sample, individual clinical findings can be a warning sign for some adolescents with diabetes. Current recommendations for screening of early renal complications and associated treatment are provided.
Among rural children with asthma and their parents, this study examined the relationship between parental and child reports of quality of life and described the relationship of several factors such as asthma severity, missed days of work and asthma education on their quality of life.
Two hundred and one rural families with asthma were enrolled in a school-based educational program. Intervention parents and children received interactive asthma workshop(s), asthma devices and literature. Parent and child quality of life measurements were obtained pre and post intervention using Juniper's Paediatric Caregivers Quality of Life and Juniper's Paediatric Quality of Life Questionnaires. Asthma severity was measured using criteria from the National Asthma Education and Prevention Program (NAEPP) guidelines.
There was no association between parent and child total quality of life scores, and mean parental total quality of life scores were higher at baseline and follow-up than those of the children. All the parents' quality of life scores were correlated with parental reports of missed days of work. For all children, emotional quality of life (EQOL) was significantly associated with parental reports of school days missed (p= .03) and marginally associated with parental reports of hospitalizations due to asthma (p=.0.08). Parent's emotional quality of life (EQOL) and activity quality of life (AQOL) were significantly associated with children's asthma severity (EQOL, p=.009, AQOL, p=0.03), but not the asthma educational intervention. None of the child quality of life measurements were associated with asthma severity.
Asthma interventions for rural families should help families focus on gaining and maintaining low asthma severity levels in order for families to enjoy an optimal quality of life. Health care providers should try to assess the child's quality of life at each asthma care visit independently of the parents.