http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Developmental/Behavior" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/124/5/e817?rss=1 OBJECTIVE: We examined whether an association between preterm birth and risk of autistic disorders could be explained by pregnancy complications or neonatal morbidity. METHODS: This Swedish, population-based, case-control study included 1216 case subjects with autistic disorders who were born between 1987 and 2002 and 6080 control subjects who were matched with respect to gender, birth year, and birth hospital. We assessed associations between gestational age and autistic disorders and adjusted for maternal, birth, and neonatal characteristics. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Compared with infants born at term, the unadjusted ORs for autistic disorders among very and moderately preterm infants were 2.05 [95% CI: 1.26-3.34] and 1.55 [95% CI: 1.22-1.96], respectively. When we controlled for maternal, pregnancy, and birth characteristics, ORs were reduced to 1.48 [95% CI: 0.77-2.84] and 1.33 [95% CI: 0.98-1.81], respectively. When we also controlled for neonatal complications, ORs were 0.98 [95% CI: 0.45-2.16] and 1.25 [95% CI: 0.90-1.75], respectively. Reductions in risks of autistic disorders related to preterm birth were primarily attributable to preeclampsia, small-for-gestational age birth, congenital malformations, low Apgar scores at 5 minutes, and intracranial bleeding, cerebral edema, or seizures in the neonatal period. Neonatal hypoglycemia, respiratory distress, and neonatal jaundice were associated with increased risk of autistic disorders for term but not preterm infants. CONCLUSION: The increased risk of autistic disorders related to preterm birth is mediated primarily by prenatal and neonatal complications that occur more commonly among preterm infants. Buchmayer, S. Johansson, S. Johansson, A. Hultman, C. M. Sparen, P. Cnattingius, S. 2009-11-01 doi:10.1542/peds.2008-3582 Can Association Between Preterm Birth and Autism be Explained by Maternal or Neonatal Morbidity? American Academy of Pediatrics 5 124 825 817 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/5/1395?rss=1 OBJECTIVES: The reported increasing prevalence of autism spectrum disorder (ASD) and attendant health and family impact make monitoring of ASD prevalence a public health priority. METHODS: The prevalence of parent-reported diagnosis of ASD among US children aged 3 to 17 years was estimated from the 2007 National Survey of Children's Health (sample size: 78037). A child was considered to have ASD if a parent/guardian reported that a doctor or other health care provider had ever said that the child had ASD and that the child currently had the condition. The point-prevalence for ASD was calculated for those children meeting both criteria. We examined sociodemographic factors associated with current ASD and with a past (but not current) ASD diagnosis. The health care experiences for children in both ASD groups were explored. RESULTS: The weighted current ASD point-prevalence was 110 per 10,000. We estimate that 673,000 US children have ASD. Odds of having ASD were 4 times as large for boys than girls. Non-Hispanic (NH) black and multiracial children had lower odds of ASD than NH white children. Nearly 40% of those ever diagnosed with ASD did not currently have the condition; NH black children were more likely than NH white children to not have current ASD. Children in both ASD groups were less likely than children without ASD to receive care within a medical home. CONCLUSIONS: The observed point-prevalence is higher than previous US estimates. More inclusive survey questions, increased population awareness, and improved screening and identification by providers may partly explain this finding. Kogan, M. D. Blumberg, S. J. Schieve, L. A. Boyle, C. A. Perrin, J. M. Ghandour, R. M. Singh, G. K. Strickland, B. B. Trevathan, E. van Dyck, P. C. 2009-11-01 doi:10.1542/peds.2009-1522 Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007 American Academy of Pediatrics 5 124 1403 1395 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/4/e633?rss=1 OBJECTIVE: The objective of this study was to assess the usefulness of the Academic Performance Questionnaire (APQ) to identify low reading and math achievement in children who are being evaluated for attention-deficit/hyperactivity disorder (ADHD). METHODS: Charts of 997 patients who were seen in a multidisciplinary ADHD evaluation program were reviewed. Patients who were in first- through sixth-grade and had complete APQ and Wechsler Individual Achievement Test II Basic Reading and Numerical Operations subtests were enrolled in this study. The 271 eligible patients were randomly assigned to a score-development group (n = 215) and a validation group (n = 56). By using data from the score-development sample, APQ questions that predicted low academic achievement were identified and the scores for these questions were entered into a logistic regression to identify the APQ questions that independently predicted low achievement. RESULTS: Only 2 APQ questions, 1 about reading and 1 about math, independently predicted low achievement. By using these 2 questions, the area under the receiver operating characteristic curve was 0.834, and the optimal combination of sensitivity and specificity occurred when the total score for the 2 items was >4. This cutoff had a sensitivity of 0.86 and a specificity of 0.63 in the score-development group and a sensitivity of 1.0 and a specificity of 0.53 in the validation sample. CONCLUSIONS: The APQ may be a useful screening tool to identify children being evaluated for ADHD who need additional testing for learning problems. Although the predictive value of a negative screen on the APQ is good, the predictive value of a positive test is relatively low. Bennett, A. E. Power, T. J. Eiraldi, R. B. Leff, S. S. Blum, N. J. 2009-10-01 doi:10.1542/peds.2009-0143 Identifying Learning Problems in Children Evaluated for ADHD: The Academic Performance Questionnaire American Academy of Pediatrics 4 124 639 633 2009-10-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/4/e705?rss=1 OBJECTIVES: The goals were to investigate parents' and early intervention (EI) specialists' beliefs and experiences regarding discussing child development in primary care and to identify communication barriers and opportunities. METHODS: Focus groups were held with (1) mothers of young children with typical development, (2) mothers of young children who received EI services, and (3) EI specialists. Seven groups (N = 46 participants) were conducted in the greater Cleveland, Ohio, area. Meetings were audio-recorded, transcribed, coded, and analyzed, to identify themes. RESULTS: Most mothers reported a preference for a nonalarmist style of communication when developmental delays are suspected. In contrast, some mothers preferred a more direct style, including the use of labels to help them understand their child's development. The importance of preparation to accept information about developmental delays emerged as a theme in all groups. Elements contributing to preparedness included information about expected developmental skills, suggestions for promoting skills, and a specific time frame for follow-up evaluation. Mothers of children with disabilities perceived that early reassurance of normalcy by providers in response to their concerns led to self-doubt and increased difficulty accepting the diagnosis. CONCLUSIONS: Mothers and EI specialists have clear ideas about factors that promote or impede communication regarding child development. This information can inform primary care providers' approaches to monitoring and screening the development of young children and to communicating with parents regarding suspected developmental delays. Sices, L. Egbert, L. Mercer, M. B. 2009-10-01 doi:10.1542/peds.2009-0286 Sugar-coaters and Straight Talkers: Communicating About Developmental Delays in Primary Care American Academy of Pediatrics 4 124 713 705 2009-10-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/4/e782?rss=1 OBJECTIVE: The objective of this study was to systematically review evidence from controlled trials on the efficacy of motor development interventions in young children. METHODS: A literature search of interventions was conducted of 14 electronic databases. Three reviewers independently evaluated studies to determine whether they met the inclusion criteria. Studies were compared on 5 components: design, methodologic quality, intervention components, efficacy, and alignment with the Consolidated Standard of Reporting Trials (CONSORT) and Transparent Reporting of Evaluation with Nonrandomized Designs (TREND) statements. RESULTS: Seventeen studies met the inclusion criteria. More than half (65%) were controlled trials and delivered at child care settings or schools (65%). Three studies had high methodologic quality. Studies were [~]12 weeks in duration and delivered by teachers, researchers, and students. Parents were involved in only 3 studies. Nearly 60% of the studies reported statistically significant improvements at follow-up. Three studies aligned with the CONSORT and TREND statements. CONCLUSIONS: This review highlights the limited quantity and quality of interventions to improve motor development in young children. The following recommendations are made: (1) both teachers and researchers should be involved in the implementation of an intervention; (2) parental involvement is critical to ensuring transfer of knowledge from the intervention setting to the home environment; and (3) interventions should be methodologically sound and follow guidelines detailed in the CONSORT or TREND statement. Riethmuller, A. M. Jones, R. A. Okely, A. D. 2009-10-01 doi:10.1542/peds.2009-0333 Efficacy of Interventions to Improve Motor Development in Young Children: A Systematic Review American Academy of Pediatrics 4 124 792 782 2009-10-01 REVIEW ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/4/1009?rss=1 OBJECTIVE: Our objective was to determine the impact of Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care on length of stay of very low birth weight (VLBW) infants. Secondary outcome measures were days of ventilation, incidence of chronic lung disease, and 18-month neurodevelopmental outcomes. METHODS: This cluster-randomized, controlled trial took place in a large NICU in Canada, with follow-up evaluation at 18 months of age, from September 1999 to September 2004. One hundred VLBW singleton infants and 10 VLBW twin sets were assigned randomly to NIDCAP-based or control care, and 90% participated in follow-up assessments. The intervention was NIDCAP-based care (N = 56), that is, care by NIDCAP-educated staff members and behavioral observations. The control group (N = 55) received standard NICU care. Statistical analyses were adjusted for cluster randomization. Although the intervention was not blinded, the pediatricians making the decisions to discharge the infants were not involved in the study, and the follow-up staff members were blinded with respect to group. RESULTS: NIDCAP group infants had reduced length of stay (median: NIDCAP: 74 days; control: 84 days; P = .003) and incidence of chronic lung disease (NIDCAP: 29%; control: 49%; odds ratio: 0.42 [95% confidence interval: 0.18-0.95]; P = .035). At 18 months of adjusted age, NIDCAP group infants had less disability, specifically mental delay (NIDCAP: 10%; control: 30%; odds ratio: 0.25 [95% confidence interval: 0.08-0.82]; P = .017). CONCLUSION: NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly. Peters, K. L. Rosychuk, R. J. Hendson, L. Cote, J. J. McPherson, C. Tyebkhan, J. M. 2009-10-01 doi:10.1542/peds.2008-3808 Improvement of Short- and Long-Term Outcomes for Very Low Birth Weight Infants: Edmonton NIDCAP Trial American Academy of Pediatrics 4 124 1020 1009 2009-10-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/4/1213?rss=1 In the early 1980s, Als conceptualized the "synactive" theory of child development and established the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).1,2 This program requires trained caregivers to observe neonatal behaviors before, during, and after caregiving interventions and provide recommendations for care by staff and parents. These recommendations are often generalized to include reductions in noise and light levels, aids to promote flexion and self-regulation, clustering of care, and parental involvement. Authors who have performed meta-analyses regarding NIDCAP have concluded that the evidence to support NIDCAP as a framework within which to provide developmental care to improve medical and developmental outcomes is inconclusive.3- ... Ohlsson, A. 2009-10-01 doi:10.1542/peds.2009-1884 NIDCAP: New Controversial Evidence for Its Effectiveness American Academy of Pediatrics 4 124 1215 1213 2009-10-01 COMMENTARIES http://pediatrics.aappublications.org:80/cgi/content/short/124/3/e380?rss=1 OBJECTIVE: To examine whether the association between childhood IQ and later mortality risk was explained by early developmental advantages or mediated by adult sociodemographic factors and health behaviors. PARTICIPANTS AND METHODS: Participants were 10 620 men and women from the 1958 British Birth Cohort Study whose IQ was assessed at the age of 11 years and who were followed up to age 46. Childhood covariates included birth weight, childhood height at 11 years of age, problem behaviors, father's occupational class, parents' interest in child's education, family size, and family difficulties. Adult risk factors were assessed at ages 23, 33, and 42 years, and they included education, occupational class, marital status, smoking, BMI, alcohol use, and psychosomatic symptoms. RESULTS: Between ages 23 and 46 years, 192 participants died. Higher childhood IQ was related to lower mortality risk (standardized odds ratio [OR]: 0.80 [95% confidence interval (CI): 0.69-0.93]) with no gender differences (OR: 0.81 [95% CI: 0.67-0.98] [men] and 0.79 [95% CI: 0.63-0.98] [women]). Adjusting for parents' interest in child's education attenuated the IQ-mortality association by 15% to 20%, and adult education and psychosomatic symptoms both attenuated the association by 25%. Other covariates were less influential. CONCLUSIONS: In a cohort of British men and women, the most important explanatory factors for the lower mortality rate among individuals with high IQ were parental interest in child's education, high adult educational level, and low prevalence of psychosomatic symptoms. However, common sociodemographic risk factors and health behaviors may not be sufficient to explain the association between IQ and early mortality completely. Jokela, M. Batty, G. D. Deary, I. J. Gale, C. R. Kivimaki, M. 2009-09-01 doi:10.1542/peds.2009-0334 Low Childhood IQ and Early Adult Mortality: The Role of Explanatory Factors in the 1958 British Birth Cohort American Academy of Pediatrics 3 124 388 380 2009-09-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/124/3/e532?rss=1 OBJECTIVE: Although the efficacy of meditation interventions has been examined among adult samples, meditation treatment effects among youth are relatively unknown. We systematically reviewed empirical studies for the health-related effects of sitting-meditative practices implemented among youth aged 6 to 18 years in school, clinic, and community settings. METHODS: A systematic review of electronic databases (PubMed, Ovid, Web of Science, Cochrane Reviews Database, Google Scholar) was conducted from 1982 to 2008, obtaining a sample of 16 empirical studies related to sitting-meditation interventions among youth. RESULTS: Meditation modalities included mindfulness meditation, transcendental meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy. Study samples primarily consisted of youth with preexisting conditions such as high-normal blood pressure, attention-deficit/hyperactivity disorder, and learning disabilities. Studies that examined physiologic outcomes were composed almost entirely of African American/black participants. Median effect sizes were slightly smaller than those obtained from adult samples and ranged from 0.16 to 0.29 for physiologic outcomes and 0.27 to 0.70 for psychosocial/behavioral outcomes. CONCLUSIONS: Sitting meditation seems to be an effective intervention in the treatment of physiologic, psychosocial, and behavioral conditions among youth. Because of current limitations, carefully constructed research is needed to advance our understanding of sitting meditation and its future use as an effective treatment modality among younger populations. Black, D. S. Milam, J. Sussman, S. 2009-09-01 doi:10.1542/peds.2008-3434 Sitting-Meditation Interventions Among Youth: A Review of Treatment Efficacy American Academy of Pediatrics 3 124 541 532 2009-09-01 REVIEW ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/3/e490?rss=1 OBJECTIVE. The objective of this study was to estimate the prevalence of developmental and behavioral disorders in a convenience sample of children in an acute care pediatric hospital setting. We hypothesized that hospitalized children would have a higher prevalence of developmental and behavioral disorders than the general population. METHODS. Data for this cross-sectional study were collected during interviews with primary caregivers of 325 children from infancy throughout childhood who were admitted to a general pediatric service. Screening tests included the Child Development Inventory (3 months to 6 years), Parents' Evaluation of Developmental Status (0-8 years), Pediatric Symptom Checklist (4-18 years), and Vanderbilt Attention-Deficit/Hyperactivity Disorder Parent Rating Scale (6-18 years). Children were classified as having a known developmental and behavioral disorder, a suspected developmental and behavioral disorder, or no developmental and behavioral disorder. RESULTS. The prevalence of developmental and behavioral disorders among the hospitalized children 6 months to 17 years of age was 33.5%. A total of 72 children (22.1%) had known developmental and behavioral disorders and 37 (11.4%) had suspected developmental and behavioral disorders. This high prevalence of developmental and behavioral disorders included high rates of cerebral palsy (6.1%) and mental retardation or developmental delay (8.6%). CONCLUSION. Hospitalization for treatment of acute conditions provides another opportunity for developmental surveillance. This higher prevalence of developmental and behavioral disorders in hospitalized children emphasizes the need to screen for developmental disabilities at every opportunity. Strategies to implement systematic screening of hospitalized children should be examined. Petersen, M. C. Kube, D. A. Whitaker, T. M. Graff, J. C. Palmer, F. B. 2009-03-01 doi:10.1542/peds.2008-2750 Prevalence of Developmental and Behavioral Disorders in a Pediatric Hospital American Academy of Pediatrics 3 123 495 490 2009-03-01 ARTICLES