Issues of Developmental Measurement in Clinical Research and Practice Settings with Children Who Were Prenatally Exposed to Drugs

Health care providers in clinical and research settings assess the developmental status of increasing numbers of infants and children who were prenatally exposed to drugs. Although assessment of these infants is similar to that of other at-risk infants, limitations and other issues of assessment may be overlooked given societal concerns about drug exposure. In order to meet the evaluation nneeds of children who were prenatally exposed to drugs, providers must know the limitations associated with the process and instrumentation of assessment, and address the shortcomings of evaluation itself. We review the issues and provide recommendations for change related to measurement; sources of bias; specificity and sensitivity of assessment tools; longitudinal assessment; and multidimensional approaches to assessment.     

Findings and Implications of Developmental Screening for High-Risk Children Referred to a Tertiary Developmental Disability Center

IntroductionThe primary goal of this article is to describe an intake process and results of screening for developmental and autism spectrum disorders in children referred to a tertiary center. A secondary analysis of abnormal screening results, demographic variables, and parental concerns of autism was conducted, along with a correlation analysis between developmental and autism-specific screening tools.MethodsA total of 379 children younger than 6 years were “prescreened” with the Ages and Stages Questionnaire-3 and the Modified Checklist for Autism in Toddlers or the Social Communication Questionnaire. Medical records were reviewed to identify demographic variables and parental primary concerns.ResultsIn approximately 11% of participants who screened positive for autism, no parental concerns of autism were present. Medium effect size correlations were found between the failed autism screening tools and delays in two domains on the Ages and Stages Questionnaire-3.DiscussionClinical implications are addressed concerning diligent use of developmental and autism-specific rating scales to identify children at risk.     

Cost Effects of a Health Coaching in Children and Adolescents With Mental Health and Developmental Disorders

ObjectiveHealth coaching (HC) aims to strengthen the role of primary care pediatricians in the treatment of children and adolescents with mental health and developmental disorders by extending consultation time and using disease-specific manuals. We evaluated the effect of HC on costs of specialized, pediatrician, and overall care.MethodsIn a retrospective cohort study based on German health insurance claims data, we identified children aged up to 17 years with a newly diagnosed mental health and/or developmental disorder between 2013 and 2015. Patients getting HC were matched to patients receiving usual care. Costs were calculated for 1 year following the start of the treatment and compared by 2-part and gamma models. Absolute costs and cost differences were calculated with bootstrapped 95% confidence intervals (CI).ResultsWe compared 5597 patients receiving HC with 5597 control patients. The probability of incurring specialized care costs was similar between the groups (0.96, 95% CI: 0.88; 1.05). However, for those who did incur costs, specialized care costs were significantly lower for HC-treated patients (0.77, 95% CI: 0.63; 0.93). Accordingly, specialized care costs were lower by €-94 (95% CI: €-175; €-18), while pediatrician care costs were higher for HC-treated patients by €57 (95% CI: €49; €64). Hence, overall costs did not differ between the groups (€-59, 95% CI: €-191; €71).ConclusionProvision of HC has the potential to lower the costs of specialized care, while increasing the costs of pediatrician care. Overall costs did not differ, suggesting that the additional costs incurred by the HC were offset.     

Malaise Scores in Adulthood of Children and Young People Who Have Been in Care

Data from the National Child Development Study are used to assess the risk of high Malaise scores (indicating a tendency towards depression) amongst young adults at age 23 and 33. Results indicate that adults who have been in care are more likely to have high Malaise scores than are those who have not been in care. For men this risk increases as they grow older. Those with an early experience of social disadvantage are also more vulnerable to a high Malaise score than those not so disadvantaged. Overall, when other factors are controlled, the risk of a high Malaise score in adulthood is significantly greater for young adults who have been in care than those who have experienced severe social disadvantage in their childhood, except for women at age 33, where an early experience of social disadvantage carries a greater risk than the care experience.     

Evaluation of Neurodevelopment and Factors Affecting it in Children With Acyanotic Congenital Cardiac Disease

Background:

The rate of congenital heart disease is 0.8% in all live births. The majority of this, however, is acyanotic congenital heart disease. The survival rate of children with cardiac disease has increased with the developments provided in recent years and their lifetime is extended.

Objectives:

This study aims to evaluate neurodevelopment of children with uncomplicated acyanotic congenital heart disease in preschool period and determine the factors affecting their neurodevelopmental process.

Patients and Methods:

132 children with acyanotic congenital heart disease aged 6 - 72 months were involved in the study. Mental development and intelligence levels of patients under 2 years old were assessed by using Bayley Development Scale-III, and Stanford Binet Intelligence test was employed for patients over 2 years old. Denver Developmental Screening Test II was applied to all patients for their personal-social, fine motor, gross motor and language development.

Results:

The average age of patients (67 girls, 65 boys) included in the study was 35.2 ± 19.6 months. It was determined that there were subnormal mental level in 13 (10%) patients and at least one specific developmental disorder in 33 (25%) patients. Bayley Mental Development Scale score of patients who had received incubator care in perinatal period was found significantly low (88 ± 4.2) compared to those with no incubator care (93.17 ± 8.5) (P = 0.028). Low educational level of father was established to be linked with low mental development scores at the age of 2 and following that age (P < 0.05). Iron deficiency anemia was discovered to be related to low psychometric test scores at every age (P < 0.05).

Conclusions:

Neurodevelopmental problems in children with acyanotic congenital heart disease were found higher compared to those in society. Mental development and intelligence levels of patients were determined to be closely associated with receiving incubator care, father’s educational level and iron deficiency anemia.     

Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.     

Predictors of Unmet Dental Need in Children With Autism Spectrum Disorder: Results From a National Sample

ObjectiveUnmet dental need in children with autism spectrum disorder (ASD) is common. We tested hypotheses that lacking a medical home or having characteristics of more severe ASD is positively associated with having unmet dental need among children with ASD.MethodsUsing data from the 2009 to 2010 National Survey of Children with Special Health Care Needs, we analyzed 2772 children 5 to 17 years old with ASD. We theorized that unmet dental need would be positively associated with not having a medical home and having characteristics of more severe ASD (eg, parent reported severe ASD, an intellectual disability, communication, or behavior difficulties). Prevalence of unmet dental need was estimated, and unadjusted and adjusted odds ratios, 95% confidence intervals, and P values were computed using survey methods for logistic regression.ResultsNationally, 15.1% of children with ASD had unmet dental need. Among children with ASD, those without a medical home were more apt to have unmet dental need than those with a medical home (adjusted odds ratio, 4.46; 95% confidence interval, 2.59–7.69). Children with ASD with intellectual disability or greater communication or behavioral difficulties had greater odds of unmet dental need than those with ASD without these characteristics. Parent-reported ASD severity was not associated with unmet dental need.ConclusionsChildren with ASD without a medical home and with characteristics suggestive of increased ASD-related difficulties were more apt to have unmet dental need. Pediatricians might use these findings to aid in identifying children with ASD who might not receive all needed dental care.     

Reaction Time and Movement Time in Children with a Developmental Coordination Disorder

The Test of Motor Impairment (TOMI) was used to select 12 children with a Developmental Coordination Disorder (DCD) and 12 age-matched controls. In an aiming task, movement latency, movement duration and its variability were significantly prolonged in the DCD group. In a coincidence timing version of the task, absolute timing error was significantly greater in the DCD group. The most robust chronometric effect for differentiating the two groups seemed to be the duration of movement when the target was small. Multiple regression showed that TOMI was a powerful indicator of movement duration.     

Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents.

Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.     

Children with a Pervasive Developmental Disorder, Children with a Language Disorder and Normally Developing Children in Situations with High- and Low-level Involvement of the Caregiver

The social behaviour of tow-functioning children with a Pervasive Developmental Disorder (PDD). high-functioning children with a PDD, children with a Language Disorder (LD) and normally developing children (ND| was investigated in a playroom session while they were iteracting with one of their parents. High-functioning children with a PDD were found to differ from the other groups in social responsivity. Low-functioning children with a PDD differed from high-functioning children with a PDD in the total number of social bids, type of social bids, number of looks at parent and social responsivity. When parents structured the behaviour of their children, this resulted in an increase in number of social bids and looks in the low-functioning children with PDD.     

Transitioning a Research Protocol for Videosomnography to Assess Sleep and Nighttime Caregiving Activities in School-Aged Children With Developmental Disabilities During the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic significantly affected children with developmental disabilities (DDs)' sleep. Videosomnography is a noninvasive, portable time-lapse video recording system to objectively obtain a child's sleep-wake behaviors and parents' caregiving activities in a natural environment.MethodFrom September 2020 to February 2021, we conducted a feasibility study using actigraphy (in mothers) and videosomnography in children with DDs for seven consecutive nights to assess sleep and nighttime caregiving activities. Because of the pandemic, we developed and implemented alternative data collection strategies, such as delivering a “study package” with easy-to-follow written instructions and emailed video-recorded instructions on recording a child's sleep.ResultsWe aimed to enroll 10 mothers and 10 school-aged children with DDs and achieved this goal. Nine out of 10 mothers completed video recordings of their child's sleep, with only 10% missing data for videosomnography.DiscussionThis paper shared adaptations to our videosomnography protocol and lessons learned.     

Prevalence of Overweight and Obesity in a Large Clinical Sample of Children With Autism

BackgroundOverweight and obesity are major pediatric public health problems in the United States; however, limited data exist on the prevalence and correlates of overnutrition in children with autism.MethodsThrough a large integrated health care system's patient database, we identified 6672 children ages 2 to 20 years with an assigned ICD-9 code of autism (299.0), Asperger syndrome (299.8), and control subjects from 2008 to 2011 who had at least 1 weight and height recorded in the same visit. We calculated age-adjusted, sex-adjusted body mass index and classified children as overweight (body mass index 85th to 95th percentile) or obese (≥95th percentile). We used multinomial logistic regression to compare the odds of overweight and obesity between groups. We then used logistic regression to evaluate factors associated with overweight and obesity in children with autism, including demographic and clinical characteristics.ResultsCompared to control subjects, children with autism and Asperger syndrome had significantly higher odds of overweight (odds ratio, 95% confidence interval: autism 2.24, 1.74–2.88; Asperger syndrome 1.49, 1.12–1.97) and obesity (autism 4.83, 3.85–6.06; Asperger syndrome 5.69, 4.50–7.21). Among children with autism, we found a higher odds of obesity in older children (aged 12–15 years 1.87, 1.33–2.63; aged 16–20 years 1.94, 1.39–2.71) compared to children aged 6 to 11 years. We also found higher odds of overweight and obesity in those with public insurance (overweight 1.54, 1.25–1.89; obese 1.16, 1.02–1.40) and with co-occurring sleep disorder (obese 1.23, 1.00–1.53).ConclusionsChildren with autism and Asperger syndrome had significantly higher odds of overweight and obesity than control subjects. Older age, public insurance, and co-occurring sleep disorder were associated with overweight or obesity in this population.     

Developmental outcome in a group of twins: Relation to perinatal factors and general movements

Background

The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins.

Fundamental Movement Skills Development under the Influence of a Gymnastics Program and Everyday Physical Activity in Seven-Year-Old Children

Objective

The objectives of this study were: a) to examine the influence of an 18-week basic artistic gymnastics program on fundamental movement skills (FMS) development in seven-year-old children; b) to determine correlations between children’s daily activities and successful performance of FMS and basic artistic gymnastics skills.

Methods

Seventy five first grade primary school children took part in this study. A physical education teacher specialized in artistic gymnastics conducted a gymnastics program for 18 weeks, three times a week. The level of gymnastics skills and FMS were identified at the beginning and at the end of the program. The level of gymnastics skills was evaluated by performance of eight artistic gymnastics skills, while FMS were evaluated by the use of FMS-polygon. Physical activity and inactivity was evaluated by using a proxy-questionnaire “Netherlands Physical Activity Questionnaire˝ (NPAQ).

Findings

According to the dependent samples t test, significant differences were found in the FMS-polygon and all gymnastics skills before and after the 18-week gymnastics program. Increasing correlations were established over time between gymnastics skills and the FMS-polygon. Unorganized daily activity of children significantly correlated with their mastering of gymnastics skills and FMS. The presented findings confirm: (1) the thesis that basic artistic gymnastics skills and FMS could be developed simultaneously, (2) the theory of positive transfer of similar skills between FMS and artistic gymnastic skills.

Conclusion

Mastering basic artistic gymnastics skills will provoke improvement of FMS and finally become a prerequisite for successful introduction of learning more complex gymnastics skills. The obtained results imply that an increase of children’s unorganized daily activities can improve the mastering of basic gymnastics skills and simultaneously the development of FMS.     

Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy

Aims: Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. Methods: In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. Results: Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. Conclusion: Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.