Identification of developmental-behavioral problems in primary care: a systematic review

Developmental Surveillance and Anticipatory Guidance for Working Parents in Supporting Child Development

Early childhood development shapes lifelong learning and skill development. This paper elucidates developmental surveillance and screening in pediatric care, particularly within the Indian context. Developmental surveillance monitors a child's progress during routine visits using age-appropriate milestone checklists, while developmental screening uses standardized tools at key stages to detect delays early, complementing ongoing surveillance efforts.Various screening tools have been examined, along with the challenges of selecting culturally appropriate instruments, especially in resource-limited settings. The role of Rashtriya Bal Swasthya Karyakram (RBSK) as a structured approach to screening and early intervention that provides comprehensive child health services is highlighted. The importance of anticipatory guidance, which equips parents with the knowledge and strategies to handle childhood challenges before they occur, is emphasized.Working parents face challenges in creating stimulating home environments that support their children's development. Despite time constraints, maximizing quality interactions, choosing appropriate toys, managing screen time, incorporating learning into daily routines, and promoting shared reading can all foster development. Success lies in warm, consistent interactions and transforming daily moments into learning opportunities, rather than relying on expensive resources. Healthcare providers play a vital role in guiding parents with advice and strategies to enhance child development effectively.

Using codesign to engage primary care practices in a participatory change process

Healthcare has experienced significant transformation in recent years with many changes being imposed on practices from outside sources. When tailoring outside interventions to specific settings, it is important to engage practice members in participatory processes. Yet, tailoring remains a difficult and poorly understood element of implementation. Codesign is one method to achieve context-sensitive, bottom-up change by engaging stakeholders in the design process. With a complex adaptive system (CAS) perspective, codesign reframes interventions as tools to empower practices to drive change based on local challenges and experiences rather than change being imposed upon them. Observing adaptations and facilitating innovations of practice members offers insight into dynamics of the CAS, implementation context, and its limitations. Here, the codesign process is illustrated through a pediatric primary care practice adopting integrated health. Contextual inquiry was performed using ethnographic observations to identify barriers and facilitators to integrated health. Observation findings informed codesign workshops with clinicians. Workshop transcripts and drawings were analyzed using an immersion/crystallization approach guided by the Practice Change Model (PCM), an established framework based on complexity science concepts. In these workshops, clinicians described tension between their motivations to care for complex patients and limitations imposed by the health system. Participants' knowledge of their real-world context allowed them to identify resources and opportunities for changes they could make within their current environment. The reconciliation of the ideal and the real is a core benefit of codesign methods. This innovative approach can be applied more generally to support the development, implementation, and evaluation of interventions that reflect real world interactions and complexities.

Screening for psychological problems in deaf and hard of hearing students

This paper reports upon an evaluation of a school-based screening program aimed at detecting psychological problems1 in 495 deaf and hard of hearing (DHH) students. The first aim of the study was to evaluate the actual implementation of this program. Furthermore, the prevalence of internalizing and externalizing problems in a subset of 277 DHH students was analysed and subsequently how these problems vary as a function of age, gender, context, and negative life circumstances (NLCs). The results show higher prevalence rates of psychological problems compared to typical hearing peers, but lower than in previous studies. More problems were observed in the context of school than at home. No age or gender differences were found, but significantly more internalizing problems in DHH adolescents than externalizing problems. Prevalence of psychological problems among DHH students without NLCs were significantly lower than among students with one or more NLCs. The results shows a screening program to identify psychological problems in special schools can be successfully implemented. Such programs will help to identify psychological problems at an early stage and provide care for DHH children and adolescents with psychological problems.

Challenges and Opportunities: Identification and Monitoring of Attention-Deficit/Hyperactivity Disorder in Pediatrics

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that typically presents in childhood and can cause significant impairment from youth into adulthood across multiple settings (eg, school, home). Pediatricians are the most likely health professionals to identify and treat ADHD. However, ADHD symptoms often overlap with other common mental health disorders, making accurate identification challenging. The diagnosis of ADHD relies on a combination of history gathering, screening tools, and clinical judgment. In this article, we review tools and strategies for ADHD identification, assessment, and treatment monitoring in primary care pediatrics. [Pediatr Ann. 2025;54(1):e6-e11.].

Pediatric clinicians' perspectives on assessing concerns about young children's social-emotional wellbeing in primary care

We surveyed pediatric primary care clinicians working in Federally Qualified Health Centers about their perceptions of children's social-emotional wellbeing. We identified clinician's current methods for assessing social-emotional wellbeing in practices, perceived implementation barriers to providing behavioral health care, and interest in adopting a validated, low-burden developmentally sensitive parent-report instrument for screening for social-emotional wellbeing in young children. We surveyed 72 PCCs working in FQHCs from 9 US states. Analyses included examining central tendencies, correlations, analysis of variance, and group differences via t-tests. Average PCC perceptions of social-emotional wellbeing importance for overall health were statistically significantly higher than their confidence in providing care for common social-emotional wellbeing concerns (mean difference = 1.31, 95% CI = 1.13-1.49). PCCs expressed low satisfaction with currently available screening measures for identifying concerns in social-emotional wellbeing. Fewer than half of clinicians reported using any standardized parent-reported measure for identifying concerns in social-emotional wellbeing. Assessment methods and decision tools that improve clinician confidence concerning risk indications are needed, particularly at the critical early childhood period. Policymakers and payers ought to facilitate funding mechanisms that support pediatric PCCs in identifying early concerns in social-emotional wellbeing and providing referral guidance to evidence-based interventions to support parents and caregivers.

Mental Health Screening and Measurement in Children and Adolescents

Approximately 20% of children experience a mental, emotional, or behavioral health problem each year and 40% will meet criteria for a disorder by the age of 18 years. The American Academy of Pediatrics now recommends global and domain-specific screening at every routine health maintenance visit starting in infancy. Based on US Preventative Services Task Force recommendations, anxiety screening should begin after the age of 8 years and depression and suicide risk screening after the age of 12 years. Screening should be combined with ongoing surveillance to ensure a comprehensive program to detect children with mental, emotional, and behavior problems.

Validation of the autism behavior checklist in Egyptian children with autism spectrum disorder

This study was designed to validate the Arabic version of the Autism Behavior Checklist (ABC) for the Egyptian population. A total of 500 mothers of children aged 4-14 years, of whom 150 had a diagnosis of ASD, 100 with intellectual disability, and 250 typically developing children completed the ABC. The factor analysis showed that 48 of 57 ABC items yielded a five-dimensional factor structure. The ABC-Arabic version indicated acceptable internal consistency (α = 0.85) and test - retest reliability (0.82). Also, the ABC exhibited good concurrent validity and discriminative validity. A cutoff score of 58 obtained a sensitivity of 94.7% and a specificity of 92.14% for detecting children with ASD. Our findings support the use of the ABC as a valid screening measure for ASD cases, and it may promote the use of the ABC for clinical and research purposes among Arabic-speaking communities.

Cerebral palsy in children: A clinical practice review

Cerebral palsy is a disorder characterized by abnormal tone, posture, and movement. In clinical practice, it is often useful to approach cerebral palsy based on the predominant motor system findings - spastic hemiplegia, spastic diplegia, spastic quadriplegia, extrapyramidal or dyskinetic, and ataxic. The prevalence of cerebral palsy is between 1.5 and 3 per 1,000 live births with higher percentage of cases in low to middle income countries and geographic regions. Pre-term birth and low birthweight are recognized as the most frequent risk factors for cerebral palsy; other risk factors include hypoxic-ischemic encephalopathy, maternal infections, and multiple gestation. In most cases of cerebral palsy, the initial injury to the brain occurs during early fetal brain development. Intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop spastic cerebral palsy. The diagnosis of cerebral palsy is primarily based on clinical findings. Early recognition of infants at risk for cerebral palsy as well as those with cerebral palsy is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging; however, in clinical practice, cerebral palsy is more reliably diagnosed by 2 years of age. Magnetic resonance imaging scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic testing and tests for inborn errors of metabolism are indicated to identify specific disorders, especially treatable disorders. Because cerebral palsy is associated with multiple associated and secondary medical conditions, its management requires a sustained and consistent collaboration among multiple disciplines and specialties. With appropriate support, most children with cerebral palsy grow up to be adults with good functional abilities.

Addressing Child and Adolescent Mental Health Problems in the Community. Evaluation of a Consultation and Advise Team for Assessment, Support and Referral

Introduction

Youths with mental health problems are often not identified in primary healthcare, which may prevent or delay appropriate support. In the Netherlands, a Consultation and Advise expert team (CandA team) was implemented to support general practitioners (GPs), youth professionals and youths with mental health problems. This study investigates the team's scope, activities, stakeholders' and users' experiences.

Method

Interviews and focus groups with policymakers, healthcare professionals, parents and youths were analysed using ATLAS.ti. Demographics and mental health problems of 706 youths (0-18 years) consulting the CandA team, type of healthcare providers consulting the team, and type of care provided by the team (2015-2017) were analysed, using descriptive statistics and Chi-square tests.

Results

Youths consulted the CandA team for 'other behavioural/psychological complaints' (41%); irritable/angry behaviour (14%); anxious/nervous behaviour (10%); overactivity (8%); feeling down/depressed (6%). CandA team services were used by GPs, youth counsellors, and youth physicians/nurses. Most stakeholders were positive about the team's services.

Conclusion

The CandA team seems an adequate form of integrated assessment and support for youth mental health problems in the community. The team's composition, expertise and positioning are success factors. Cooperation with schools could be improved. Quantitative evaluation is needed to investigate effects of the team and adequacy of referrals.

Prospective associations between early childhood mental health concerns and formal diagnosis of neurodevelopmental disorders in adolescence

Introduction

Understanding associations between psychosocial development in early childhood and formal diagnosis of neurodevelopmental disorders (NDDs) in adolescence is critical for early identification and for tailoring interventions and support. This study investigated whether the Strengths and Difficulties Questionnaire (SDQ) scores in early childhood (4-5 years) predict mental health (MH) problems as evidenced by SDQ scores and formal diagnosis of NDDs in adolescence (16-17 years).

Methods

This study analysed data from a sample of 4968 children and adolescents using data from the Longitudinal Study of Australian Children. We used hierarchical regression models to determine the association between SDQ subscales and total scores at ages 4-5 years (primary exposure) and total SDQ scores and NDD diagnoses at ages 16-17 years (outcomes) whilst controlling for sociodemographic risk factors.

Results

Each unit increase in SDQ score at age 4-5 led to a rise in SDQ scores at age 16-17. Autism and ADHD diagnoses, female gender, lower maternal education, and financial hardship were associated with higher SDQ scores at age 16-17. Furthermore, parent reported SDQ at age 4-5 was linked to higher likelihoods of formal diagnoses of ADHD, autism, and ADHD/autism at age 16-17. Additionally, social determinants of health such as female gender, culturally and linguistically diverse (CALD) backgrounds, and financial hardship were associated with increased odds of ADHD, autism, and ADHD/autism diagnoses at age 16-17.

Conclusion

Our findings highlight the opportunity for early identification of transdiagnostic developmental and MH issues in the preschool period. Findings also emphasise the critical role of social determinants of health in the longitudinal trajectory of MH and NDDs and highlight the need for implementing early supports for improving peer relations and behavioural support strategies. If coupled with wrap around social care, early support strategies can enhance MH and wellbeing in adolescence and beyond.

Screening accuracy and cut-offs of the Polish version of Communication and Symbolic Behavior Scales-Developmental Profile Infant-Toddler Checklist

BACKGROUND

The first stage of diagnosing autism spectrum disorders usually involves population screening to detect children at risk. This study aims to assess the predictive convergent validity of the Polish version of the Communication and Symbolic Behavior Scales-Developmental Profile Infant-Toddler Checklist (CSBS-DP ITC) with the Autism Spectrum Rating Scales (ASRS), evaluate its sensitivity and specificity and assess the cut-off points for the possibility of using this questionnaire in population screening among children aged 6 to 24 months.

METHOD

The study was conducted among 602 children from the general population who had previously participated in the earlier phase of validation of the questionnaire for Polish conditions. The collected data were statistically processed to calculate the accuracy (i.e. sensitivity, specificity) of the questionnaire.

RESULTS

In individual age groups, the sensitivity of the questionnaire varies from 0.667 to 0.750, specificity from 0.854 to 0.939, positive predictive value from 0.261 to 0.4 and negative predictive value-from 0.979 to 0.981. Screening accuracy ranges from 0.847 to 0.923 depending on the age group. The adopted cut-off points are 21 points for children aged 9-12 months, 36 for children aged 13-18 months, 39 for children aged 19-24 months. Cut-off points could not be established for children aged 6-8 months. The convergent validity values with the ASRS ranged from -0.28 to -0.431 and were highest in the group of the oldest children.

CONCLUSIONS

These results indicate that the Polish version of the CSBS-DP ITC can be used as an effective tool for ASD universal screening.

Psychometric properties of the Norwegian version of the Strength and Difficulties Questionnaire in a preschool sample

PURPOSE

The Strength and Difficulties Questionnaire (SDQ) is widely used internationally, however less so in preschool populations and validations studies are thus needed. This study examined the psychometric properties of the Norwegian version parent report of the SDQ - preschool version (SDQ 2-4).

MATERIALS AND METHODS

Parents of 289 Norwegian children in the age span 1-6 years old filled out the SDQ 2-4, the Child Behavior Checklist (CBCL), and background information. Internal consistency, factor structure, and convergent validity were assessed.

RESULTS

The results showed satisfying internal consistency for the total difficulties score, but worse for some of the subscales. The five-factor structure showed a good fit. Good convergent and divergent validity was found in terms of correlations with CBCL. Sex differences were found on all scales, boys scoring higher on all problem scales.

CONCLUSIONS

The SDQ 2-4 can be a promising instrument to screen for emotional and behavioral difficulties among Norwegian preschoolers, particularly in high-risk populations.

Role of Primary Care Clinician Concern During Screening for Early Identification of Autism

OBJECTIVE

The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism.

METHODS

Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24-22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study-before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation.

RESULTS

Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism.

CONCLUSION

The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.

Implementing an Early Detection Program for Autism Spectrum Disorders in the Polish Primary Healthcare Setting-Possible Obstacles and Experiences from Online ASD Screening

A screening questionnaire for autism symptoms is not yet available in Poland, and there are no recommendations regarding screening for developmental disorders in Polish primary healthcare. The aim of this study was to assess the opinions of parents and physicians on the legitimacy and necessity of screening for autism spectrum disorders, potential barriers to the implementation of the screening program, and the evaluation and presentation of the process of online ASD screening, which was part of the validation program for the Polish version of one of the screening tools. This study involved 418 parents whose children were screened online and 95 primary care physicians who expressed their opinions in prepared surveys. The results indicate that both parents and doctors perceive the need to screen children for ASD in the general population without a clear preference as to the screening method (online or in person). Moreover, online screening is considered by respondents as a satisfactory diagnostic method. Therefore, online screening may prove to be at least a partial method of solving numerous obstacles indicated by participants' systemic difficulties including time constraints, the lack of experienced specialists in the field of developmental disorders and organizational difficulties of healthcare systems.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems.    Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review

OBJECTIVE

To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation.

DESIGN

Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting.

RESULTS

Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%).

CONCLUSIONS

The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.

Utilizing screening as a trauma-responsive approach in pediatric health care settings

Given the widespread impact of child trauma, it is important that child- and family-serving systems adopt trauma-informed care. Because of their integral relationships with families, pediatricians and family medicine physicians play critical roles in disrupting negative societal and developmental cascades for trauma-exposed youth through their potential for early identification and intervention. When implemented alongside organization-wide trauma-informed care practices, trauma screening is one concrete trauma-informed care practice that has shown both feasibility and positive impacts on pediatric healthcare. In support of this practice, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) helps pediatric care providers to identify and respond to children and adolescents who may need trauma-focused supports. In this paper we discuss the importance of pediatric physicians adopting trauma-informed care and how evidence-based screening practices in pediatric settings is a trauma-responsive approach with great potential for meeting unmet needs among trauma-exposed children and families.

Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity

Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current "waitlist crisis" for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12-53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n = 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.

Mental Health Screening in Pediatric Primary Care: Factors Associated With Screening Completion and Elevated Scores

This study aimed to examine predictors of complete and elevated youth mental health screens. Parents of 4- to 11-year-old children completed the Strengths and Difficulties Questionnaire (SDQ) during a routine, universal mental health screening initiative in primary care. Bivariate logistic regressions were run to examine associations between independent (visit age, sex, race/ethnicity, language, insurance, and guardian) and dependent variables (screening completion and elevated SDQ score). Parents of younger and Spanish-speaking (vs English-speaking) children were less likely to have a complete SDQ screen. Among those with complete SDQ screens, older children, male children, those with public or no insurance, and those who had a mother (vs father) complete the screener were more likely to have an elevated score. Understanding patterns of screening completion rates and predictors of elevated screens provides valuable information to improve resource mapping and planning. Findings can inform mental health screening implementation and optimization within primary care.

Psychological therapists' perceptions of adolescent depression and its treatment: A mixed methods online survey

BACKGROUND

Challenges to implementating interventions for adolescent depression exist. Exploring the perceptions of key stakeholders in the treatment of adolescent depression is essential for improving implementation . This study aimed to explore psychological therapists' perceptions of, and experiences treating, adolescent depression to identify future avenues for exploration.

METHOD

Data were collected opportunistically via a survey integrated within an e-learning package about adolescent depression.

RESULTS

Participants believed that adolescent depression was characterised by adolescents' lack of understanding, isolation, and a lack of hope and knowledge. Participants overcame engagement barriers by building trust. Following the e-learning, participants expressed increased understanding of the risk factors associated with adolescent depression and of assessment using different measures. Several key areas for future research to explore were identified and discussed, including (1) whether clinicians of different modalities or at different career stages have difference perceptions, (2) how to meaningfully engage adolescents in treatment and (3) how to train clinicians on different modalities so patients have a choice over their treatment.

CONCLUSION

This study demonstrates the value of knowledge gained from understanding psychological therapists' perceptions and illustrates how this can contribute to the improved treatment of adolescent depression.

The Medical Home and Mental Health Services in Children and Youth with Special Health Care Needs

BACKGROUND AND OBJECTIVES

Children and youth with special health care needs (CYSHCN) commonly experience mental health concerns, but conditions are often not identified or treated within primary care. Mental health care is often not a primary focus of pediatric primary care, but the medical home model has potential to address these concerns more adequately. The purpose of this study is to examine the relationship between the medical home and use of mental health services in CYSHCN.

METHODS

Data came from the Medical Expenditure Panel Survey years 2015-2017, a nationally representative survey of health and healthcare in US families. The study included CYSHCN ages 6-17. We compared the use of mental health services, expenditures, and psychotropic medications across CYSHCN with and without a medical home using multivariable regression.

RESULTS

45% of CYSHCN received care within a medical home. CYSHCN with and without a medical home reported similar frequency of office-based mental health visits (21.2% versus 25.2%), average expenditures for visits ($147 versus $128), and psychotropic medications (11.9% versus 15.1%). Medical home status was not associated with office-based mental health visits, use of psychotropic medications, or cost for either.

CONCLUSIONS

CYSHCN with mental health care needs face barriers to satisfactory care. Creating better connections between primary and mental health care could help to ameliorate this problem. Findings suggest the medical home, a more comprehensive primary care model, may not address mental health care needs of CYSHCN.

Psychometric Properties and Validation of the Italian Version of Ages & Stages Questionnaires Third Edition

Objectives: The Ages & Stages Questionnaires Third Version (ASQ-3) identifies the risk of developmental delay in children aged 1 to 66 months. The aim of this study was to determine a reliable and valid instrument for the Italian population to enable the screening of children's development. Methods: Data from 2278 Italian children (age range: 1-66 months) were used to evaluate item discrimination power using the corrected item-total correlation. Internal consistency was analyzed by Cronbach's alpha scores and a Confirmative Factor Analysis was conducted to test the factor structure of the test. Data were also collected to examine the ASQ-3 test-retest reliability and concurrent validity, which was investigated using the Griffiths Scales of Child Development, Third Edition, the Peabody Developmental Motor Scale, Second Edition, and the Developmental Profile, Third Edition tools. In order to evaluate discriminant validity, differences between typical development children and several clinical groups have been performed. Finally, two different cut-off scores have been proposed. Results: The results showed that the questionnaires are composed of high-quality items; the original factor structure has been confirmed and strong Pearson product-moment correlation coefficients between the overall and the total for each domain (ranging from 0.73 to 0.88). The Italian version of the ASQ-3 had adequate internal consistency and a strong agreement between observations with two weeks' intervals. Moreover, the test showed a high discriminant validity due to the possibility of fully discriminating between typical development children and several clinical groups. Finally, two different cut-off scores have been identified using ROC curves in order to have a screening and a diagnostic cut-off value. Conclusion: This study evaluated the psychometric properties of the Italian adaptation of ASQ-3 questionnaires. We demonstrated the validity of the ASQ-3 and determined new cut-off scores for Italian children. Early identification and accurate assessment are important starting points to better understand and anticipate the needs of children and their link to services.

Validation of tool to assess pediatric residents' knowledge of development and behavior

OBJECTIVE

This study aimed to create and validate an instrument to measure pediatric residents' knowledge about development and behavior.

METHODS

This was a longitudinal study with the consecutive application of questionnaires to validate an instrument of analysis. The modified Delphi technique was used for validation, which involved judges who were selected based on their expertise. Judges, who were renowned for their knowledge of the subject and willing to participate, were chosen from different states of Brazil. A convenience sample was obtained. The original questionnaire included 45 open questions divided into 13 relevant thematic axes on development and behavior.

RESULTS

After the third round using the Delphi technique, the whole questionnaire had a validity index of more than 80% on scope and relevance as well as all thematic axes, and the 44 final questions.

CONCLUSIONS

The whole questionnaire was considered validated by the 14 expert judges who participated in the study.

A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children

OBJECTIVE

To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18 years old in California based on levels of current and past child protection system (CPS) involvement.

STUDY DESIGN

In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n = 3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes.

RESULTS

Overall, 14% (n = 470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care.

CONCLUSIONS

Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.

Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months: A Systematic Review and Meta-analysis

Importance

The Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated.

Objectives

To conduct a a systematic review and meta-analysis to evaluate ASQ's utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months.

Data Sources

Medline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021.

Study Selection

Studies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ.

Data Extraction and Synthesis

True positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines.

Main Outcomes and Measures

Ability of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-2SD) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability.

Results

Initial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR, and NLR are as follows: ASQ-2SD to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81 (95% CI, 0.75-0.86), 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-2SD to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41 (95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61 (95% CI, 0.43-0.86). The COE was low/very low.

Conclusions and Relevance

If a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE).

Trial Registration

PROSPERO (CRD42021268543).

Outcomes Accountability Systems for Early Childhood Disruptive Behaviors: A Scoping Review of Availability

Early childhood disruptive behaviors are common mental health problems among American youth, and if poorly-managed, pose costly psychological and societal burdens. Outcomes accountability systems in clinical practice are vital opportunities to optimize early intervention for common mental health problems; however, such systems seem rare. A scoping review was conducted to summarize the current availability of outcomes accountability systems in clinical programs addressing early childhood disruptive behaviors, particularly in the US. We used PsycINFO to identify peer-reviewed literature published in English from 2005 to 2021, from which we selected 23 publications from the US, UK, and Netherlands on outcomes accountability systems within clinical programs treating common childhood mental health problems. Only 3 out of 23 publications described outcomes accountability efforts specifically for early childhood problems. Within the 3 studies, only one UK-based study specifically targeted early childhood disruptive behaviors. We did not find publications specifically describing outcomes accountability efforts in US-based clinical programs to treat early childhood disruptive behaviors. There are multi-level challenges preventing changes to the prevalent US model of paying a fee for each unit of child mental healthcare, with little regard for patient outcomes. However, opportunities exist to improve US-based accountability efforts; from top-down expansion of financial incentives, accountability initiatives, and PDT evidence-based practices to an iterative, bottom-up development of meaningful outcomes measurement by providers. Greater adoption of outcomes monitoring in US clinical practice for common mental health problems can optimize management of early childhood disruptive behaviors and mitigate long-term societal and economic burdens.

Diagnostic Accuracy of Parents' Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones, and PEDS Combined in Indian Children Aged Less than 2 Years

OBJECTIVE

To assess the diagnostic accuracy of Parent's Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones (PEDS:DM) and PEDS Combined for developmental screening of Indian children aged less than 2 y.

METHOD

A hospital-based study of diagnostic accuracy was conducted over 17 mo. Children under 24 mo (n = 180) were enrolled after exclusion of severe illnesses or known neurodevelopment disorders. The index tools included standardized Hindi translations of PEDS and PEDS:DM. The reference tool was Developmental Assessment Scale for Indian Infants (DASII). Both were administered by blinded researchers. Parameters of diagnostic accuracy were computed.

RESULTS

There were 13 (7.2%) failures in PEDS, 119 (66.1%) in PEDS:DM and 119 (66.1%) in PEDS Combined. DASII identified 3 children with developmental delay. Sensitivity (Sn) [95% CI] of PEDS was 33.3 [0.8-90.6] and Specificity (Sp) 93.2 [88.5-96.5]. The Sn and Sp of both PEDS:DM and PEDS Combined were 100 [29.2-100] and 34.5 [27.5-42.0], respectively.

CONCLUSIONS

Hindi translations of PEDS, PEDS:DM and PEDS Combined are not suitable for developmental screening of children less than 2 y due to suboptimal diagnostic accuracy.

Tools for early screening of autism spectrum disorders in primary health care - a scoping review

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests itself in early childhood. Early diagnosis of these disorders allows for the initiation of early therapy, which is crucial for the child's further functioning in society.

OBJECTIVES

This review aims to gather and present the existing ASD screening tools that can be used in primary care and adapted to different countries conditions linguistically and culturally.

ELIGIBILITY CRITERIA

We searched for English-language publications on ASD screening tools for children aged 0-3 years suitable for use in primary care (i.e. free, requiring no additional training or qualifications).

SOURCES OF EVIDENCE

Four databases were explored to find English studies on ASD screening tools intended for the rapid assessment of children aged 0-3.

CHARTING METHODS

The information sought (specific features of the questionnaires relevant to primary health care workers, psychometric and diagnostic values of a given cultural adaptation of screening tools, and the linguistic and cultural changes made) were extracted and collected to create profiles of these tools.

RESULTS

We found 81 studies which met inclusion criteria and underwent full data extraction. Three additional data sources were included. These allowed to create 75 profiles of adaptations for 26 different screening tools and collect data on their psychometric values and characteristic features.

CONCLUSIONS

The results of our study indicate the availability of several diagnostic tools for early ASD screening in primary care setting concordant culturally and linguistically with a given population. They could be an effective method of accelerating the diagnostic process and starting personalized therapy faster. However, most tools have significant limitations - some are only available for research purposes, while others do not have scientific evidence to prove their effectiveness.

Translating RDoC to Real-World Impact in Developmental Psychopathology: A Neurodevelopmental Framework for Application of Mental Health Risk Calculators

The National Institute of Mental Health Research Domain Criteria's (RDoC) has prompted a paradigm shift from categorical psychiatric disorders to considering multiple levels of vulnerability for probabilistic risk of disorder. However, the lack of neurodevelopmentally-based tools for clinical decision-making has limited RDoC's real-world impact. Integration with developmental psychopathology principles and statistical methods actualize the clinical implementation of RDoC to inform neurodevelopmental risk. In this conceptual paper, we introduce the probabilistic mental health risk calculator as an innovation for such translation and lay out a research agenda for generating an RDoC- and developmentally-informed paradigm that could be applied to predict a range of developmental psychopathologies from early childhood to young adulthood. We discuss methods that weigh the incremental utility for prediction based on intensity and burden of assessment, the addition of developmental change patterns, considerations for assessing outcomes, and integrative data approaches. Throughout, we illustrate the risk calculator approach with different neurodevelopmental pathways and phenotypes. Finally, we discuss real-world implementation of these methods for improving early identification and prevention of developmental psychopathology. We propose that mental health risk calculators can build a needed bridge between RDoC's multiple units of analysis and developmental science.

Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review

Context: Parent/caregiver completing developmental screening questionnaires (DSQs) for children before 5 years of age is currently recommended. The DSQs recommended by the American Academy of Pediatrics (AAP) are the Ages and Stages Questionnaires (ASQ), Parents' Evaluation of Developmental Status (PEDS), and the Survey of Well-being of Young Children (SWYC). Nevertheless, their predictive validity has not been well-established. Objective: To assess in the current literature, the value of AAP-recommended DSQs (ASQ, PEDS, SWYC) administered between 0 and 5 years of age, for predicting long-term cognitive achievement and/or school performance (CA/SP), after 1 year or more of evaluation and at/or after age 5 years, in the general population. Data Sources: Cochrane, MEDLINE PubMed, CINAHL, EMBASE, Web of Science, Scielo, and Scopus databases (until March 2021). Study Selection: Two authors selected the studies. Forward and backward citation follow-up was done; authors of DSQ were contacted to identify additional studies. Data Extraction: Cohorts were identified, and authors of selected studies were contacted to corroborate and complete extracted data. Results: Thirty-two publications, corresponding to 10 cohorts, were included. All cohorts used ASQ. Only cohort using PEDS was identified but did not meet the inclusion criteria. No cohorts conducted with SWYC were identified. Associations between ASQ and CA/SP were extracted for eight cohorts. The odds ratios were >3, and the area under the curve was 0.66-0.87. A trade-off between sensitivity and specificity was observed. Limitations: Heterogeneity in population characteristics and in DSQ adaptations. Conclusions: A positive association between ASQ and later CA/SP was found in different social, cultural, and economic settings. Additional studies are necessary to determine the impact factors in the predictive capacity of DSQs. Systematic Review Registration: PROSPERO, identifier: CRD42020183883.

Practice of Early Childhood Developmental Milestone Assessment and Its Determinants Among Health Professionals Working at Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study

Background

Early childhood developmental assessment refers to the continual process of observing, gathering, recording, and interpreting information to make developmental and instructional decisions and measure young children’s performance over time. Significant changes in the physical and neuropsychomotor developmental milestones take place in the first 2 years of life. Children younger than 3 years of age (36 months) who are at risk of having developmental delays may be eligible for early intervention treatment services. The study aimed to assess practice in early childhood developmental assessment and its determinants among health professionals working in public hospitals in Addis Ababa, Ethiopia.

Methods

This facility-based descriptive cross-sectional study was conducted from September to April 2018, with a total sample size of 268 health professionals from six public hospitals in Addis Ababa, Ethiopia. The data were entered into EpiData software version 4.2, and analyzed by SPSS version 23 software for bivariate and multivariable logistic regression analysis. Significant associations were taken as p<0.05 and the strength of associations was expressed using odds ratios.

Results

The practice of early childhood developmental milestone assessment was found to be 27.8%. Being a general practitioner (AOR=23.826, 95% CI: 6.77–83.9, p=0.000) or health officer (AOR=11.02, 95% CI: 2.1–58.812, p=0.005), and work experience greater than 11 years (AOR=20.897, 95% CI: 1.5–291.49, p=0.024) were significantly associated with good practice of early childhood developmental milestone assessment.

Conclusion

Practice of early childhood developmental milestone assessment remains poor. Training and sharing experiences among different professions, and assigning professionals with the highest levels of work experience in the service could improve the practice levels.

Association of Primary and Behavioral Health Integrated Care Upon Pediatric Mental Disorder Treatment

OBJECTIVE

The objective of this study was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care arrangements (ICAs), following incident attention deficit hyperactive disorder (ADHD) and major depressive disorder (MDD) diagnoses given by primary care providers (PCPs) in the pediatric setting.

METHODS

Using claims linking with multiple public data sources, we examined the treatment initiation among children receiving an incident diagnosis of ADHD or MDD from PCPs working in practices with various ICAs. ICAs were categorized as PCP practiced alone (non-co-located), PCP practiced with specialist outside the practice but co-located at the practice site (co-located), and employed specialists who were co-located (co-located and co-affiliated).

RESULTS

A total of 4203 incident ADHD and 298 incident MDD cases diagnosed by PCPs were identified, of which 3123 (74%) with ADHD and 200 (67%) with MDD received treatment within 90 days since the diagnosis. Children diagnosed with ADHD by co-located and co-affiliated PCPs were twice as likely to receive treatment as those diagnosed by non-co-located PCPs (odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.24-2.78). Of those treated, children diagnosed by co-located and co-affiliated PCPs were 2 times more likely to receive guideline recommended psychotherapy (OR = 2.15; 95% CI, 1.35-3.44). These patients were also more likely to be treated at the diagnosing site versus elsewhere. Similar beneficial effects were not observed in those first diagnosed by co-located but non-affiliated PCPs.

CONCLUSIONS

Service co-location between co-affiliated PCPs and MH specialists was associated with significant higher ADHD treatment rate and the receipt of guideline-recommended psychotherapy.

The Many Roles of Pediatric Integrated Behavioral Health Specialists

The primary care pediatric setting is intended to provide continuous and comprehensive care throughout a child's life, ensuring overall well-being. Routinely scheduled well-child visits are ideal to assess developmental progress, environmental health, behavior/psychosocial issues, and other concerns. Delivering integrated behavioral health (IBH) in the primary care setting may aid in identifying any early concerns or difficulties and provides resources and support when these issues first emerge; thus, promoting the child's well-being. IBH should be engaged early and often to establish a relationship with families and follow them as the child develops, regardless of the presence of a precipitating behavior concern.

Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices

OBJECTIVE

A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project. The current study investigated this screening over 2 years to assess its implementation and risk rates over time.

METHODS

Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year.

RESULTS

A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age.

CONCLUSIONS

The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.

Assessment of Agreement Between Human Ratings and Lexicon-Based Sentiment Ratings of Open-Ended Responses on a Behavioral Rating Scale

To date, there is a paucity of research conducting natural language processing (NLP) on the open-ended responses of behavior rating scales. Using three NLP lexicons for sentiment analysis of the open-ended responses of the Behavior Assessment System for Children-Third Edition, the researchers discovered a moderately positive correlation between the human composite rating and the sentiment score using each of the lexicons for strengths comments and a slightly positive correlation for the concerns comments made by guardians and teachers. In addition, the researchers found that as the word count increased for open-ended responses regarding the child's strengths, there was a greater positive sentiment rating. Conversely, as word count increased for open-ended responses regarding child concerns, the human raters scored comments more negatively. The authors offer a proof-of-concept to use NLP-based sentiment analysis of open-ended comments to complement other data for clinical decision making.

Provider Responses to Positive Developmental Screening: Disparities in Referral Practices?

OBJECTIVES

Guidelines recommend universal screening for developmental concerns in young children in pediatric primary care, with referral to early intervention (EI) as early as possible for children with a positive screen. However, participation in EI differs by child race, ethnicity, language, and sex. This study evaluated disparities in rates of referral to EI and estimated the factors associated with referral before and immediately after a positive developmental screen.

METHODS

Children seen in a large primary care network that has implemented universal developmental screening were included if they screened positive on the Survey of Well-being of Young Children (SWYC) Milestones during a 16- to 30-month well-child visit (n = 7358). Demographics, screening results, and referrals were extracted from the electronic health record.

RESULTS

Among children who screened positive, 17.5% were already in EI, and 39.9% were referred to EI during the visit with positive screen; 42.5% were not referred. In adjusted regression, the following factors were associated with being in EI before the positive screen: lower SWYC score and being male, older, and White. The following factors were associated with new referral to EI during a visit with positive SWYC: having lower SWYC score or lower income and being male, older, and Black race.

CONCLUSION

The finding that White children were more likely referred before developmental screening and non-White children more likely referred at the time of positive screen suggests that screening decreases disparities by increasing referral for children with developmental delays from traditionally underserved backgrounds.

Pediatric Provider Experiences with Implementation of Routine Mental Health Screening

OBJECTIVE

Despite the utility of universal screening, most pediatric providers rarely use mental health (MH) screening tools. As such, provider descriptions of their experiences with universal screening are limited. The goal of this study was to describe barriers to, and facilitators of, universal MH screening implementation, the perceived impact of such screening, impressions of a screening-focused quality improvement (QI) Learning Collaborative, and lessons learned.

METHOD

We invited primary care clinicians participating in a large-scale QI Learning Collaborative on MH screening (n = 107) to complete postproject interviews. Interviews were transcribed and analyzed using constant comparative qualitative analysis, an inductive, iterative process.

RESULTS

Eleven interviews were completed and analyzed. Practice sites included academic health centers, a private practice, and a federally qualified health center. Providers described the positive impact of screening (increased identification of MH concerns) and barriers and facilitators of screening at the practice level (clinic and leadership buy-in and electronic medical record integration), the provider level (provider beliefs about the importance of screening), and the patient level (parent literacy). Challenges of linking families with care after screening included lack of adequate referrals, long wait lists, limited bilingual providers, insurance gaps, and inadequate feedback loops. Access to on-site MH clinicians and participation in the Learning Collaborative were described as beneficial.

CONCLUSION

Findings elucidate how universal MH screening can be sustainably integrated into real-world primary care settings and may facilitate the uptake of American Academy of Pediatrics recommendations for best practices in screening for MH concerns.

Developmental Concerns, Parental Perceptions and Missed Opportunities from Different Levels of Health Centers in a Middle-Income Country

OBJECTIVE

To evaluate the concerns the parents have with the development of their children and related conditions and investigate how often these concerns are addressed at all levels of the healthcare system. Determining parental perceptions of these issues and highlighting missed opportunities is valuable for improving healthcare services.

METHODS

A total of 451 parents attending a medical appointment for their children in outpatient clinics at tertiary, secondary and primary health centers were administered a questionnaire comprised of 45 questions pertaining to their concerns regarding the development of their children and related conditions, including sociodemographic characteristics, practices supporting child development, information resources and personal opinions, such as whether they had sufficient information.

RESULTS

The parents of 130 children (28.8%) reported at least one developmental concern. Less than half of the concerned parents had visited a health center for these concerns. The area of greatest concern was language development, but the concerns differed based on setting. Among the related factors, having insufficient information (p = 0.000, OR: 0.375, CI: 0.24-0.58) and not playing with the child (p = 0.029, OR: 0.563, CI: 0.33-0.94) increased the risk of having developmental concerns. Only 15.5% of children were followed up in a developmental and behavioral manner.

CONCLUSIONS

The authors observed many concerns and missed opportunities to address them at all levels of health centers. Family physicians were more effective at eliciting these issues than pediatricians. These issues need to be addressed in the health system with consideration of its complexity and integrated culture.

Rapid Conversion from Clinic to Telehealth Behavioral Services During the COVID-19 Pandemic

Survival often depends on behavior that can adapt to rapid changes in contingencies, which should be particularly well suited to a contingency-sensitive and data-based discipline such as applied behavior analysis (ABA). The speed and scale with which contingencies shifted in early March 2020 due to the effects of COVID-19 represent a textbook case for rapid adaptation with a direct impact on the survival of many types of enterprises. We describe here the impact, changes, and outcomes achieved by a large, multifaceted ABA clinical program that has (a) ongoing data that forecasted and tracked changes, (b) staff well practiced with data-based shifts in operations (behavior), and (c) up-to-date information (data) on policy and regulations. The results showed rapid shifts in client and staff behavior on a daily basis, shifts in services from in-person services to telehealth, and increases in volumes, revenue, and margins. We detail regulations and provide actionable steps that clinical organizations can take pertinent to this shift now and in the future. The challenges of the COVID-19 pandemic underscore the importance of maintaining robust coordination and communication across our field in order to address crises that affect our field.

What Caregivers Want: Preferences for Behavioral Health Screening Implementation Procedures in Pediatric Primary Care

There has been a national push for universal psychosocial prevention screening in pediatric primary care. Implementation science highlights the importance of considering patients' perspectives when developing such procedures; however, minimal studies have examined this. The present study employed a mixed-methods design to examine caregivers of pediatric patients' (n = 149) preferences and comfort with psychosocial screening procedures. A subset of participants (n = 20) were interviewed to better understand reasons for responses. Results indicated that caregivers rated screening for physical health, development, emotion and behavior, caregiver adverse childhood experiences (ACEs), and child ACEs within primary care as important or very important. The majority of caregivers were not comfortable completing screenings in the waiting room and preferred the exam room. Caregivers primarily preferred the primary care provider to administer screenings and communicate results and recommendations. Parents also preferred the behavioral health provider to provide recommendations on emotion and behavior, parent ACEs, and child ACEs. Qualitative reasons for responses included relationship quality, knowledge of child, expertise, and desire for direct communication. Findings have implications for developing family-centered, trauma-informed practices within primary care, particularly among those within under-resourced rural communities.

Biological basis of child health 7: growth, development and the reproductive system

This article is the seventh in a series on the biological basis of child health. It describes early developmental milestones, stages of growth, puberty and the development of the reproductive system. It also outlines the methods used to assess growth and development, and describes conditions that affect growth and development in infants, children and young people. Understanding childhood growth and development is crucial for children's nurses, who need to be able to identify potential deviations from the norm, since these often reveal underlying conditions that require treatment.

A Systematic Review of External Validity in Pediatric Integrated Primary Care Trials

OBJECTIVE

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns.

METHODS

We searched Medline, CINAHL, PsycINFO, the Cochrane Center Register of Controlled Trials, and relevant literature to identify publications from 1998 to 2018 reporting on open, randomized, or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. For each publication, we extracted the information reported in each RE-AIM domain and calculated the proportion of the total studies reviewed.

RESULTS

Thirty-nine publications describing 25 studies were included in the review. Publications rarely reported some indicators of external validity, including the representativeness of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies reported on key pragmatic factors such as cost or organizational change processes related to implementation and maintenance. Strengths of some studies included comparisons of multiple active treatments, use of tailorable interventions, and implementation in "real world" settings.

CONCLUSIONS

Although IPC interventions appear efficacious under research conditions, there are significant knowledge gaps regarding the degree to which they reach and engage target recipients, what factors impact adoption and implementation of IPC interventions by clinicians, how fidelity can be maintained over time, and cost-effectiveness. Pediatric IPC researchers should embrace dissemination and implementation science methods to balance internal and external validity concerns moving forward.

Using Measurement-Based Care Data in Population Health Management

Although screening can significantly improve the identification of youth with mental health needs in primary care, there is no evidence that screening improves outcomes. Measurement-based care using clinical mental health registries has been shown to improve screening outcomes in adult primary care populations and pediatric physical health needs; however, there is limited attention to pediatric mental health registries in primary care. This article describes clinical mental health registries, discusses the barriers to implementation with youth, and describes next steps in expanding the use of pediatric mental health registries in primary care.

Screening for Mental Health Problems in Pediatric Primary Care

Systematic mental health screening is a recommended but controversial process in the pediatricians' behavioral health tool kit. Although the American Academy of Pediatrics and other organizations promote routine behavioral health screening, implementing an effective and sustainable screening program can be challenging. We discuss the rationale for and barriers to screening in pediatric settings, identify accessible validated tools that can be easily incorporated into practice, and suggest a practical strategy for implementing a more accurate screening system for common mental health concerns in pediatric primary care. [Pediatr Ann. 2020;49(10):e421-e425.].

Preschool mental health: The Brief Child and Family Intake and Outcomes System

Despite the availability of effective early interventions, few preschoolers with mental health issues receive these services. This situation exists partly due to challenges in the identification of emotional and behavioral issues in young children. We developed the Brief Child and Family Intake and Outcomes System for Preschoolers, which is a 60-item standardized online parent questionnaire including three externalizing scales (Regulating Attention, Impulsivity, and Activity; Cooperating; Regulating Conduct), five internalizing scales (Separating from Parents; Managing Anxiety; Managing Social Anxiety; Regulating Compulsive Behaviour; Managing Mood), and two regulating states scales (Eating; Sleeping). We conducted a normative study of 1,200 Canadian children 3–5 years old, stratified by sex, age, geographic region, and parents’ marital status, income, and education. Confirmatory factor analyses demonstrated good model fit, and the relationship between items and scales did not vary significantly between boys and girls or among 3-, 4-, and 5-year-old children. Reliability estimates indicated high internal consistency and 2-month test–retest reliability for a subsample ( n = 100) ranging from .44 to .73. Providing preliminary evidence of validity, scale scores had positive relations with measures of child functioning challenges, family distress, caregiver mood, and demographic risk variables. We extend earlier work by including clinically relevant emotional-behavioral scales while at the same time minimizing respondent burden and providing norms for Canadian preschoolers. The questionnaire could be used in children’s mental health settings, primary care, child welfare, and day-care and school facilities, for intake, triage, and describing 3- to 5-year-old children.

[Psychomotor development in late premature newborns at five years. Comparison with term newborns using the ASQ3®]

INTRODUCTION

Late prematures (LP) belong to a subgroup of many premature babies with a risk of delayed psychomotor development (PMD). Many subtle changes pass unnoticed if adequate assessment tools are not used. The Ages & Stages Questionnaires 3® (ASQ3®) for parents appears simple and useful for the detection of risk of impairment of PMD, and is recommended by scientific societies that study LP.

OBJECTIVES

To evaluate the risk of impaired PMD in LP at 5years-old, and compare them with term newborns (TNB) using the ASQ3.

PATIENTS AND METHODS

Data were collected on the LP born in a third level hospital in 2010, as well as 2TNB of the same gender for each LP. The prenatal and postnatal morbidity variables were compared. At 5years, their families (excluding those with other neurological risks) were asked to complete the ASQ3. The cut-off point was determined for the total score of the ASQ3 that would discriminate the risk of PMD impairment using ROC analysis. The cut-off point to determine a change in each domain was obtained according to the ASQ3 manual.

RESULTS

The ASQ3 was completed for 88 (47%) and 131 (35%) TNB. All the overall mean scores and those for domains were lower in LP, with no significant differences found between the two groups. A risk of PMD impairment (≤253 points) was observed in 7LP compared to 4TNB, with no significant difference. More maternal, foetal, and neonatal illnesses were observed in 195LP than in the 390TNB. In the univariate analysis, male gender and restricted uterine growth (RUG) were factors associated with a risk of PMD impairment and only RUG in the multivariate analysis.

CONCLUSION

The risk of PMD impairment between LP and TNB at 5years appears not to be shown, with no significant differences between both, and with the values obtained in the ASQ3 being slightly lower in the LP. Male gender and RUG negatively influence this risk.

Evaluation of the Ages and Stages Questionnaire (ASQ 3) as a developmental screener at 9, 18, and 24 months

BACKGROUND

Without the use of standardized screening tools, only 30% of the estimated 5-15% of children with developmental delay can be identified, potentially delaying intervention.

AIM

1)To evaluate the ASQ-3's reliability and validity at 9, 18, and 24 months and to compare the results with normative USA data. 2)To determine the risk factors for a screen positive result, which requires further evaluation.

METHODS

Study of 649 low-risk children was part of a larger longitudinal cohort study, the GUSTO project. Socio-demographic and ASQ3 data were analyzed to estimate reliability, validity, mean ASQ scores, and cut-off scores.

RESULTS

ASQ-3 showed an acceptable to good internal consistency (0.49-0.83) and a medium level of correlations (0.22-0.59) between the five domains but differed significantly compared to normative USA data. Using local cut-off scores, 12.6-13.6% of the cohort had a positive screen in ≥ 1 domain at 9, 18, or 24 months. ASQ-3 screening categorization was consistent, with only 3-11% of children showing change in categorization longitudinally. On regression, lower family income (OR 3.3-9.42) and maternal education (OR2.65-3.03) were predictive of a positive screen across domains and age intervals.

INTERPRETATION

ASQ-3 is a useful, valid screening tool in Singapore. Further research is needed to investigate item functioning and to assess its concurrent validity with a criterion standard tool for culturally sensitive developmental screening.