Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017

COVID-19 Pandemic and the Developmental Health of Kindergarteners

Importance

Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data.

Objective

To examine the impact of the COVID-19 pandemic on US kindergarteners' developmental health.

Design, Setting, and Participants

This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024.

Exposure

Kindergarteners' developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts.

Main Outcomes and Measures

Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed.

Results

In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, -0.45; 95% CI, -0.48 to -0.43), social competence (mean change, -0.03; 95% CI, -0.06 to -0.01), and communication and general knowledge (mean change, -0.18; 95% CI, -0.22 to -0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, -0.01 to 0.02).

Conclusions and Relevance

The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners' development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.

Prevalence and Trends in Pediatric-Onset Chronic Conditions in the United States, 1999-2018

OBJECTIVE

We sought to provide an updated estimate of the current prevalence and recent trends (over the past two decades) in pediatric-onset conditions among a nationally-representative sample of youth to identify opportunities for prevention and intervention.

METHODS

We performed a secondary data analysis of nationally-representative data on 236,412 participants (ages 5-25 years) from the 1999 to 2018 National Health Interview Survey. Chronic conditions (CCs) and functional limitations (FLs) were self-reported by the participant or a qualified proxy-respondent. We employed multivariate linear probability models to estimate annual average increase in CC/FL prevalence and differences in prevalence across sociodemographic characteristics.

RESULTS

The prevalence of children (5-17 years) with a CC/FL has risen from 22.57% in 1999/2000 to 30.21% in 2017/2018 - an adjusted annual increase of 0.24% points per year (P<.0001) or about 130,000 additional children per year. The prevalence of young adults (18-25 years) with a CC/FL has risen similarly (adjusted annual increase of 0.33% points per year, P<.0001). Asthma and mental/behavioral health conditions were some of the leading CC and FL (respectively) contributors to this increase for both age groups. We estimate that approximately 1.2 million youth with a CC or FL currently turn 18 each year.

CONCLUSIONS

The US is currently seeing an unprecedented number of youth with pediatric-onset conditions. It is incumbent for the US health system to seek ways to treat these patients in pediatric settings and eventually matriculate them into adult care.

Neurobehavioral effects of gestational exposure to mixtures of non-persistent endocrine disruptors in preschool-aged children: The environmental influences on child health outcomes (ECHO) program

Exposures to phthalates and synthetic phenols are common among expectant mothers in the US. Previous studies on the neurotoxicity of these compounds have primarily assessed the effects of individual compounds on child behavior, but have not assessed potential combined effects of these substances. We assessed associations between prenatal exposure to a mixture of phthalates and phenols with behavioral problems among preschool-age children participating in the Environmental influences on Child Health Outcome (ECHO) Program. The study sample included 878 mother-child pairs from three cohorts with data on urinary concentrations of 10 phenols and 11 phthalate metabolites during pregnancy, along with caregiver reported Child Behavioral Checklist Ages 1½ to 5 (CBCL) data. Using covariate-adjusted weighted quantile sum (WQS) regression, we estimated associations between the phenol - phthalate mixture and CBCL behavioral scales T-scores. We fitted additional models stratified by sex due to previous reports of sex-specific associations. No statistically significant associations were observed in the overall sample when both male and female children were combined. However, in males, a quintile increase in the WQS index was associated with a 0.04 (95% CI: 0.00; 0.08) higher T-score of externalizing problems. The major contributors to this mixture effect were butylparaben (with a weight of 21%), benzophenone-3 (15%) and MCNP (11%). Conversely, in females, significant negative associations were observed between the WQS index with the total behavioral problems scale (beta = −0.05, 95% CI: −0.09; −0.01), externalizing problems (beta = −0.06, 95% CI = −0.10; −0.02) and internalizing problems (beta = −0.04, 95% CI: −0.08; −0.00).

Suicide-Risk Identification Across Developmental and Behavioral Pediatric Practices: A DBPNet Study

OBJECTIVE

To identify variations in practices, facilitators of and barriers to universal suicide screening of children and adolescents with IDDs in pediatric developmental and behavioral health settings.

METHODS

Centers from the Developmental Behavioral Pediatrics Research Network (DBPNet) were invited to describe suicide-screening practices in their developmental-behavioral pediatrics, psychology, and/or psychiatry clinics. A representative per site/specialty was asked to complete surveys (summarized with descriptive statistics) and semi-structured interviews (summarized using thematic analysis) to explore sites' current practices, and barriers/facilitators to screening.

RESULTS

Participants included 34 survey respondents and 21 interviewees. Surveys revealed variation in suicide screening practices across sites; 44.1% of respondents reported that their practice conducts universal screening, but the screening processes varied widely. Interviews identified some facilitators to screening youth with IDD, such as standardizing procedures, training, and having staff available to respond to positive screens. Barriers to universal screening include factors at the patient, family, provider, and system levels. Insufficient mental health care systems, as well as a lack of IDD-specific supports, are significant challenges.

CONCLUSIONS

Despite Joint Commission requirements and specific expertise in behavioral health, sites serving patients with IDD vary widely in how suicide screening is implemented and how positive screens are addressed. Findings offer opportunities to standardize procedures to increase suicide risk identification and response.

Age-related trajectories of health and cognition in mothers of children with developmental disabilities: Longitudinal findings from two independent studies

Developmental disabilities are a heterogenous group of disorders characterized by impairments in physical functioning, learning, language, behavior, and self-care (Zablotsky et al., 2019). Parenting a child with a developmental disability can be a profound source of stress, particularly for mothers. This atypical parenting experience can begin with the birth of the child, or soon thereafter, and continues over the life course, often extending six decades or more. However, there is limited research on the impact of this parenting role across the full adult life course - from mothers' early years of parenting through older age. Here we draw on data from two separate studies, one a national study of mothers of children with a range of developmental conditions (n = 96) and the other a community study of mothers of children with autism (n = 391). We used an accelerated longitudinal design to estimate mothers' trajectories of health, mental health, and cognitive functioning beginning in their 20s and extending until their 80s or beyond, and conducted a series of cohort and sensitivity analyses. Together, the results of analyses of these two studies revealed very similar patterns across a number of important outcomes. The inclusion in one of the studies of a nationally representative comparison group of mothers whose children did not have disabilities (n = 1,181) indicated that after around age 65, aging in mothers of children with developmental disabilities differed from the norm, suggesting the 'wear-and-tear' effects of this common form of stressful parenting.

Maternal Inflammatory Proteins in Pregnancy and Neurodevelopmental Disorders at Age 10 Years

IMPORTANCE

Maternal inflammation during pregnancy has been associated with an increased risk of neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD) and autism, and cognitive deficits in early childhood. However, little is known about the contributions of a wider range of inflammatory proteins to this risk.

OBJECTIVE

To determine whether maternal inflammatory proteins during pregnancy are associated with the risk of NDDs and executive functions (EF) in middle childhood and to identify protein patterns associated with NDDs and EF.

DESIGN, SETTING, AND PARTICIPANTS

This was a 10-year follow-up cohort study of the Danish Copenhagen Prospective Studies on Asthma 2010 mother-child birth cohort, using plasma samples collected at week 24 in pregnancy, where 92 inflammatory proteins were assessed. NDDs and EF were assessed in the offspring at age 10 years, between January 2019 and December 2021. Mother-offspring dyads with available maternal prenatal inflammatory proteins during pregnancy and offspring NDD psychopathology data at follow-up were included. Data analyses took place between December 2023 and August 2024.

EXPOSURES

Levels of 92 inflammatory proteins from panel collected at week 24 during pregnancy.

MAIN OUTCOMES AND MEASURES

Categorical and dimensional psychopathology of NDDs (primary outcome) and EF (secondary outcome).

RESULTS

A total of 555 mothers (mean [SD] age, 32.4 [4.3] years) and their children (285 male [51%]) were included. The principal component analysis showed that higher levels of maternal inflammatory proteins depicted in principal component 1 were associated with a higher risk of any NDD (OR, 1.49; 95% CI, 1.15-1.94; P = .003), particularly autism (OR, 2.76; 95% CI, 1.45-5.63; P = .003) and ADHD with predominantly inattentive presentation (OR, 1.57; 95% CI, 1.05-2.39; P = .03). The single protein analysis showed that 18 of 92 proteins reached false discovery rate (FDR) 5% significance after adjustment. Vascular endothelial growth factor A, C-C motif chemokine ligand, CD5, interleukin 12B, fibroblast growth factor-23, and monocyte chemoattractant protein-1 emerged as top proteins associated with risk of NDDs. The sparse partial least squares approach identified 34 proteins associated with any NDD, and 39 with ADHD with predominantly inattentive presentation. There were no associations with EF after FDR correction.

CONCLUSIONS AND RELEVANCE

The maternal inflammatory proteome during pregnancy was associated with NDDs risks in offspring at age 10 years. Further research is warranted to elucidate the specific pathways involving these proteins during pregnancy that could be targeted with prevention strategies to reduce risk of NDDs in children.

Visuomotor Integration Assessment Using Immersive Virtual Reality for Children With Cerebral Palsy: A Pilot Study

BACKGROUND

Visuomotor integration (VMI) impairments are common in children with cerebral palsy (CP) and can impact performance of goal-directed upper-extremity tasks. VMI impairment is clinically assessed using the gold-standard Beery-Buktenica test, whereas research paradigms use computerized assessments incorporating eye and hand movement tracking with touchscreen displays. Immersive virtual reality (VR) may potentially enable more ecologically valid VMI assessments through the inclusion of 3D tasks and visual distractions. However, the potential of immersive VR as a VMI assessment method in children with CP has not been evaluated. The current study aims to investigate how VR can assess VMI impairments in children with CP.

METHODS

Twelve children with CP completed the Beery-Buktenica VMI test and performed eye-only, hand-only and eye-hand VMI tasks in touchscreen, visually simple VR and visually complex VR conditions. Eye and hand endpoint accuracy and task completion time quantified VMI performance. We compared performance on each task and in each environment between children with below- versus above-average Beery-VMI scores.

RESULTS

There were no significant relationships between Beery-VMI score and eye-hand task performance in visually simple VR. Compared to the touchscreen task, participants demonstrated significantly reduced eye and hand endpoint accuracy in visually simple VR, with no difference between Beery-VMI groups. Children with below-average Beery-VMI scores decreased eye endpoint accuracy and increased trial completion time in visually complex VR.

CONCLUSION

Findings from this pilot study do not support immersive VR as a VMI assessment method in children with CP.

Exploring the Influences of Sleep Disturbances in Mothers of School-Aged Children With Developmental Disabilities

BACKGROUND

Although sleep is a modifiable health behavior linked to health and daytime functioning, studies have limited exploration of how mother and child-related factors interplay with mothers' sleep disturbance in mothers of children with developmental disabilities.

OBJECTIVE

We aimed to explore the nature of sleep disturbances, their impact on health and daytime functioning, and strategies used to promote restful sleep in mothers of children with developmental disabilities.

METHODS

Using a qualitative descriptive approach, 13 mothers of school-aged children (6-12 years) with developmental disabilities who reported poor sleep quality completed semi-structured interviews. Interviews were transcribed, followed by thematic analysis.

RESULTS

Four themes were revealed: (1) I haven't slept well in years; (2) My child doesn't sleep well; (3) Being a mother of a child with a special need; and (4) Different strategies used to sleep better. Mothers reported chronic sleep disturbances that often started with the birth of their children and the negative effect of sleep disturbance on their health and daytime functioning. Mothers attributed their children with developmental disabilities' sleep problems and chronic stress associated with daily caregiving as reasons for their sleep disturbances. Mothers tried various sleep-promoting activities to improve their sleep; they remained frustrated with not having consistent solutions and desired to learn specific strategies to manage sleep for themselves and their children.

CONCLUSION

Our findings highlight the need to develop sleep health interventions, including strategies to reduce mothers' stress and manage their children with developmental disabilities' sleep problems, which may improve sleep and prevent adverse health outcomes.

Family management styles of families of children and adolescents with developmental disabilities during the COVID-19 pandemic: a cross-sectional study

Raising a child with developmental disabilities (DDs) involves both rewards and challenges, with family management styles influencing the quality of life (QoL) of both children and families, particularly during crises. This study identified family management styles and their relationships with the QoL of children and adolescents and family functioning during the COVID-19 pandemic. Conducted between September 2020 and October 2021, the study included 200 Korean parents of individuals with DDs under the age of 21. Online data collection assessed family management styles, family functioning, and children's QoL. Cluster analysis and analysis of variance were used to identify family management styles and to compare demographics, family functioning, and QoL across groups, respectively. Three clusters were identified: "Thriving" (n = 20), "Somewhat Resilient" (n = 118), and "Struggling" (n = 62). The Thriving cluster demonstrated effective condition management, a positive outlook, and high parental cooperation. The Somewhat Resilient cluster displayed moderate functioning. The Struggling cluster demonstrated the greatest challenges and the lowest capacity for managing the condition. Significant differences in children's QoL, family functioning, and demographic variables were observed across clusters. These findings highlight how families manage DDs during the pandemic and the need for tailored interventions based on family management styles.

Sex differences in the comorbidity between attention deficit-hyperactivity disorder and posttraumatic stress disorder: A systematic literature review and meta-analysis

OBJECTIVE

Attention Deficit-Hyperactivity Disorder (ADHD) and Posttraumatic Stress Disorder (PTSD) are often comorbid and share a common core of symptoms. However, sex and gender-related factors significantly influence their prevalence, clinical presentation, and diagnosis. Here, we conducted a systematic literature review and meta-analysis to examine sex differences in ADHD/PTSD comorbidity during childhood and adulthood.

METHODS

A scoping review of PsycINFO and PubMed yielded 13 eligible studies with complete outcome data. We conducted fixed-effects meta-analyses of the sex-stratified prevalence of ADHD/PTSD using pooled odds ratios (OR) with a 95 % confidence interval (CI). Fixed-effects subgroup analyses were performed using age as a subgroup. Effect size heterogeneity was assessed using the I2 index and Cochran's Q test.

RESULTS

In the whole sample (N = 13,585; F = 7005, M = 6580), the diagnosis of ADHD/PTSD was significantly higher in females than in males (OR = 1.32, p = 0.02). Between-study heterogeneity was low-to-moderate and not significant (I2 = 41 %; p = 0.06), validating the fixed-effects model. Age-stratified subgroup analyses revealed higher ADHD/PTSD odds in females compared to males only in adult populations (OR = 1.41; p = 0.01). Additionally, females were more likely to be diagnosed with both disorders in studies where ADHD was the primary diagnosis (OR = 1.60; p = 0.002), and in studies employing structured clinical interviews as diagnostic tools (OR = 1.46; p = 0.009).

CONCLUSIONS

Our study is the first to show that the association between ADHD and PTSD is stronger in females, suggesting that ADHD may increase risk for PTSD in a sex-specific manner.

Frequency of depression and anxiety symptoms among adults with childhood- versus adult-onset disability

BACKGROUND

Individuals with disabilities experience high rates of depression and anxiety. Potential differences between those with childhood- versus adult-onset disability have not been adequately explored.

OBJECTIVE

To examine the relationship between age of disability onset and frequency of reported depression and anxiety symptoms.

DESIGN

Secondary data analysis.

SETTING

2020-2021 National Health Interview Survey (NHIS), a nationally representative survey of adults on illness and disability in the United States.

PARTICIPANTS

NHIS respondents aged 22-80 years with mobility, cognitive, or mobility + cognitive disability (n = 6386).

INTERVENTIONS

Age of disability onset (childhood onset, defined as onset before age 22, per NHIS question, vs. adult onset) was our independent variable.

MAIN OUTCOME MEASURES

We calculated frequency of reported current depression and anxiety symptoms among those with childhood- versus adult-onset disability. Logistic regression was used to calculate the odds ratios (OR) of frequent versus infrequent depression and anxiety symptoms for childhood- versus adult-onset disability, adjusted for demographic factors.

RESULTS

A higher percentage of participants with childhood- compared to adult-onset disability reported frequent depression symptoms (mobility: 32.7% vs. 21.9%, p < .01; cognitive: 55.6% vs. 44.5%, p < .01; mobility + cognitive: 71.4% vs. 52.8%, p < .01) and anxiety symptoms (mobility: 44.3% vs. 35.5%, p < .01; cognitive: 83.5% vs. 63.1%, p < .01; mobility + cognitive: 82.8% vs. 70.3%, p < .01). Participants with childhood-onset disability had higher adjusted odds of frequent depression symptoms for all disability types (mobility adjusted odds ratio [aOR], 1.58 [95% confidence interval (CI), 1.15-2.16]; cognitive aOR, 1.84 [95% CI, 1.12-3.02]; mobility + cognitive aOR, 2.06 [95% CI, 1.16-3.67]), and frequent anxiety symptoms for cognitive (aOR, 3.28 [95% CI, 1.92-5.60]) and mobility + cognitive disabilities (aOR, 2.01 [95% CI, 1.07-3.75]) compared to those with adult-onset disability.

CONCLUSION

Individuals with childhood-onset disabilities may be at uniquely higher risk for mental health symptoms than their peers with adult-onset disabilities, warranting specific attention to their health care and outcomes.

Effect of sex on neuropsychiatric comorbidities in childhood epilepsy

OBJECTIVE

Neuropsychiatric comorbidities are prevalent in children with epilepsy and often pose greater concerns than the seizures themselves. Identifying children at risk for these conditions is crucial for developing effective therapies. In prepubescent rodents, sex significantly influences cognitive dysfunction related to seizures, with prepubescent male rats exhibiting more severe adverse effects than females. However, it remains unclear whether sex plays a similar role in cognitive and behavioral outcomes in children. This review aims to assess the literature on whether sex is a biological factor affecting behavioral and cognitive outcomes in pediatric epilepsy.

MATERIALS AND METHODS

We conducted a literature review to explore the impact of sex on cognitive and behavioral outcomes in children (up to age 18 years) with epilepsy of all types. Studies were categorized into observational and interventional types. We analyzed population studies involving children with epilepsy, as well as those addressing genetic factors, surgical interventions, status epilepticus, infantile spasms, pharmacological treatments, and the ketogenic diet.

RESULTS

Few adequately powered studies have examined sex as a biological variable in relation to cognitive and behavioral impairments in children with epilepsy. In addition, many studies failed to examine sex-related differences in behavior and cognition in children without epilepsy. Generally, the sex-related differences in cognitive and behavioral impairments in children with epilepsy match those seen in children without epilepsy. One exception is that in several studies girls with epilepsy had a similar risk for attention deficit hyperactive disorder (ADHD) as boys, whereas in children without epilepsy ADHD is more common in boys than girls. Although there is a modest trend indicating worse cognitive outcomes for boys with epilepsy compared to girls, consistency across studies is lacking.

CONCLUSION

Sex is not yet a well-explored prognostic factor for outcomes following childhood epilepsy, though some small differences were identified for specific outcomes. More rigorously designed studies are necessary to report outcomes by sex while controlling for potential confounders. The variability in methods for assessing neurodevelopmental outcomes underscores the need for standardized and comprehensive evaluations of cognitive and behavior in children with epilepsy.

Perceived Parent Needs for Improving Parent Participation in School-Based Therapies for Children with Disabilities Using the Parent-Therapist Partnership Survey

Rehabilitative and habilitative therapies can help children with disabilities increase independence and overall wellbeing. However, children and their caregivers face many barriers to accessing these therapies and often rely on the school for therapy access. Given the limited resources available within the special education system, increasing parent involvement in special education therapies could improve service delivery. However, providers must first understand what parents need to participate in therapies before attempting to engage families. 217 parents completed an online survey consisting of the Parent-Therapist Partnership Survey and demographic questionnaires about theirfamiliesand their child[ren] with disabilities. The percentage of needs parents endorsed as important and thepercentageofimportantneedsendorsedasunmetwere calculated. Differences across demographic variables were assessed. Overall, parents reported an average of 75% of needs as important with significantly more needs endorsed as important regarding being an informed, engaged member of the child's care team (M = 83%) than needs related to support and guidance (M = 65%, p < 0.001). Furthermore, parentsreportedan average of 58% of important needs as unmet, with no significant differences in subscale averages. Significant associations were found for race/ethnicity, education, income, partner availability, number of children with disabilities in the household, transportation access, neighborhood opportunities, parent efficacy and social, emotional, and behavioral concerns. Parents reported a high percentage of needs as important, but a large percentage of these important needs were considered unmet. Significant disparities based on racial/ethnic identities and access to resources were found. In order to successfully engage parents in special education therapy activities, providers must work to understand and address parents' engagement needs, paying special attention to each family's unique circumstances to optimize engagement.

A Pilot Test to Support Healthcare Providers in Promoting Vaccine Uptake Among Individuals With Intellectual and Developmental Disabilities

Individuals with intellectual and/or developmental disabilities encounter barriers to vaccine access, uptake, and confidence, leading to health inequities. These include barriers related to healthcare provider capacity to effectively address the social determinants of health, provide accessible needle procedures, and translate and disseminate inclusive public health information. The current study aimed to test the preliminary effectiveness of a virtual continuing medical education (CME) course on enhancing healthcare provider capacity to address these barriers. This CME was available free-of-charge online. Participants included 120 healthcare providers (physicians: 45%; nurses: 37%; and other learners: 18%) in internal medicine, family practice, and related disciplines. The CME-created based on video interviews with patients and providers-focused on factors that affect vaccine uptake/access/confidence (Module 1); strategies to increase vaccine receipt (Module 2); and inclusive public health communication (Module 3). The pre-post survey assessed self-reported understanding, confidence, and abilities. Following CME completion, learners were significantly more likely to report higher understanding, confidence, and abilities in responding to the social determinants of health (Module 1); addressing barriers to vaccine access/uptake/confidence (Module 2); and engaging in effective public health communication (Module 3). Findings support the utility of short-term healthcare provider trainings on this topic. Future research should evaluate longer-term impacts and identify opportunities to create standardized medical curricula for this population.

Embryo-restricted responses to maternal IL-17A promote neurodevelopmental disorders in mouse offspring

Prenatal imprinting to interleukin 17A (IL-17A) triggers behavioral disorders in offspring. However, reported models of maternal immune activation utilizing immunostimulants, lack specificity to elucidate the anatomical compartments of IL-17A's action and the distinct behavioral disturbances it causes. By combining transgenic IL-17A overexpression with maternal deficiency in its receptor, we established a novel model of prenatal imprinting to maternal IL-17A (acronym: PRIMA-17 model). This model allowed us to study prenatal imprinting established exclusively through embryo-restricted IL-17A responses. We demonstrated a transfer of transgenic IL-17A across the placental barrier, which triggered the development of selected behavioral deficits in mouse offspring. More specifically, embryonic responses to IL-17A resulted in communicative impairment in early-life measured by reduced numbers of nest retrieval calls. In adulthood, IL-17A-imprinted offspring displayed an increase in anxiety-like behavior. We advocate our PRIMA-17 model as a useful tool to study neurological deficits in mice.

Health disparities persist for adults with developmental disabilities: NHIS insights, 1999-2018

This study assesses changes in self-reported health and healthcare status among adults with intellectual and developmental disabilities (I/DD) over the past 20 years, utilizing data from the National Health Interview Survey. We conducted a cross-sectional analysis of 601 464 adults 18 and older, categorized by disability status: no functional limitations, developmental disabilities, intellectual disabilities, and other functional limitations. We aimed to identify trends in health status, healthcare access, affordability, and utilization from 1999 to 2018, comparing outcomes across disability groups. Results indicate adults with intellectual disabilities reported poorer health compared to those without functional limitations, particularly in the most recent period (2014-2018). Adults with developmental disabilities exhibited increased odds of poor health during 2009-2013 compared to 1999-2003, but no significant differences occurred between other periods. Additionally, poverty rates for adults with I/DD were higher, with a substantial proportion of adults with intellectual disabilities living in poverty compared to those without functional limitations, indicating persistent disparities without significant trend improvements. Despite advancements in healthcare access and affordability, self-reported health outcomes for adults with I/DD have not improved, highlighting the need for policies to enhance care quality. Future research should focus on effective healthcare practices and provider training to address these persistent disparities.

Developmental Monitoring and Promotion in Home Visiting: a Qualitative Study of Parents and Providers

Developmental monitoring and promotion efforts are keys to identifying potential developmental concerns and connecting young children to intervention services. Evidence-based home visiting programs are one avenue for developmental monitoring and promotion, particularly for families with young children who may need extra support (e.g., families living in poverty, families dealing with substance use). In the present qualitative study, we interviewed parents (N = 23) and providers (N = 18) from three home visiting programs to understand the ways in which home visiting engages in developmental monitoring and promotion. Findings indicated that children participating in home visiting were regularly screened for developmental concerns (developmental monitoring). Providers also discussed screener results with parents and provided activities and materials to encourage parents to engage in positive parenting behaviors (developmental promotion). Barriers to monitoring and promotion were also uncovered and included family buy-in and logistical constraints. Implications suggest enhanced provider training to overcome barriers and greater policy and funding support for home visiting to extend the reach of home visiting and bolster developmental monitoring and promotion efforts.

Peripheral Blood Monocytes as Biomarkers of Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

Accumulating evidence implicates immune dysregulation and chronic inflammation in neurodevelopmental disorders (NDDs), often manifesting as abnormal alterations in peripheral blood immune cell levels. The mononuclear phagocyte system, including monocytes and microglia, has been increasingly recognized for its involvement in the pathogenesis of NDDs. However, due to inconsistent findings in the literature, whether monocytes can serve as a reliable biomarker for NDDs remains controversial. To address this issue, we conducted a systematic review and meta-analysis of studies examining monocyte counts in NDD individuals. A comprehensive search was conducted across PubMed, Web of Science, and Scopus databases. Variables extracted for analysis encompassed the author's name, year of study, sample size, patient's age, type of disease, mean, standard deviation of monocytes and sex ratio. A total of 2503 articles were found by searching the three databases. After removed duplicates and screening titles, abstracts, and full texts, 17 articles met the inclusion criteria, and 20 independent studies were included in the meta-analysis. The results indicated significantly increased monocyte counts in 5 type NDDs compared to Typical Development (TD) groups (g = 0.36, 95%CI [0.23, 0.49]). Subgroup analyses revealed no significant differences in monocyte counts across different NDD types, gender, or age. These findings suggest that aberrant alterations in monocyte counts are common in NDD cases, indicating their potential as biomarkers for these conditions. Future research should further investigate the role of monocyte in understanding the mechanisms, early detection, and clinical diagnosis of NDDs.

Acute exposure of perchlorate on zebrafish larvae: Neurotoxicity during development

OBJECTIVE

This study aimed to assess the acute developmental toxicity of perchlorate exposure and identify its manifestation of neurotoxicity in zebrafish (Danio rerio) model.

METHODS

Zebrafish larvae were exposed to sodium perchlorate at early developmental stages and the phenotypes of various developmental abnormalities were observed and recorded. Neurodevelopmental toxicity has been studied in particular in terms of central nervous system apoptosis, peripheral motor abnormalities, and abnormal autonomic motor behavior. Samples were processed for pathological, transcriptomic, and PCR analyses.

RESULTS

Acute exposure of zebrafish larvae to perchlorate resulted in developmental toxicity in a concentration-dependent manner. Heart rate abnormality (33 %), slow blood flow (37 %), abnormal size of liver (23 %), delayed yolk absorption (70 %), and abnormal body pigmentation (100 %) were observed in the 3.83 mg/mL group. Heart edema (10 %), heart rate abnormality (60 %), slow blood flow (67 %), abnormal size of liver (77 %), delayed yolk absorption (100 %), abnormalities in intestinal morphology (30 %), abnormal body pigmentation (100 %), and shorter body length (47 %) were observed in the 4.03 mg/mL group. Developmental neurotoxicity was characterized by brain apoptosis, damage to the central nervous system (P < 0.01) and peripheral motor neurons (P < 0.0001), and reduced autonomous motor distance (P < 0.01). Transcriptomic analysis revealed that c3a.1, c5, fga, fgb, and fgg were upregulated in the complement and coagulation cascades, and the mRNA levels of c3a.1, dusp1, slc2a6, purba, and klf9 were found upregulated in PCR.

CONCLUSION

Acute perchlorate exposure on zebrafish larvae caused various developmental toxicity in a concentration-dependent manner, notably neurotoxicity. We believed the immunological and inflammatory responses were involved.

Increased incidence of complicated appendicitis in patients with neurodevelopmental disabilities

Healthcare disparities that impact patients with disabilities are relatively understudied in surgery. We investigated whether patients with neurodevelopmental disabilities present more often with complicated appendicitis than do patients without disabilities by conducting a retrospective review of patients under the age of 50 presenting with acute appendicitis between 2016 and 2021 within the largest public hospital system in the United States. Patients with neurodevelopmental disabilities (NDD) were identified using ICD-10 codes for the most common diagnoses in this category and matched to controls in a 1:2 ratio based on age, gender, and race/ethnicity. Our results indicate that patients with NDD presented significantly more often with complicated appendicitis with an odds ratio of 2.15 (p ​= ​0.003), had greater LOS, and more post-operative complications. These results point to a potential disparity that patients with disabilities may experience within emergency general surgery.

Caries pattern and dental treatment features of children with autism spectrum disorder under general anesthesia

Difficulty in the cooperation of children with autism spectrum disorder (ASD) leads to a poor diagnosis of caries patterns and poor clinical and radiographic findings. This study aimed to investigate the association between caries patterns and treatment characteristics in children with ASD and compare these variables with those in healthy children treated under general anesthesia. The medical records of children with ASD undergoing dental treatment under general anesthesia (n = 40) were analyzed in this study. The collected data included demographic profile, medical status (ASD severity and associated comorbidities), dental history (behavior, care approach, past dental treatment, and follow-up period), caries pattern (surface and depth), and clinical and radiographic findings (e.g., percussion/palpation pain, fistula, furcation involvement, and pathologic resorption). We compared the caries patterns and treatment of children with ASD to those of their healthy counterparts (n = 40). In children with ASD, age and severity were significantly associated with presentation behavior (P = .03 and P = .04) and the chosen care approach (P = .03). Clinical and radiographic examinations revealed that furcation involvement or pathological resorption was more frequent in children with ASD from families with lower average monthly income (P = .05) and in those with associated comorbidities (P = .02). Caries involving 1 or 2 surfaces were more prevalent in children with ASD, with a significant proportion extending to the dental pulp (P < .001). Dental caries characteristics and patterns among children with ASD differ from those of healthy children, which influences dental treatment decisions.

Global randomized controlled trial of knowledge translation of children's environmental health

Objectives

Toxic chemicals can harm children's brain development, but the public's understanding of these harmful impacts is largely unknown. People's knowledge of toxic chemicals and their awareness of how to reduce children's exposure was examined. This study also assessed whether a video was efficacious in increasing knowledge about toxic chemicals and brain development and encouraging behavioral change to reduce exposure to toxic chemicals.

Methods

15,594 participants of child-bearing age (18-45 years old) from five countries (Canada, United States, United Kingdom, India, and Australia) were surveyed via CloudResearch's Prime Panels®. After completing a baseline survey, Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT), participants were randomly assigned to watch a knowledge translation video (experimental group) or serve as a control group. Next, participants were asked about barriers and intentions to reduce exposure to toxic chemicals. After 6 weeks, a subset (n = 4,842) of participants were surveyed with PRoTECT and asked whether they modified behaviors to reduce exposure to toxic chemicals or plan to speak to their healthcare provider (HCP) about toxic chemicals.

Results

Participants expressed strong preferences for lowering exposures and preventing disabilities. Participants who knew more about the impact of toxic chemicals on children's health were more likely to prefer investing in prevention and reducing their exposures. Participants who viewed the video showed significantly greater changes in PRoTECT scores. At the 6-week follow-up, no differences in behavioral changes were observed by group assignment, but two-thirds of all participants reported making changes to reduce their exposures and half intended to speak with their HCP.

Conclusion

There were significant differences in knowledge and preferences by group assignment, but systemic barriers, such as cost of non-toxic products and difficulty determining how and where to buy them, hindered people from making changes to reduce their exposures to toxic chemicals.

Advancing Mental Health and Equity Through Infant and Early Childhood Mental Health Consultation

Early intervention services are a critical support for young children experiencing developmental delays and disabilities. Due to myriad negative social and economic conditions, some infants and young children, namely Black, Indigenous, and other children of color, as well as those experiencing poverty, are at greater risk of experiencing a developmental delay or disability and experiencing issues of access to needed services and supports within and beyond early intervention programs. Due to these systemic issues, these infants and young children are more likely to have caregivers experiencing mental health concerns and issues of access to services and supports. Early childhood serving programs are faced with meeting the behavioral health needs of families experiencing cumulative vulnerabilities. Some early intervention (EI) programs are partnering with infant and early childhood mental health (IECMH) providers to meet mental health needs. IECMH consultation (IECMHC) is a multi-level support that aims to build the capacity of early childhood programs to meet the needs of young children, families, caregivers, and staff. IECMHC has an intentional focus on promoting and ensuring equity, specifically more equitable systems. It focuses on addressing inequities impacting young children and their caregivers, thus strengthening these essential collaborations. This paper highlights research demonstrating the importance and collective power of IECMHC in early intervention programs to advance behavioral health and equity.

Prevalence and Characteristics of Developmental Disabilities Among Children Who Receive Hearing Health Care

PURPOSE

We aim to determine the prevalence and characteristics of developmental disabilities among the clinical population of children who receive hearing health care in the United States.

METHOD

Using electronic health records of 131,709 children (0-18 years), we identified those with a diagnosis of attention deficit/hyperactivity disorder, autism spectrum disorder, vision differences, cerebral palsy, chromosomal abnormalities, delayed milestones, Down syndrome, or intellectual disability. We determined prevalence, age of first audiology encounter, age of diagnosis for the developmental disability, and hearing status based on the specific disability and the number of diagnoses. Binomial and multinomial logistic regressions were performed.

RESULTS

One in four children had a diagnosed developmental disability. The most common disabilities were delayed milestones (11.3%), vision differences (7.4%), attention-deficit/hyperactivity disorder (6.6%), and autism spectrum disorder (6.2%). Half of the children with developmental disabilities had at least one diagnosis before their first audiology encounter. Children with developmental disabilities were more likely to have a reduced hearing or an unknown hearing status than children without developmental diagnoses. For children with reduced hearing, those with developmental disabilities had higher rates of bilateral configurations and poorer hearing severity levels.

CONCLUSIONS

Developmental disabilities are common among children who seek hearing health care. Moreover, developmental disabilities often co-occur with reduced hearing. Further research and advocacy efforts are critical for creating clinical practices that are inclusive of, and equitable for, children with complex and diverse developmental profiles.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27857847.

A new screener predicts toddlers' language development from age 2-3: The QUILS:TOD

Language interventions may yield greater benefits for younger children than their older counterparts, making it critical to evaluate children's language skills as early as possible. Yet, assessing young children's language presents many challenges, such as limited attention spans, low expressive language, and hesitancy to speak with an unfamiliar examiner. To address these challenges, the Quick Interactive Language Screener for Toddlers (QUILS:TOD; for children 24- to 36-months of age) was developed as a quick, tablet-based language screener capable of assessing children's vocabulary, syntax, and word learning skills. We explored how children's performance on the QUILS:TOD and the MacArthur-Bates Communicative Development Inventory, another language screener, at two years of age relates to their performance one year later on the Quick Interactive Language Screener (QUILS), a validated and normed screener for children between three and six years of age. Results revealed that performance on the QUILS:TOD was predictive of QUILS performance, highlighting the utility of the QUILS:TOD for identifying which children at age two would continue to lag behind their peers at age three. Lastly, although all QUILS:TOD areas (vocabulary, syntax, and word learning) were predictive of QUILS performance, the most robust predictor of children's performance on the same receptive language dimensions at 3 years was their syntax, emphasizing the necessity of evaluating language beyond vocabulary.

The relationship between parental stress and treatment adherence in parents of children with neurodevelopmental disorders: A cross-sectional study

BACKGROUND

Children with neurodevelopmental disorders (NDDs) require long-term medical care from clinicians and high-level daily support from their parents throughout the lifespan. Parents, as the primary caregivers, serve as major providers of daily care and important supporters of medical services.

OBJECTIVE

This cross-sectional study aimed to investigate the relationship between parental stress and treatment adherence, while also examining the roles of family resilience and affiliate stigma in this dynamic among parents of children with NDDs.

METHOD

Utilizing a convenience sampling approach, we recruited parents of children with NDDs to participate in an online survey. The survey included validated measures assessing parental stress, treatment compliance, family resilience, and affiliate stigma. Descriptive statistics were computed to summarize demographic characteristics and key study variables. Pearson correlation analyses were conducted to examine the bivariate relationships among the key study variables. Multiple linear regression analyses were conducted to identify predictive factors of treatment compliance. Mediation analysis was performed using the PROCESS macro for SPSS to explore the effect of affiliate stigma and family resilience on the relationship between parental stress and treatment compliance.

RESULT

A total of 310 parents of children with NDDs participated in the online survey. Pearson correlation analysis revealed that treatment compliance was negatively correlated with parental stress (r = -0.385, p < 0.001) and affiliate stigma (r = -0.787, p < 0.001), while treatment compliance was positively correlated with family resilience (r = 0.856, p < 0.001). Multiple linear regression analysis indicated that parental stress (β = - 0.091, p < 0.001) and affiliate stigma (β = - 0.410, p < 0.001) were significant negative predictors of treatment compliance, while family resilience (β = 0.576, p < 0.001) was a significant positive predictor of treatment compliance. Moderated mediation analysis revealed that affiliate stigma mediated while family resilience moderated the relationship between parental stress and treatment compliance (all p < 0.001).

CONCLUSION

This study underscores the complex interplay between parental stress, affiliate stigma, family resilience, and treatment adherence among parents of children with NDDs. The findings advocate for both clinical efforts and academic initiatives focused on developing targeted support programs and intervention strategies. These measures aim to alleviate parental stress, reduce affiliate stigma, and enhance family resilience, ultimately promoting treatment adherence and optimizing developmental outcomes for children.

Outcomes from an enhanced developmental screening programme in Singapore

INTRODUCTION

Historically, low referral rates of 3-4 % have been reported from Singapore primary health care. Early identification of and intervention for developmental delays and autism enable achievement of optimal outcomes. An enhanced developmental screening (EDS) programme was introduced in primary care to improve identification of developmental delays and autism for children aged 18 and 30 months. This study evaluated prevalence of positive screening for developmental delays/autism at 18 months, identified associated socio-demographic risk factors and studied the correlation between primary care screening tools with outcomes following tertiary care assessments.

METHODS

In primary care, EDS was conducted using Parents' Evaluation of Developmental Status (PEDS), Parents' Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), Ages & Stages Questionnaires-Third Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised - Follow-Up (M-CHATR/F) along with collection of socio-demographic data. Tertiary care assessment included Developmental Profile-3 (DP-3) screening and, a developmental paediatrician consultation.

RESULTS

Of 4212 children screened at 18 months, 14 % screened positive for developmental delays and 2 % for autism at primary care. Lower maternal education, ethnic minority status and lower socioeconomic status were associated with a positive screen. Moderate- strong correlation was seen between the ASQ-3 gross motor domain and DP-3 physical domain, moderate correlation between the communication domains of the 2 tools and the ASQ-3 personal-social domain with DP-3 adaptive domain.

CONCLUSION

EDS enabled improved identification of children for developmental delays/autism. Identification of socio-demographic risk factors will enable children from such families to be identified early and referred for intervention.

All on the Same Team: Simulated Learning to Introduce Pediatric Residents to Interprofessional Collaboration With Individualized Education Program Teams

OBJECTIVE

Our study sought to determine if participation in a simulated Individualized Education Program (IEP) meeting improved pediatric medical residents' attitudes toward the IEP team as an interprofessional health care team.

METHODS

Pediatric medical residents on the Developmental-Behavioral and Advocacy rotations at an urban medical center participated in a simulated IEP eligibility meeting for a case of a fourth grader with a specific learning disability. Standardized actors portrayed the child's parent, principal, school psychologist, and classroom teacher. Residents were instructed to participate as members of the team. After participation, changes in the residents' readiness to participate on the IEP team were measured by the Interprofessional Socialization and Valuing Scale 9A (presimulation) and 9B (postsimulation).

RESULTS

Sixty-six pediatric residents participated over 24 months. The mean scores of the aggregate pre- (4.92, SD = 0.83) and postsurveys (5.75, SD = 0.74) illustrated residents' improvement in 3 areas of interprofessional practice: understanding their role as a member of an IEP team; appreciation of an IEP team as an interprofessional health care team; and comfort and confidence in working as a member of an IEP team (Z = -6.37; p < 0.001; r = 0.78). Comparison of disaggregated data illustrated improvement for post-graduate year 1 (Z = -4.95; p < 0.001; r = 0.85) and categorical pediatric residents (Z = -5.86; p < 0.001; r = 0.83).

CONCLUSION

Simulated IEP meetings help pediatric residents reconceptualize their role in the school health of children with disabilities to include participation in and understanding of the IEP process.

The Grief Experiences of Children with Developmental Disabilities: A Narrative Literature Review

BACKGROUND

Children with developmental disabilities have wide-ranging social, developmental, and communication challenges impacting their grieving process. This narrative review examined the literature relating to the grief experiences of children with developmental disabilities to identify implications for practice and areas for future research.

METHODS

The literature review was conducted using five databases, and a hand search of dissertations with original research, due to the sparse body of published works.

RESULTS

Nine works were included in the review, which were thematically synthesized into three categories: (1) Understanding of death concepts, (2) Social-emotional responses to loss, and (3) Disenfranchised grief.

CONCLUSIONS

Children with developmental disabilities are affected by loss, even if their comprehension of death concepts is impacted by their level of disability. They may experience challenges due to changes in routines and concrete thinking, and are at risk of disenfranchised grief. Future research is needed to inform developmentally appropriate grief interventions.

Gamified mHealth System for Evaluating Upper Limb Motor Performance in Children: Cross-Sectional Feasibility Study

BACKGROUND

Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions.

OBJECTIVE

This feasibility study examines whether MoEvGame can assess children's whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to (1) design and develop novel mHealth gamified software tools to examine theory-driven features of UL movement, (2) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and (3) validate assessment methods with healthy participants from schools.

METHODS

Elementary school children (N=31, median 9.0, IQR 4.0-14.0 years old) participated by playing 5 games. The game tasks were focused on key features of skilled motor control: (1) whole limb reaching, (2) fine motor control and manual dexterity, and (3) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (ie, the pruned exact linear time method), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (ie, Pearson correlation, mean, standard deviation, P value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance.

RESULTS

A negative correlation was identified between speed and accuracy in the whole limb movement (r=-0.30 to -0.42). Significant relationships between age and upper limb performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (in-phase congruent [mean 28.85, SD 18.97] vs antiphase congruent [mean 112.64, SD 25.82] and in-phase mirrored [mean 23.78, SD 16.07] vs antiphase mirrored [mean 121.39, SD 28.19]). Moreover, the average speed (revolutions per second) and travel distance (m) of the in-phase mode were significantly higher than those of the antiphase coordination.

CONCLUSIONS

Results of this feasibility study show that spatiotemporal data captured from the mHealth app can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment.

Association between maternal smoking during pregnancy and developmental disabilities in US children and adolescents: A cross-sectional study from NHANES

INTRODUCTION

Maternal smoking during pregnancy is associated with placental DNA methylation and RNA expression, offspring DNA methylation, and affects the decline of mature neurons and the prenatal human brain development trajectory.

METHODS

This study is a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2008, comprising 10111 children and adolescents. Inclusion criteria required participants to have complete questionnaire responses regarding maternal smoking during pregnancy and receipt of special education or early intervention services. The risk of developmental disabilities was assessed using a multifactor logistic regression model.

RESULTS

In the cohort of 10111 children and adolescents, 727 (7.2%) received special education or early intervention services. Of these participants, 1504 (14.9%) were exposed to maternal smoking during pregnancy. The prevalence of maternal smoking was higher (12.3%) in the group receiving special education or early intervention compared to those who did not (6.3%). After adjusting for other relevant factors in a multifactorial logistic regression model, maternal smoking during pregnancy was significantly associated with an increased likelihood of requiring special education or early intervention services (adjusted odds ratio, AOR=1.51; 95% CI: 1.24-1.83, p<0.001).

CONCLUSIONS

This cross-sectional analysis found an association between maternal smoking during pregnancy and the need for special education or early intervention services among US children and adolescents, after adjusting for confounding variables. Our findings suggest that maternal smoking during pregnancy may increase the odds of developmental disabilities.

Uncovering distinct motor development trajectories in infants during the first half year of life

Infants undergo significant developmental changes in the first few months of life. While some risk factors increase the risk of developmental disability, such as preterm birth, the developmental trajectories of infants born pre-term (PT) and full-term (FT) present with individual variability. This study aims to investigate whether the utilization of data-driven unsupervised machine learning can identify patterns within groups of infants and categorize infants into specific developmental trajectories. Thirty-four infants, 19 FT and 15 PT, were assessed with the gross and fine motor subscales of the Bayley Scales of Infant and Toddler Development, version III (BSID-III) monthly for 2-5 visits between the ages of 1 and 6 months. Latent class growth analysis (LCGA) models were adopted to identify clusters of motor developmental trajectories during this critical time. Based on statistical significance, the linear, 2-class trend was selected as the best-fitting model for both gross and fine motor trajectories. Within this, LCGA reveals 2 developmental trends with varying beginning scores and developmental rates, including the low-baseline slow-growth (LBSG) subgroup, and the high-baseline fast-growth (HBFG) subgroup, with age (adjusted for prematurity) being equally distributed across both subgroups. Both subgroups, HBFG and LBSG, had a combination of infants born FT and PT (55% FT in HBFG, 56% FT in LBSG), supporting that preterm birth alone may not sufficiently categorize an infant's developmental trajectory. The later BSID-III gross motor score showed marginal difference between groups (p = 0.062). Similarly, the fine motor model displayed a mixture of both infants born FT and PT (68% FT in HBFG, 40% FT in LBSG). In this case, the late motor composite BSID score was different between groups (p = 0.04). Our study uses a novel approach of LCGA to elucidate heterogeneous trajectories of motor development for gross and fine motor skills during the first half of life and offers potential for early identification of subgroup membership. Furthermore, these findings underscore the necessity for individualized risk assessments and intervention strategies tailored to individual needs. Ultimately, further validation of these models may provide usefulness in uncovering distinct motor development trajectories in infants.

Social cognition in autism and ADHD

Social cognition is a crucial capacity for social functioning. The last decades have seen a plethora of social cognition research in neurodevelopmental conditions, foremost autism and, to a lesser extent, ADHD, both characterized by social challenges. Social cognition is a multifaceted construct comprising various overlapping subdomains, such as Theory of Mind/mentalizing, emotion recognition, and social perception. Mechanisms underpinning social cognition are complex, including implicit and explicit, cognitive and affective, and hyper- and hypo-social information processing. This review explores the intricacies of social cognition in the context of autism and ADHD. Research indicates altered performance on social cognition tests in autism, compared to neurotypical groups, with social cognition alterations having a small but robust effect on the defining features of autism. The nature of such alterations in autism appears primarily in relation to implicit processing. ADHD groups show intermediate social cognition performance, appearing to be influenced by executive function difficulties. Social cognition varies with intellectual and verbal abilities and seems to improve with age in autism and ADHD. Social skills interventions in autism, and stimulant medication in ADHD have been shown to improve social cognition test performance, while mentalizing training effects in autism are less conclusive. A limitation of the field is that social cognition constructs and tests are not well delineated. Further, most research has been embedded in a nativist approach rather than a constructivist approach. The former has been questioned for ignoring environmental contributions, especially the dimension of mutual miscommunication between neurodivergent and neurotypical individuals.

Indications for tracheostomy placement in pediatric patients with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is the most common neuromuscular disorder in children, and children with CP are at increased risk of respiratory distress potentially requiring tracheostomy placement. Previous studies have characterized indications for tracheostomy in neurologically compromised children, however no studies focus specifically on children with CP. The purpose of this study was to identify the indications for tracheostomy placement, sites of airway obstruction, and rate of decannulation in children with CP.

METHODS

We conducted a single-center retrospective chart review of all patients who presented with cerebral palsy and required tracheostomy at our center between 2005 and 2023. Patients were categorized according to primary indication for tracheostomy placement. The most common sites of airway obstruction in the cohort were recorded. The date of decannulation was recorded for those patients who had undergone decannulation.

RESULTS

933 patients with tracheostomies were identified, of whom 169 (18 %) had CP and 122 met inclusion criteria. The median age at tracheostomy placement was 1.69 (IQR 0.539-6.609) years. The most common indications for tracheostomy placement were: prolonged intubation or BiPAP dependence (81 %), airway obstruction/hypotonia (13 %), and aspiration/recurrent respiratory infection (6 %). At the time of tracheostomy placement: 38 % of patients had a single site of upper airway obstruction, while 27 % had multi-level obstruction. The most common sites of upper airway obstruction were the supraglottis (23.0 %), tongue base (12 %), and the tonsils/pharyngeal wall (8 %). 24 % of patients had tracheobronchomalacia, and 16 % had subglottic stenosis. Among all patients, 4 of 122 (3 %) were ultimately decannulated.

CONCLUSIONS

Patients in our cohort most often received tracheostomy after failure of less invasive ventilation therapies. Tracheostomy placement occurred at a young age. Patients presented with a variety of sites of airway obstruction. Decannulation rate in this cohort was low. Further work is needed to confirm indications for tracheostomy placement and decannulation rate in this population.

Preschool and Me: Educational-clinical linkage to improve health equity for children with developmental delays and disabilities from historically marginalized communities

Societal and structural inequities have resulted in longstanding health care disparities among Black, Latino/a/e, and low-income preschool children with developmental delays and disabilities (PCw/DD), depriving them of educational and therapeutic services that improve future academic, economic, and health outcomes. To address this issue, we developed Preschool and Me (PreM), a community-clinical linkage (CCL) implemented within healthcare settings serving historically marginalized communities. This novel CCL, an educational-medical linkage model, aims to increase access to school-based services for PCw/DD. Combining key components of CCLs with a personalized medical-education care plan and remote navigator support, PreM targets multiple levels of influence impacting access to school-based therapeutic and educational services. We will utilize a hybrid effectiveness-implementation approach in two models of real-world service delivery conditions. Participants (n = 320) will be randomized to either 6 months of PreM or a waitlist control arm beginning the intervention after a 6-month delay. Our specific aims are to test the effectiveness of PreM on access to school-based services as well as health service outcomes; examine mediators of intervention effects using a mixed-methods approach; and explore social determinants of health as potential moderators. We will simultaneously conduct an implementation evaluation. The results of this study have the potential to support effective implementation of CCL models within pediatric clinical settings serving historically marginalized communities which can be utilized to improve health outcomes for families and their children with a range of health conditions.

Prevalence of Urinary Incontinence and Its Association With Neurodevelopmental Disorders Among Children in Japan

AIM

To investigate urinary incontinence prevalence and its association with neurodevelopmental disorders among children in Japan.

METHODS

A web-based survey was conducted on children aged 5-15 years in Japan. Information on daytime and nocturnal incontinence and neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder, and intellectual disability, was collected.

RESULTS

Responses from 5186 questionnaires (2619 boys, 2517 girls) were evaluated. In total, 505 children had neurodevelopmental disorders. Furthermore, 148 children had daytime urinary incontinence. The incidence of daytime urinary incontinence did not differ significantly according to sex. Daytime urinary incontinence was associated with neurodevelopmental disorders in 33.1% of children. Moreover, 220 children had nocturnal enuresis. Boys had a significantly higher prevalence of nocturnal enuresis than girls in the overall cohort and early elementary school age group. Nocturnal enuresis was associated with neurodevelopmental disorders in 29.1% of children. Children with daytime urinary incontinence or nocturnal enuresis had a significantly higher incidence of neurodevelopmental disorders.

CONCLUSIONS

The prevalence of concomitant daytime and nocturnal urinary incontinence and neurodevelopmental disorders in children is significant.

Child Development Allied Health Services in Rural and Remote Areas: A Systematic Scoping Review of Drivers, Barriers and Enabling Strategies to Delivery of Services

BACKGROUND

Access to child development allied health services is challenging in rural and remote areas. A companion review has described the types of models of care that are used to deliver these services and their impact on the quality of healthcare.

OBJECTIVE

This review aimed to identify service drivers for, and barriers and enabling strategies to the delivery of these services.

DESIGN

A scoping review was conducted in alignment with the Joanna Briggs Institute methodology and PRISMA methodology. Data from included citations were thematically organised to describe and connect drivers, enabling strategies and barriers.

FINDINGS

Twenty-five citations met the inclusion criteria. Six key drivers were identified, four key enabling strategies and five key barriers.

DISCUSSION

Most models of care were driven by the need to address the inadequacy of child development allied health services. Place-based strategies were described by most citations as key to enabling the delivery of new models of care. However, understanding the community's capacity for a new model of care was a prominent barrier to implementation.

CONCLUSION

Findings from this review highlight the complexities of devising and delivering new models of care for children in rural and remote areas with developmental needs. While place-based approaches were the most widely adopted enabling strategy, these strategies presented their own challenges. Understanding community needs, capacity and assets from end-user (including children) perspectives is complex but should underpin designing and implementing models of care.

A systematic review of portable technologies for the early assessment of motor development in infants

Early screening and evaluation of infant motor development are crucial for detecting motor deficits and enabling timely interventions. Traditional clinical assessments are often subjective, without fully capturing infants' "real-world" behavior. This has sparked interest in portable, low-cost technologies to objectively and precisely measure infant motion at home, with a goal of enhancing ecological validity. In this systematic review, we explored the current landscape of portable, technology-based solutions to assess early motor development (within the first year), outlining the prevailing challenges and future directions. We reviewed 66 publications, which utilized video, sensors, or a combination of technologies. There were three key applications of these technologies: (1) automating clinical assessments, (2) illuminating new measures of motor development, and (3) predicting developmental outcomes. There was a promising trend toward earlier and more accurate detection using portable technologies. Additional research and demographic diversity are needed to develop fully automated, robust, and user-friendly tools. Registration & Protocol OSF Registries https://doi.org/10.17605/OSF.IO/R6JAE .

Caregiver report of infant behavior associated with autism likelihood in first year of life

BACKGROUND

Identification of prodromal indicators of autism in infancy has the potential to identify behaviors relevant to early autism screening.

METHODS

We report on data from a prospective general population birth cohort with maternal reported measures at 9 and 12 months: the Survey of Well-Being of Young Children (SWYC; general developmental surveillance) and the First Year Inventory-Lite v3.1b (FYI-Lite; autism specific parent report research tool). Mothers completed the surveys and the Broad Autism Phenotype Questionnaire (BAPQ), a self-report measure of subclinical features of autism.

RESULTS

In this sample of 332 infants (168 males), maternal-reported infant developmental milestones and behavioral indicators of difficult temperament, poor adaptability, and sleep problems at 9 months (SWYC) and maternal self-reported subclinical autism characteristics (BAPQ) were correlated with maternal-reported autism-related behaviors on the FYI-Lite at 12 months. Regression models revealed significant unique associations between infant temperament, developmental milestones, and FYI-Lite scores while controlling for significant effects of maternal BAPQ scores and education.

CONCLUSIONS

Maternal report of infant temperament and developmental milestones at 9 months were associated with maternal-report early indicators of autism likelihood at 12 months in a general birth cohort. Follow up of this cohort is needed to determine associations with formal diagnostic outcomes.

IMPACT

Identifying scalable measures of infant behaviors in general and specific to autism may help identify targets of intervention for infants in the first year of life. This study aims to contribute to improved first-year surveillance by assessing potential early autism indicators in a prospective general birth cohort, whereas other observational studies utilize enriched risk cohorts (e.g., infant siblings of autistic children). Preliminary findings of this cohort revealed that a maternal report of 9-month temperament significantly predicted higher scores on a maternal report 12-month autism screener and indicated the importance of considering maternal self-reported subclinical autism characteristics when interpreting parent report screeners.

Excess neonatal testosterone causes male-specific social and fear memory deficits in wild-type mice

Neurodevelopmental disorders disproportionately affect males compared to females. The biological mechanisms of this male susceptibility or female protection have not been identified. There is evidence that fetal/neonatal gonadal hormones, which play a pivotal role in many aspects of development, may contribute. Here, we investigate the effects of excess testosterone during a critical period of sex-specific brain organization on social approach and fear learning behaviors in C57BL/6J wild-type mice. Male, but not female, mice treated with testosterone on the day of birth (PN0) exhibited decreased social approach as juveniles and decreased contextual fear memory as adults, compared to vehicle-treated controls. These deficits were not driven by anxiety-like behavior or changes in locomotion or body weight. Mice treated with the same dose of testosterone on postnatal day 18 (PN18), which is outside of the critical period of brain masculinization, did not demonstrate impairments compared to the vehicle group. These findings indicate that excess testosterone during a critical period of early development, but not shortly after, induces long-term deficits relevant to the male sex bias in neurodevelopmental disorders.

Diversity and consequences of structural variation in the human genome

The biomedical community is increasingly invested in capturing all genetic variants across human genomes, interpreting their functional consequences and translating these findings to the clinic. A crucial component of this endeavour is the discovery and characterization of structural variants (SVs), which are ubiquitous in the human population, heterogeneous in their mutational processes, key substrates for evolution and adaptation, and profound drivers of human disease. The recent emergence of new technologies and the remarkable scale of sequence-based population studies have begun to crystalize our understanding of SVs as a mutational class and their widespread influence across phenotypes. In this Review, we summarize recent discoveries and new insights into SVs in the human genome in terms of their mutational patterns, population genetics, functional consequences, and impact on human traits and disease. We conclude by outlining three frontiers to be explored by the field over the next decade.

Mental health in children with and without ADHD: the role of physical activity and parental nativity

BACKGROUND

Physical activity (PA) can improve mental health, including anxiety/depression, in individuals with attention-deficit/hyperactivity disorder (ADHD) with minimal side effects, unlike pharmacotherapy that can result in significant side effects. However, the influence of PA on mental health among children with ADHD is understudied. Also, immigrants tend to have better mental health, but the influence of parental nativity on children's mental health is unknown. We examined the relationship between PA, parental nativity, and current anxiety/depression among U.S. children with and without ADHD. We also analyzed whether ADHD diagnosis status moderates the relationship between anxiety/depression and PA or parental nativity.

METHODS

We used national annual cross-sectional data from the 2016 to 2021 National Survey of Children's Health to conduct weighted multivariable logistic regression and moderation analyses, with current anxiety/depression status as the outcome variable. The sampling involves selecting households with children and rostering children in the household from each state and the District of Columbia. A parent or caregiver of the selected child completes the surveys. We restricted the analysis to children aged 6-17 years (N = 140,977).

RESULTS

The prevalence of current anxiety/depression was higher in children with ADHD diagnosis (37.34%) than those without ADHD diagnosis (7.42%). Children with ADHD (versus no ADHD) had higher odds of anxiety/depression. Engaging in PA (versus no PA) and having immigrant parents (versus non-immigrant parents) were associated with lower anxiety/depression odds. ADHD diagnosis status significantly moderated the association between anxiety/depression and PA or parental nativity. However, the three-way interaction between ADHD status, parental nativity, and physical activity was not statistically significant. Stratified by ADHD diagnosis status, those who engaged in PA (versus did not) for 1 to 3 days, 4 to 6 days, and daily were less often diagnosed with anxiety/depression disorder among those with or without ADHD, especially children without ADHD. The odds were also lower for children with or without ADHD whose parents were immigrants than children with non-immigrant parents, particularly children without ADHD who had immigrant parents. Parental nativity did not significantly moderate the association between PA and anxiety/depression among children with and without ADHD.

CONCLUSIONS

Physical activity was associated with lower risks of diagnosed with anxiety/depression disorder among children, especially children without ADHD and those with immigrant parents. Considering parental nativity and incorporating personalized PA in ADHD and anxiety/depression management can improve mental illness and ADHD symptoms among children.

Prenatal exposure to a mixture of organophosphate ester and organophosphorus pesticides in relation to child neurodevelopment in the Shanghai Birth Cohort

Neurotoxicity of organophosphate esters (OPEs) and organophosphorus pesticides (OPPs) has been documented in toxicological studies, though epidemiological evidence remains inconsistent. The developing fetal brain is susceptible to environmental exposures. Thus, we aim to investigate how prenatal exposure to OPEs and OPPs as mixture affects offspring neurodevelopment in preschool-aged children. In a study involving 530 mother-child dyads from the Shanghai Birth Cohort (SBC) with enrollment occurring between 2013 and 2016, 14 OPEs/OPPs metabolites were evaluated using high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS) in maternal urine collected during both the first and second trimester. Child neurodevelopment was evaluated using the parent-reported Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and the Strengths and Difficulties Questionnaire (SDQ). We utilized multivariable linear regression and Bayesian kernel machine regression (BKMR) to estimate associations with individual and mixture component, respectively. We also investigated whether these associations varied by child sex. Of the 14 OPEs/OPPs metabolites, 6 were quantifiable in over 75 % of the samples. Higher prenatal O,O-dimethyl phosphate (DMP) concentrations in the first and second trimesters, as well as O,O-dimethyl thiophosphate (DMTP) in the second trimester, were associated with more behavioral difficulties. When stratified by child sex, the statistically significant inverse associations were observed exclusively in girls. Results from BKMR showed that the overall effect of prenatal exposure to OPEs and OPPs mixtures was associated with some neurodevelopmental domains in girls. For example, holding the mixture at the 75th percentile compared to the 50th percentile during the first trimester was associated with a 0.65 increase in SDQ total scores (95 % confidence interval: 0.03-1.26). DMP and DMTP may be the dominant contributors. Our findings add to the literature on the effect of prenatal exposure to OPEs and OPPs on offspring neurodevelopment and suggest that the effect seems to be sex-specific. Additional research is required to validate our findings and elucidate the underlying mechanisms.

A protocol to study the effect of targeted parental education intervention to identify early childhood development disorder - multisite interventional study

BACKGROUND

In India, approximately 3.5 million children are affected by Developmental Delay (DD), often stemming from preterm births. These delays contribute to neurological and motor development delays, placing a significant financial burden on families. Maternal unemployment rates are also elevated in such cases. Delayed Developmental Milestones identification, often due to a lack of parental awareness, further compounds these challenges. This study introduces a multiphasic approach aimed at educating antenatal women on monitoring neurological maturation, with the overarching objective of assessing the effectiveness of a targeted multi-method parental education intervention in improving parents' knowledge and early detection of developmental disorders in early childhood.

METHODS

Antenatal women will be assigned to intervention or control groups. The intervention group will undergo specialized training in a multiphasic study, while the control group will receive routine care. A meticulously developed intervention module for early detection of neurodevelopmental disorders will empower mothers to monitor their newborns for potential deficits. Outcomes will be assessed through questionnaires, analyzing knowledge improvement and early identification of DD using statistical methods such as chi-square tests. The study involves three phases: preparatory, implementation, and evaluation, aiming to empower mothers to detect developmental concerns early and improve maternal awareness of child development. The study was approved by the SRM Institutional Ethical Committee with the reference number 8688/IEC/2023.

DISCUSSION

This study will identify DD and improve parental awareness by providing tools for early detection thereby empowers parents to identify developmental concerns early. The study supports policy goals to reduce the burden of DD, enhance early intervention, and improve long-term outcomes for children. It is anticipated that this intervention will complement existing health policies, contributing to better child health and developmental outcomes in India.

TRIAL REGISTRATION

Trail is registered under Clinical Trails Registry - India (CTRI/2024/04/065008) registered on 01 April 2024.

Sex Differences in the Comorbidity between Attention Deficit-Hyperactivity Disorder and Posttraumatic Stress Disorder: A Systematic Literature Review and Meta-Analysis

Objective

Attention Deficit-Hyperactivity Disorder (ADHD) and Posttraumatic Stress Disorder (PTSD) are often comorbid and share a common core of symptoms. However, sex and gender-related factors significantly influence their prevalence, clinical presentation, and diagnosis. Here, we conducted a systematic literature review and meta-analysis to examine sex differences in ADHD/PTSD comorbidity during childhood and adulthood.

Methods

A scoping review of PsycINFO and PubMed yielded 13 eligible studies with complete outcome data. We conducted fixed-effects meta-analyses of the sex-stratified prevalence of ADHD/PTSD using pooled odds ratios (OR) with a 95% confidence interval (CI). Fixed-effects subgroup analyses were performed using age as a subgroup. Effect size heterogeneity was assessed using the I2 index and Cochran's Q test.

Results

In the whole sample (N= 13,585; F= 7005, M= 6580), the diagnosis of ADHD/PTSD was significantly higher in females than in males (OR = 1.32, p = 0.02). Between-study heterogeneity was low-to-moderate and not significant (I2 = 41%; p = 0.06), validating the fixed-effects model. Age-stratified subgroup analyses revealed higher ADHD/PTSD odds in females compared to males only in adult populations (OR=1.41; p = 0.01). Additionally, females were more likely to be diagnosed with both disorders in studies where ADHD was the primary diagnosis (OR = 1.60; p = 0.002), and in studies employing structured clinical interviews as diagnostic tools (OR = 1.46; p = 0.009).

Conclusions

Our study is the first to show that the association between ADHD and PTSD is stronger in females, suggesting that ADHD may increase risk for PTSD in a sex-specific manner.

Education strategies are the most commonly used in pediatric rehabilitation implementation research: a scoping review

BACKGROUND

Approximately one in six children has a disability, and effective, evidence-based rehabilitation can ameliorate the impact of these conditions over the lifespan. However, implementing interventions in real-world settings remains a challenge. This scoping review aimed to summarize the characteristics, implementation strategies, and outcomes of implementation studies in pediatric rehabilitation.

METHODS

A comprehensive search was conducted in PubMed/MEDLINE, EMBASE, CINAHL, SCOPUS, and Web of Science from the database inception to December 2, 2022. Studies testing implementation strategies in pediatric rehabilitation interventions were included. Data extracted included study characteristics (e.g., country, intervention type, field of rehabilitation), implementation strategies characterized using the Expert Recommendations for Implementing Change taxonomy, and outcomes based on the Implementation Outcomes Framework.

RESULTS

Of the 11,740 studies identified, 44 met the inclusion criteria. Most studies were conducted in the United States (n = 15, 34%) or Canada (n = 10, 23%) and used a mixed-methods design (n = 13, 30%). Interventions primarily targeted motor skills (n = 19, 43%) and were conducted in outpatient settings (n = 14, 32%) or homes (n = 11, 23%). The most commonly used implementation strategies were "train and educate key informant" (n = 21, 48%) and "use evaluative/iterative strategies" (n = 19, 43%). Feasibility (n = 19, 43%) and acceptability (n = 16, 36%) were the most frequently targeted implementation outcomes.

CONCLUSIONS

Reporting implementation strategies and outcomes in pediatric rehabilitation studies is limited and highly variable. Most strategies focused on developing and sharing educational materials, while administrative and systems-level interventions were largely absent. Standardized documentation of implementation strategies and outcomes could advance the field's understanding of the effective development of interventions designed for implementation, encouraging faster uptake of effective interventions.

Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources

BACKGROUND

An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families.

OBJECTIVE

This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions.

METHODS

We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale.

RESULTS

The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=-4.35, P<.001; digital resources; t67=-4.95, P<.001).

CONCLUSIONS

The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped.