The impact of adverse childhood events on service support and educational outcomes of children who are autistic: A theory-guided analysis using structural equation modeling.

Autistic children who have experienced adverse childhood experiences (ACEs) may have barriers to receiving special education or other developmental services-thus, impacting educational outcomes. Our objective was to model such a pathway using the 2016-2021 National Survey of Children's Health datasets. We extracted data for school outcomes, use of special education and autism-related specialty services and sociodemographic characteristics among autistic children within the data. Associations between sociodemographics and ACEs (categorized as 0, 1-3, and 4+) were tested using design-based X2 tests. We then used structural equation modeling to map the quasi-causal pathways. The sample for our analysis included 4717 autistic children-38.94% were aged 6-10 years, 35.73% of children aged 11-14 years, and 25.32% were between 15 and 17 years-with 88.70% living in metropolitan areas. The X2 showed significant relationships between ACEs and age, ethnoracial groups, and urbanicity among others. The SEM showed ACEs were directly associated with poorer school outcomes (ß = -0.14 (0.04), p = 0.002) and through their inverse relationship with support services (ß = -0.08 (0.04), p = 0.023)- when support services were increased, school outcomes improved (ß = 0.62, p < 0.001). Findings suggested ACEs have a significant direct and indirect impact on school outcomes of autistic children, and 10.76% of children who are autistic have experienced four or more ACEs-which were more likely to occur with severe autism symptomatology and in rural areas. Results highlight the need for communities to recognize the potential long-term impact of ACEs on the academic outcomes of autistic children.

Person-centered language and pediatric ADHD research: a cross-sectional examination of stigmatizing language within medical literature.

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and often goes untreated. A major barrier to treatment is the stigma surrounding the disorder, including from the educational and scientific community. Person-centered language (PCL) is associated with positive health outcomes, and its implementation is recommended by multiple professional groups, but its use has not been quantified for ADHD. OBJECTIVES: The goal of this study is to quantify the adherence to PCL among ADHD-related journal publications utilizing a cross-sectional study design. METHODS: We conducted a cross-sectional examination including a systematic search of PubMed, which encompasses MEDLINE, for ADHD-related articles from January 2014 to March 2021. All journals with at least 20 ADHD-related search returns, human research, and in the English language were included, totaling 5,308 articles from 88 journals. Articles were randomized, and the first 500 were screened for inclusion of prespecified, non-PCL terminology. After exclusion, 311 articles were retained. RESULTS: Of the 311 retained articles, 131 (42.1%) adhered to PCL guidelines. Among articles with non-PCL, stigmatizing language such as "problem(s) with [the/a] child or problem child" and "suffers from" was found most frequently- occurring in 47.6% (148/311) and 5.8% (18/311) of the articles, respectively. We found no significant association between PCL adherence and study characteristics. CONCLUSIONS: Our findings revealed that over half of the current ADHD literature did not adhere to PCL guidelines. Adherence to PCL by the scientific and medical community will increase the overall efforts to mitigate stigma and increase support for individuals with ADHD.

Racial discrimination among children in the United States from 2016 to 2020: an analysis of the National Survey of Children's Health.

CONTEXT: Sociological research has linked racism and discrimination among children to poorer health outcomes and social conditions later in life. OBJECTIVES: Given the change in the political climate in the United States, highly publicized deaths of Black men and women by police, and the rise in hate crimes against Asian Americans from 2016 through 2020, our primary objective was to assess trends in racial or ethnic discrimination among children in the United States. METHODS: We conducted a cross-sectional analysis of the National Survey of Children's Health (NSCH), a nationally representative survey, utilizing data from 2016 to 2020. We calculated yearly population estimates of whether a child had experienced discrimination based on race/ethnicity via a parent-reported item. We further divided the estimates by race/ethnicity and plotted linear trends over time. RESULTS: Data from the NSCH show that racial/ethnic discrimination reported by parents of children who are minorities increased from 6.7% in 2016 to approximately 9.3% in 2020. Indigenous children were reported to experience discrimination at high rates ranging from 10.8% in 2016 to 15.7% in 2020, as well as Black children ranging from 9.69% in 2018 to 15.04% in 2020. The percent of Asian, Hawaiian or Pacific Islander, and Hispanic children reported to have experience discrimination was between 4.4 and 6.8% during this time. CONCLUSIONS: Discrimination negatively impacts the developmental experiences of children, disproportionately affecting those identifying as Indigenous and Black. Therefore, addressing harmful stereotyping of Indigenous and Black cultures is necessary, especially in media targeted toward children. Providing culturally competent healthcare, critically in the Indigenous and Black pediatric population, may improve long-term outcomes by reducing discriminatory barriers to healthcare access.

The Crisis in Children's Mental Health: What About the Babies?

The American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Pediatrics (AAP), and the Children's Hospital Association (CHA) declared a national emergency in children's mental health.1 Much of the reporting has focused on children and teens, particularly with regard to increased emergency department visits and suicide attempts. Very little has been publicized about children between birth and 5 years of age, who may be among the most vulnerable to the psychosocial impacts of COVID-19. This commentary will outline some of the impacts of COVID-19 on very young children and their families and highlight activities of members of the Infant and Preschool Committee to address these impacts.

The Use of Person-Centered Language in Scientific Research Articles Focused on Autism.

OBJECTIVE: Individuals with developmental conditions, such as autism, experience stigma, which is reflected in derogatory language and labels. To limit stigma associated with disabilities, government agencies and medical organizations have adopted the use of person-centered language (PCL). This study investigated adherence to PCL guidelines among peer-reviewed research publications focused on autism. In addition, we investigated the co-occurrence of stigmatizing language in articles using person-first language (PFL) and identity-first language (IFL) styles. METHODS: We performed a systematic search of PubMed for autism-focused articles from January 2019 to May 2020. Articles from journals with more than 20 search returns were included, and a random sample of 700 publications were screened and examined for inclusion of prespecified, non-PCL terminology. RESULTS: Of the 315 publications, 156 (49.5%) were PCL compliant. Articles frequently used PCL and non-PCL terminology concomitantly, and 10% of publications included obsolete nomenclature. A logistic regression model showed the odds were more likely that publications using IFL were more likely to include other stigmatizing terminology than publications using PFL (odds ratio = 2.03, 95% confidence interval: 1.15-3.58). CONCLUSION: Within medical research, the language to describe individuals and populations needs to be used with intentionality and acknowledges that individuals are more than the diagnosis under study. This may reduce the structural stigma that may be implied otherwise. Our study showed that when PFL is used when addressing individuals with autism, other more stigmatizing language is often avoided and is in line with medical education and clinical practice.

Deviations in criminal filings of child abuse and neglect during COVID-19 from forecasted models: An analysis of the state of Oklahoma, USA.

BACKGROUND: The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. OBJECTIVE: The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. PARTICIPANTS AND SETTING: This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. METHODS: Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. RESULTS: Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. CONCLUSIONS: Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.

Brief Report: Public Awareness of Asperger Syndrome Following Greta Thunberg Appearances.

Thunberg's increased media attention coupled with her diagnosis-Asperger Syndrome (AS)-may foster help-seeking behaviors among those with similar psychiatric disorders. Using Google Trends data, we compared values of AS from the week of the UN Climate Summit through the end of the year compared to an ARIMA model predicting search interest had Thunberg not been in the media. The search trend for AS at peak was 254.07% higher than predicted and was on average 10.61 points above the projected model during this time. As the primary goal of AS intervention focuses on improving quality of life and preventing common comorbidities such as depression and anxiety, capitalizing on increased public interest in AS and help-seeking behaviors is imperative.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.

This Practice Parameter is a revision of a previous Parameter addressing reactive attachment disorder that was published in 2005. It reviews the current status of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DESD) with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "insufficient care" or social neglect. Assessment requires direct observation of the child in the context of his or her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed social relatedness with non-caregivers when evident.