Concurrent and Longitudinal Associations Among Temperament, Parental Feeding Styles, and Selective Eating in a Preschool Sample.

Objective: To examine the associations among negative/reactive temperament, feeding styles, and selective eating in a sample of preschoolers because preschool eating behaviors likely have lasting implications for children's health. Methods: A community sample of preschoolers aged 3-5 years (M = 4.49 years, 49.5% female, 75.7% European American) in the Midwest of the United States was recruited to participate in the study (N = 297). Parents completed measures of temperament and feeding styles at two time points 6 months apart. Results: A series of regressions indicated that children who had temperaments high in negative affectivity were significantly more likely to experience instrumental and emotional feeding styles. They were also significantly more likely to be selective eaters. These associations were present when examined both concurrently and after 6 months. Conclusions: This study provides a novel investigation of child temperament and eating behaviors, allowing for a better understanding of how negative affectivity is associated with instrumental feeding, emotional feeding, and selective eating. These results inform interventions to improve child health.

Type 1 diabetes in very young children: a model of parent and child influences on management and outcomes.

The incidence of type 1 diabetes (T1D) in very young children (YC-T1D) is increasing globally. Managing YC-T1D is challenging from both a medical and psychosocial perspective during this vulnerable developmental period when complete dependence upon parental caretaking is normative and child behavior is unpredictable. The consequences of suboptimal glycemic control during this age range are substantial since these children will have T1D for many years and they are prone to adverse neuropsychological sequelae. Poor adaptation to T1D during these early years may engender a persistent trajectory of negative outcomes that can be very resistant to change. The empirical research on the YC-T1D population (age <6 yr) has indicated multiple mechanisms through which parent characteristics, parent coping skills, and child characteristics interact to yield a pattern of T1D management behaviors that affect T1D outcomes. However, this research has not yet led to a well-conceived conceptual model for identifying and understanding these mechanisms or for specifying research gaps and future research directions. The aim of this review is to propose such a conceptual model linking parent characteristics, parent coping, and child characteristics to T1D management behaviors and outcomes. This article reviews the literature focusing on research pertinent to YC-T1D and elements of our proposed model, identifies and discusses gaps in the literature, offers directions for future research, and considers a range of possible interventions targeting the unique needs of this special population.

Executive Control and Adolescent Health: Toward A Conceptual Framework.

Executive control is a set of cognitive abilities that may impact a variety of adolescent health behaviors and outcomes; however, research on executive control as a contributor to the physical health of youth is relatively limited. Therefore, the current article explores the possible role of executive control in adolescent health by reviewing relevant literature and proposing a conceptual framework to guide future research in this area. The development of executive control from preschool through adolescence is described, with particular attention to executive control in the unique health context of adolescence. A new conceptual model is proposed, focusing on how executive control may play a critical role in supporting health in adolescence and beyond through the mechanisms of attentional, behavioral, and emotional control. Literature exploring associations between youth executive control and key health behaviors (including diet, physical activity, sleep and substance use) is reviewed. Researchers and clinicians are encouraged to consider executive control as an important cross-cutting contributor to health during adolescence and beyond and to incorporate this construct into longitudinal studies of health.

Mental Health Outcomes of Discrimination among College Students on a Predominately White Campus: A Prospective Study.

Racial discrimination is a social stressor harmful to mental health. In this paper, we explore the links between mental health and interpersonal discrimination-related social events, exposure to vicarious racism via social media, and rumination on racial injustices using a daily diary design. We utilize data from a racially diverse sample of 149 college students with 1,489 unique time observations at a large predominantly White university. Results show that interpersonal discrimination-related social events predicted greater self-reported anger, anxiety, depressive symptoms, and loneliness both daily and on average over time. Vicarious racism from day-to- day was associated with increased anxiety symptoms. In contrast, rumination was not associated with negative mental health outcomes. These findings document an increased day-to-day mental health burden for minority students arising from frustrating and alienating social encounters experienced individually or learned about vicariously.

Feasibility of Screening for Preschool Behavioral and Emotional Problems in Primary Care Using the Early Childhood Screening Assessment.

The American Academy of Pediatrics recommends screening young children for behavioral and emotional problems (BEP) during primary care visits. Because of time constraints, few primary care providers (PCPs) use standardized screening tools to detect BEP. The Early Childhood Screening Assessment (ECSA) is a brief screening tool developed specifically to meet the needs of pediatric primary care providers (PCPs). The ECSA has established psychometric properties, but the feasibility and acceptability of the ECSA have not been established. This study examines the degree to which PCPs would incorporate ECSA screening and how PCPs value the ECSA as a tool to detect children with BEP. Twenty-seven pediatric PCPs were trained to implement ECSA screening. Six months after training, 96% of PCPs reported that the ECSA was practical for use at well-visits, 70% were still screening and 89% agreed that it helped detect more cases of BEP than by routine history-taking alone.

Collaborative Care: a Pilot Study of a Child Psychiatry Outpatient Consultation Model for Primary Care Providers.

A Child Psychiatry Consultation Model (CPCM) offering primary care providers (PCPs) expedited access to outpatient child psychiatric consultation regarding management in primary care would allow more children to access mental health services. Yet, little is known about outpatient CPCMs. This pilot study describes an outpatient CPCM for 22 PCPs in a large Northeast Florida county. PCPs referred 81 patients, of which 60 were appropriate for collaborative management and 49 were subsequently seen for outpatient psychiatric consultation. The most common psychiatric diagnoses following consultation were anxiety (57%), ADHD (53%), and depression (39%). Over half (57%) of the patients seen for consultation were discharged to their PCP with appropriate treatment recommendations, and only a small minority (10%) of patients required long-term care by a psychiatrist. This CPCM helped child psychiatrists collaborate with PCPs to deliver mental health services for youth. The CPCM should be considered for adaptation and dissemination.

The Brief Early Childhood Screening Assessment: Preliminary Validity in Pediatric Primary Care.

OBJECTIVE: Brief, well-validated instruments are needed to facilitate screening for early childhood behavioral and emotional problems (BEPs). The objectives of this study were to empirically reduce the length of the Early Childhood Screening Assessment (ECSA) and to assess the validity and reliability of this shorter tool. METHODS: Using caregiver ECSA responses for 2467 children aged 36 to 60 months seen in primary care, individual ECSA items were ranked on a scale ranging from "absolutely retain" to "absolutely delete." Items were deleted sequentially beginning with "absolutely delete" and going up the item prioritization list, resulting in 35 shorter versions of the ECSA. A separate primary care sample (n = 69) of mothers of children aged 18 to 60 months was used to determine the sensitivity and specificity of each shorter ECSA version using psychiatric diagnosis on the Diagnostic Infant and Preschool Assessment as the gold standard. The version with the optimal balance of sensitivity, specificity, and length was selected as the Brief ECSA. Associations between Brief ECSA scores and other pertinent measures were evaluated to estimate reliability and validity. RESULTS: A 22-item measure reflected the best combination of brevity, sensitivity and specificity. A cutoff score of 9 or higher on the 22-item Brief ECSA demonstrated acceptable sensitivity (89%) and specificity (85%) for predicting a psychiatric diagnosis. Brief ECSA scores correlated significantly and in expected directions with scores on pertinent measures and with demographic variables. CONCLUSION: The results indicate that the Brief ECSA has sound psychometric properties for identifying young children with BEPs in primary care.

Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids.

PURPOSE: This article describes the stakeholder-driven design, development, and testing of web-based, multimedia decision aids for youth with type 1 diabetes who are considering the insulin pump or continuous glucose monitoring and their parents. This is the initial phase of work designed to develop and evaluate the efficacy of these decision aids in promoting improved decision-making engagement with use of a selected device. METHODS: Qualitative interviews of 36 parents and adolescents who had previously faced these decisions and 12 health care providers defined the content, format and structure of the decision aids. Experts in children's health media helped the research team to plan, create, and refine multimedia content and its presentation. A web development firm helped organize the content into a user-friendly interface and enabled tracking of decision aid utilization. Throughout, members of the research team, adolescents, parents, and 3 expert consultants offered perspectives about the website content, structure, and function until the design was complete. RESULTS: With the decision aid websites completed, the next phase of the project is a randomized controlled trial of usual clinical practice alone or augmented by use of the decision aid websites. CONCLUSIONS: Stakeholder-driven development of multimedia, web-based decision aids requires meticulous attention to detail but can yield exceptional resources for adolescents and parents contemplating major changes to their diabetes regimens.