State Insurance Mandates and the Workforce for Children With Autism.

BACKGROUND: State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). METHODS: We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. RESULTS: From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. CONCLUSIONS: State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.

Multisensory Gains in Simple Detection Predict Global Cognition in Schoolchildren.

The capacity to integrate information from different senses is central for coherent perception across the lifespan from infancy onwards. Later in life, multisensory processes are related to cognitive functions, such as speech or social communication. During learning, multisensory processes can in fact enhance subsequent recognition memory for unisensory objects. These benefits can even be predicted; adults' recognition memory performance is shaped by earlier responses in the same task to multisensory - but not unisensory - information. Everyday environments where learning occurs, such as classrooms, are inherently multisensory in nature. Multisensory processes may therefore scaffold healthy cognitive development. Here, we provide the first evidence of a predictive relationship between multisensory benefits in simple detection and higher-level cognition that is present already in schoolchildren. Multiple regression analyses indicated that the extent to which a child (N = 68; aged 4.5-15years) exhibited multisensory benefits on a simple detection task not only predicted benefits on a continuous recognition task involving naturalistic objects (p = 0.009), even when controlling for age, but also the same relative multisensory benefit also predicted working memory scores (p = 0.023) and fluid intelligence scores (p = 0.033) as measured using age-standardised test batteries. By contrast, gains in unisensory detection did not show significant prediction of any of the above global cognition measures. Our findings show that low-level multisensory processes predict higher-order memory and cognition already during childhood, even if still subject to ongoing maturation. These results call for revision of traditional models of cognitive development (and likely also education) to account for the role of multisensory processing, while also opening exciting opportunities to facilitate early learning through multisensory programs. More generally, these data suggest that a simple detection task could provide direct insights into the integrity of global cognition in schoolchildren and could be further developed as a readily-implemented and cost-effective screening tool for neurodevelopmental disorders, particularly in cases when standard neuropsychological tests are infeasible or unavailable.

Immigrant Mothers' Perspectives of Barriers and Facilitators in Accessing Mental Health Care for Their Children.

Introduction: Data on immigrant and refugees' access to services in Canada typically focus on adult populations generally but not children specifically. To fill this gap, this study explored immigrant and refugee mothers' perceptions of barriers and facilitators for mental health care for their children in Edmonton, Alberta, Canada. Method: In this qualitative descriptive study, researchers conducted 18 semistructured interviews with immigrant and refugee mothers who live in Edmonton, self-identify as women, and have children living in Canada. Results: Barriers included financial strain, lack of information, racism/discrimination, language barriers, stigma, feeling isolated, and feeling unheard by service providers. Facilitators included schools offering services, personal levels of higher education, and free services. Discussion: Nurses can improve access to mental health services by addressing issues related to racism within the health system, by creating awareness related to mental health, and by providing trained interpreters to help bridge barriers in communications.

The association between role model presence and self-regulation in early adolescence: A cross-sectional study.

PURPOSE: Self-regulation is the capacity to regulate attention, emotion, and behaviour to pursue long-term goals. The current study examined the associations between role model presence and self-regulation during early adolescence, controlling for hopefulness, using a large population-based data set from the Tokyo Teen Cohort study. METHODS: Adolescents, aged 12 years, identified a role model using a single item on a paper questionnaire: 'Who is the person you most look up to?' Level of hopefulness was also assessed using a single question: 'To what extent do you feel hopeful about the future of your life?' Trained investigators evaluated self-regulation. RESULTS: Of 2550 adolescents, 2279 (89.4%) identified a role model. After adjusting for level of hopefulness, identifying a role model was associated with higher levels of self-regulation in comparison to indications of no role model. Hopeful future expectations were also associated with higher self-regulation; however, the beta coefficient was smaller than role model presence in the multivariate linear regression analysis. CONCLUSIONS: Role model presence was significantly associated with higher self-regulation among early adolescents. Educational environments should focus on support for adolescents with no role models.

The Association Between Parental Depression and Child Psychosocial Intervention Outcomes: Directions for Future Research.

Recent studies suggest that parental depressive symptoms may affect a child's ability to benefit from interventions for anxiety and depression. This article reviews the current literature, suggesting that, when parents experience current depressive symptoms, children are less likely to benefit from psychosocial interventions for anxiety and depression. Opportunities for future research are discussed, including moderators and mechanisms of the association between parental depressive symptoms and child intervention outcomes.

Tooth Fairy guilty of favouritism!

OBJECTIVES: To determine the proportion of children visited by the Tooth Fairy, the child-related factors that influence the likelihood of her visit, and the parent-related variables that affect the amount of money the Tooth Fairy leaves. DESIGN: Cross-sectional questionnaire study. SETTING: Zürich, Switzerland. PARTICIPANTS: 3617 parents of children (mean age of children, 6.8 years; 51.9% girls) who had lost at least one deciduous tooth received a self-developed questionnaire; 1274 questionnaires were returned (35.2%). MAIN OUTCOME MEASURES: Primary outcome variables were the Tooth Fairy's visit after tooth loss and the amount of money given in case of a visit. Child- and parent-related variables were assessed as predictors of the main outcomes. RESULTS: Most parents (71.0%) reported that the Tooth Fairy visited their child. She usually exchanged the lost tooth for money (55.8% of visits) or placed money next to the tooth (40.7%); rarely did she take the tooth without pecuniary substitution. The Tooth Fairy left an average of 7.20 Swiss francs (approximately AU$9.45). The Tooth Fairy favoured visiting for the teeth of older children (odds ratio [OR], per year, 1.87; 95% CI, 1.09-3.21), of boys (OR, 2.65; 95% CI, 1.09-6.42), and of children who believed in her (OR, 4.12; 95% CI, 1.77-9.64). The amount of money was influenced by maternal, but not paternal socio-demographic factors, including level of education (OR, per level, 0.78; 95% CI, 0.66-0.92) and country of origin (OR, Western countries v non-Western countries, 2.35; 95% CI, 1.20-4.62). CONCLUSIONS: The Tooth Fairy does not visit all children after tooth loss, displaying clear preferences in her choice of business partners. The odds of a visit are dramatically increased if she is believed in, and the value of a deciduous tooth is influenced by socio-demographic factors.

Validation of the Eating Pattern Inventory for Children in a General Population Sample of 11- to 12-Year-Old Children.

Previous research suggests that the Eating Pattern Inventory for Children (EPI-C) is best conceptualized as comprising four factors: dietary restraint, emotional, external eating and parental pressure to eat. This study aims to examine the psychometric properties of the EPI-C and to test gender and weight group differences. The population-based study sample comprised 1,939 children aged 11 to 12 years from the Copenhagen Child Cohort (CCC2000). Psychometric properties were evaluated using multigroup categorical data in confirmatory factor analysis (CFA) and differential item functioning (DIF) tests. CFA supported the four-factor solution for the EPI-C. Reliability estimates were satisfactory for three of the four scales. DIF with regard to weight was found for an item on weight loss intention. Girls reported higher restrained and emotional eating; overweight children reported higher restrained, emotional and external eating, while underweight children reported higher parental pressure to eat. The results support the use of EPI-C for measuring eating behaviors in preadolescence.

[Test Reviews in Child Psychology: Test Users Wish to Obtain Practical Information Relevant to their Respective Field of Work]. / Testrezensionen in der Kinderpsychologie: Testanwender wünschen sich praxisnahe und zielgruppenspezifische Informationen.

Test Reviews in Child Psychology: Test Users Wish to Obtain Practical Information Relevant to their Respective Field of Work This study investigated to what extent diagnosticians use reviews of psychometric tests for children and adolescents, how they evaluate their quality, and what they expect concerning content. Test users (n = 323) from different areas of work (notably social pediatrics, early intervention, special education, speech and language therapy) rated test reviews as one of the most important sources of information. Readers of test reviews value practically oriented descriptions and evaluations of tests that are relevant to their respective field of work. They expect independent reviews that critically discuss opportunities and limits of the tests under scrutiny. The results show that authors of test reviews should not only have a background in test theory but should also be familiar with the practical application of tests in various settings.

Motives Underlying Food Choice for Children and Perception of Nutritional Information Among Low-Income Mothers in a Latin American Country.

OBJECTIVE: The aim of the present study was to investigate the influence of nutritional information on how low-income mothers select food for their children. DESIGN: Five focus groups, each consisting of 5-10 participants, were conducted. PARTICIPANTS: Women, older than 18 years, mothers of young children who were beneficiaries of one of the national food stamps programs in Uruguay. PHENOMENON OF INTEREST: Focus group discussions were held around motives underlying food choices for children and perception of labeling systems. ANALYSIS: Transcripts of the focus group discussions were analyzed using inductive coding. RESULTS: Forty-two women, aged between 18 and 40 years, participated in 5 focus groups. Results showed that low-income mothers do not consider nutritional information when selecting food their children. Traditional nutritional labeling was perceived as complex, difficult to find, and difficult to understand. Participants stressed that they relied on the nutrition claims included on labels for assessing the healthfulness of food products. Semi-directive and directive front-of-pack labels were positively evaluated in terms of ease of interpretation. Participants preferred the traffic light system over other alternatives. CONCLUSIONS AND IMPLICATIONS: Results suggest the need to implement simplified nutritional labeling and to regulate the use of nutrition claims on products targeted at children.

[Chrono Physiological characteristics of children of primary school age - the natives of the Middle Ob].

Chronoreflexometric characteristics of the mental performance of children of primary school age - the natives of the Middle Ob were based on the statistical analysis of the latent period of time of a simple visual - motor responses. The results of a survey showed that the functional state of the nervous system of surveyed children ofprimary school age was at "reduced" and "greatly reduced" level of mental performance. This state is characterized by a weakening of attention, a sharp deterioration in time and accuracy parameters of activity and a significant decrease of efficiency on the whole.

Phone Consultation for Behavioral Health-Related Referrals in Integrated Primary Care.

Behavioral health (BH) providers add value to primary care teams. This descriptive study illustrates one such role that the BH provider can serve. The on-site BH provider responded to patient phone inquiries regarding BH topics for pediatricians over the course of 15 months. The majority of these calls were for children 10 years and younger and related to externalizing problems. Phone calls were relatively brief (i.e., 11-15 minutes). More than half of these phone calls resulted in families scheduling an appointment with nearly 75% showing up for the initial session. Providing this type of adjunctive service may result in earlier access to care and efficiently assigning responsibilities to the appropriate team member.

Maternal posttraumatic stress disorder symptom trajectories following Hurricane Katrina: An initial examination of the impact of maternal trajectories on the well-being of disaster-exposed youth.

OBJECTIVES: This study examined trajectories of posttraumatic stress disorder symptoms in impoverished mothers impacted by Hurricane Katrina, as well as how predictive the maternal trajectories were for youth posttraumatic stress symptoms 2 years post-Katrina. METHODS: 360 mother participants displaced by Hurricane Katrina completed self-report measures across four time points related to Hurricane exposure, trauma history, and posttraumatic stress symptoms. Additionally, the youth offspring completed a self-report measure of posttraumatic stress symptoms. RESULTS: Latent Class Growth Analysis demonstrated three primary trajectories emerged among females impacted by Katrina, namely, (1) chronic (4 %), (2) recovering (30 %), and (3) resilient (66 %), respectively. These trajectories were significantly impacted by prior trauma history, but not hurricane exposure. Additionally, data indicated that children whose parents fell into the chronic PTS trajectory also reported high levels of PTS symptoms. CONCLUSIONS: This study identified three main trajectories typical of female PTS symptoms following disaster and was the first known study to document associations between PTS outcomes among adults and their offspring impacted by a large natural disaster. Future research is warranted and should explore additional risk and protective factors that impact both the parental and child outcomes.

Predictors of specialist referral for developmental and behavioural problems in a Queensland urban Aboriginal and Torres Strait Islander community: a cross-sectional study.

BACKGROUND: The prevalence of developmental and/or behavioural problems is greater among Aboriginal and Torres Strait Islander children, compared with their non-Indigenous counterparts. We aimed to identify predictors of specialist paediatric referral for these problems that could enable primary health professionals to identify at-risk children and implement early interventions. METHODS: A cross-sectional study of urban Aboriginal and Torres Strait Islander children aged 0-14 years having annual child health checks from September 2010 to February 2012 was undertaken. Predictors of paediatric referral were identified using univariable and multivariable analyses. RESULTS: Of the 183 eligible children, 30% were referred to a paediatrician. Parental/carer mental illness was self-reported in 36% of cases and these children were more likely to be referred (OR = 3.07; 95% CI: 1.44, 6.57). DISCUSSION: The strong association between paediatric referral for behavioural and/or developmental problems and self-reported parental/carer mental illness highlights the intergenerational nature of health and social disadvantage.

Associations between cyberbullying and school bullying victimization and suicidal ideation, plans and attempts among Canadian schoolchildren.

PURPOSE: The negative effects of peer aggression on mental health are key issues for public health. The purpose of this study was to examine the associations between cyberbullying and school bullying victimization with suicidal ideation, plans and attempts among middle and high school students, and to test whether these relationships were mediated by reports of depression. METHODS: Data for this study are from the 2011 Eastern Ontario Youth Risk Behaviour Survey, which is a cross-sectional regional school-based survey that was conducted among students in selected Grade 7 to 12 classes (1658 girls, 1341 boys; mean ± SD age: 14.3 ± 1.8 years). RESULTS: Victims of cyberbullying and school bullying incurred a significantly higher risk of suicidal ideation (cyberbullying: crude odds ratio, 95% confidence interval  = 3.31, 2.16-5.07; school bullying: 3.48, 2.48-4.89), plans (cyberbullying: 2.79, 1.63-4.77; school bullying: 2.76, 2.20-3.45) and attempts (cyberbullying: 1.73, 1.26-2.38; school bullying: 1.64, 1.18-2.27) compared to those who had not encountered such threats. Results were similar when adjusting for sociodemographic characteristics, substance use, and sedentary activities. Mediation analyses indicated that depression fully mediated the relationship between cyberbullying victimization and each of the outcomes of suicidal ideation, plans and attempts. Depression also fully mediated the relationship between school bullying victimization and suicide attempts, but partially mediated the relationship between school bullying victimization and both suicidal ideation and plans. CONCLUSION: These findings support an association between both cyberbullying and school bullying victimization and risk of suicidal ideation, plans and attempts. The mediating role of depression on these links justifies the need for addressing depression among victims of both forms of bullying to prevent the risk of subsequent suicidal behaviours.

The change and development of statistical methods used in research articles in child development 1930-2010.

The evolution of developmental psychology has been characterized by the use of different quantitative and qualitative methods and procedures. But how does the use of methods and procedures change over time? This study explores the change and development of statistical methods used in articles published in Child Development from 1930 to 2010. The methods used in every article in the first issue of every volume were categorized into four categories. Until 1980 relatively simple statistical methods were used. During the last 30 years there has been an explosive use of more advanced statistical methods employed. The absence of statistical methods or use of simple methods had been eliminated.

Parental internalizing problems in a community sample: association with child psychosocial problems.

BACKGROUND: Offspring of depressed, anxious and stressed parents are at increased risk of developing mental disorders. However, most studies investigating this association concentrate on clinical symptoms. The objective of this study is to examine the association between parental internalizing problems (symptoms of depression, anxiety and stress) and child psychosocial problems in a community sample, crude and adjusted for potential confounders (such as child gender, parental educational level, ethnicity) and whether parental concerns affect this association. STUDY DESIGN: Preceding a routine health examination, cross-sectional data were obtained from a representative sample of 9453 parents of children aged 9-11 years (response 65%). Measures of parental internalizing problems (Depression Anxiety Stress Scale), child psychosocial problems (Strengths and Difficulties Questionnaire-Total Difficulties Score), background characteristics and parental concerns were completed by the parents. RESULTS: Parental internalizing problems were associated with child psychosocial problems in crude analysis and after adjustment for child, parent and family characteristics [ß = 0.12, 95% confidence interval (CI) = 0.10-0.14]. Parental concerns about their child's emotional and behavioural problems were also strongly associated with child psychosocial problems. After adjustment for these parental concerns, the association of parental stress with child psychosocial problems remained, while the association of parental depression and anxiety symptoms with child psychosocial problems lost statistical significance. CONCLUSIONS: As in clinical samples, parental internalizing problems in a community sample are associated with child psychosocial problems. Parental concerns on the child seem to affect this association. Further research is needed on the mechanisms affecting this association.

Childhood psychological problems in school settings in rural Southern Africa.

BACKGROUND: Many children can be exposed to multiple adversities in low and middle-income countries (LMICs) placing them at potential risk of psychological problems. However, there is a paucity of research using large representative cohorts examining the psychological adjustment of children in school settings in these countries. Children's psychological adjustment has been shown to affect educational progress which is critical for their future. This study, based in a rural, socio-economically disadvantaged area of South Africa, aimed to examine the prevalence of children's psychological problems as well as possible risk and protective factors. METHODS: Rates of psychological problems in 10-12 year olds were examined using teacher- and child-report questionnaires. Data on children from 10 rural primary schools, selected by stratified random sampling, were linked to individual and household data from the Agincourt health and socio-demographic surveillance system collected from households over 15 years. RESULTS: A total of 1,025 children were assessed. Teachers identified high levels of behavioural and emotional problems (41%). Children reported lower, but substantial rates of anxiety/depression (14%), and significant post-traumatic stress symptoms (24%); almost a quarter felt unsafe in school. Risk factors included being a second-generation former refugee and being from a large household. Protective factors highlight the importance of maternal factors, such as being more educated and in a stable partnership. CONCLUSION: The high levels of psychological problems identified by teachers are a serious public health concern, as they are likely to impact negatively on children's education, particularly given the large class sizes and limited resources in rural LMIC settings. Despite the high levels of risk, a proportion of children were managing well and research to understand resilience could inform interventions.

Modification effects of family economic status and school factors on depression risk of single-father family children in Mid-Taiwan area.

The incidence of single-parent families has increased significantly in Taiwan in recent years. Children born in single-parent families are predisposed to suffering from emotional problems. We aimed to determine if the children of single-parent families are more depressive than children from both-parent families, and to examine the individual and joint effects of various factors on the depression risk. A cross-sectional study was performed to investigate the depression status of elementary school children in MiaoLi County, Taiwan. A total of 881 eligible subjects, including 144 children from single-parent families were recruited from 29 schools. Data for depression-related demographic characteristics, family and school variables were collected. The results show that 27.6% of children from single-father families with depressive symptoms, 15.1% children from single-mother families and 15.3% children from both-parent families with repressive symptoms. This study provides significant evidences that single-father family was one significant predictor for childhood depression and the enhanced effects of socioeconomic status and peer relationship on depression of children from single father families were found up to 4-fold (OR=4.0, 95% CI=1.8-8.5) and 5-fold (OR=5.5, 95% CI=2.3-13.2) risk respectively. The results provide hints to parents and teachers for improving the mental health of children in single-parent families by reducing the occurrence of depression.

Construct validation of the Greek version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC).

BACKGROUND: The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) are 2 measures of children's participation in various activities. The purpose of this study was the validation of the Greek version of "CAPE & PAC." METHODS: The questionnaires were translated and pilot tested on a sample of 25 individuals. The reliability and validity of the questionnaires were tested on 302 individuals (253 typical population, 49 disabled), 6-21 years of age. The construct validity of the instruments was examined the directional hypothesis by comparing known groups with existing differences. An exploratory factor analysis was conducted to determine the validity of the typology of activities. The reliability was examined by checking the internal consistency of the instruments. RESULTS: The comparison between divergent groups confirmed the predicted differences of the mean scores and the validity of the instruments. Seven factors (categories of activities) emerged from the factor analysis. The acceptable range of Cronbach alpha for the PAC scale indicated high consistency. CONCLUSION: This study provides evidence that partially support the validity and reliability of "CAPE & PAC" instruments to use in Greek population. Further investigation is recommended for both clinical and research purposes.

Bibliometric assessment of publication output of child and adolescent psychiatric/psychological affiliations between 2005 and 2010 based on the databases PubMed and Scopus.

We aimed to determine the quantitative scientific publication output of child and adolescent psychiatric/psychological affiliations during 2005-2010 by country based on both, "PubMed" and "Scopus" and performed a bibliometric qualitative evaluation for 2009 using "PubMed". We performed our search by affiliation related to child and adolescent psychiatric/psychological institutions using "PubMed". For the quantitative analysis for 2005-2010, we counted the number of abstracts. For the qualitative analysis for 2009 we derived the impact factor of each abstract's journal from "Journal Citation Reports". We related total impact factor scores to the gross domestic product (GDP) and population size of each country. Additionally, we used "Scopus" to determine the number of abstracts for each country that was identified via "PubMed" for 2009 and compared the ranking of countries between the two databases. 61 % of the publications between 2005 and 2010 originated from European countries and 26 % from the USA. After adjustment for GDP and population size, the ranking positions changed in favor of smaller European countries with a population size of less than 20 million inhabitants. The ranking of countries for the count of articles in 2009 as derived from "Scopus" was similar to that identified via the "PubMed" search. The performed search revealed only minor differences between "Scopus" and "PubMed" related to the ranking of countries. Our data indicate a sharp difference between countries with a high versus low GDP with regard to scientific publication output in child and adolescent psychiatry/psychology.