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.

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.

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.

Self-concept and mental health status of 'stay-at-home' children in rural China.

AIM: To describe the self-concept and mental health status of 'stay-at-home' children and to explore the differences between stay-at-home children and non-stay-at-home children. METHODS: A cross-sectional survey was conducted in Changfeng County to collect information on self-concept and mental health status. Children were classified as 'stay-at-home' or 'non-stay-at-home' for data analysis. RESULTS: Stay-at-home children accounted for 55.1% of children. The two groups of children differed significantly on the total scores of self-concept (stay-at-home, 52.48 +/- 14.29; non-stay-at-home, 55.24 +/- 15.10). The mental health status of stay-at-home children was poor, with significant difference between them (stay-at-home, 41.17 +/- 12.25; non-stay-at-home, 40.14 +/- 13.11). Using multivariate linear regression analysis, we found that the total P-H score, gender, low family economic status, stay-at-home status and being cared for by an uncle/aunt or an older sibling were independent variables for mental health of the children. CONCLUSION: This study suggests that stay-at-home children have a greater risk of mental health problems than their counterparts in rural Anhui province, China. In addition, this study provides useful baseline information on childhood mental health and has identified important risk factors that would be important in planning strategies for prevention of mental health problems for stay-at-home children.

Services for children with diabetes.

This is the first assessment of the services available and care received by children and adolescents with Type 1 Diabetes in the Republic of Ireland. Questionnaires were mailed to 19 centres in 2006 identified as providing care for children and adolescents with Diabetes. Replies were received from all centres. 29 consultants provide care for a reported 2040 patients in the 19 centres. 16 (50%) paediatricians surveyed expressed a special interest in Diabetes while 27 (94%) see children in a designated Diabetes clinic. The average caseload per whole-time-equivalent (WTE) Diabetes Nurse Specialists (DNS) is 162 patients and 416 patients per WTE Dietician. 13 of the 19 centres (70%) have no access to Psychology services. This review of children's diabetes services highlights the current deficiencies, particularly in relation to support staff, with respect to international recommendations. Improvements in resources to reduce long-term complications needs urgent addressing at both local and national levels.

Prescription privileges for psychologists: opinions of pediatric psychologists and pediatricians.

OBJECTIVE: To examine the opinions of pediatricians and pediatric psychologists concerning prescription privileges for psychologists. METHODS: 213 pediatric psychologists and 119 pediatricians returned surveys regarding their opinions about cost, access, and quality of psychological care if psychologists had prescription privileges. RESULTS: Pediatric psychologists had significantly more positive views of prescription privileges than pediatricians. Despite not being in favor of prescription privileges, most pediatricians said that prescription privileges would not negatively impact their professional relationship, although approximately 37% said it would. CONCLUSION: Pediatric psychologists and pediatricians differ significantly in their opinions about prescription privileges for psychologists. The implications of these findings for the working relationship between these two disciplines are discussed.

Comparison of self-reported emotional and behavioural problems in adolescents from Greece and Finland.

AIM: To compare self-reported emotional and behavioural problems among Greek and Finnish adolescents. METHODS: Youth Self-Report scores were analysed for 3373 Greek adolescents aged 18 years and 7039 Finnish adolescents aged 15-16 years from the general population in both countries. The impact of country, gender, place of residence, socioeconomic status (SES) and family stability on the scores was evaluated. RESULTS: Only country and gender yielded small to medium effect on the scores. Greek boys scored significantly higher than Finns on 10 of the 11 YSR syndromes, particularly on the anxious/depressed scale. Greek girls scored significantly lower than Finnish girls on the somatic complaints and delinquent behaviour scales. In general, girls scored higher than boys on both internalising and externalising problems. The gender by country interaction revealed that Finnish girls reported more externalising problems. CONCLUSION: The main differences marked in this comparison were the higher level of anxiety and depression in Greeks than Finns and the higher level of externalising problems in Finnish girls than boys. Cultural standards could play an important role in explaining these differences. Overall, it seems that only a small number of differences exist between a northern and southern European region.

Bender performance and socioeconomic status in Mexican children: a cross-cultural study.

Normative data are presented for Bender test performance, following the system of Koppitz, of 695 Mexican students between 5.0 and 12.1 yr. old (M = 8.7, SD = 2.01) and belonging to different socioeconomic status. The data are compared with the normative group of U.S. students used by Koppitz and with a representative sample of children from Barcelona, Spain. The results indicate that the total number of Bender errors decreased with increasing age of the children and that significant differences existed with respect to socioeconomic status. The comparison of these data with U.S. and Spanish children shows significant differences in all age groups, with the Mexican children scoring lowest. Differences in quality of schooling and in other aspects of education could explain the variability in Bender test performance.

[About the state of counselling and therapy of parents with their infants in Germany--results of an expertise]. / Zur Lage der Beratung und Therapie von Eltern mit Säuglingen und Kleinkindern in Deutschland. Ergebnisse einer Expertise.

Topic of this study is the acquisition and documentation of all German services of early psychosocial interventions as well as the description of attributes of these care providers. On the basis of this attributes the quality of the offers is evaluated. The services provide counseling and therapy for parents with babies and toddlers. Their aim is to assess and treat disorders of behavior regulation in the context of dysfunctional parent-child-relationships. The expertise was initiated by the German Federal Centre for Health Education. It is based on data of 288 services in Germany. Different attributes of structural and process qualities are described and evaluated e.g. the institutional context, presented problems, training of specialists, kind of interventions. Number and attributes of the early interventions show great variation from region to region. The discrepancy between the number of services and the prevalence of early childhood regulation disorders is high. Due to the unresolved question of financing, parents often have to pay the treatment by themselves. On the basis of the results different implications for the improvement of structural quality are formulated. Relevant issues of research in psychosocial early childhood interventions are discussed.

A prevalence estimate of pervasive developmental disorder among immigrants to Israel and Israeli natives- a file review study.

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.

Contrasts and correlations in theory assessment.

OBJECTIVE: To describe a systematic quantitative approach to assessing the predictions made by competing theories using contrasts and correlational indices of effect sizes. METHODS: We illustrate the use of the contrast F and t to compare and combine predictions when the raw data are continuous scores, and z contrasts when working with frequencies in 2 x k tables of counts. RESULTS: The traditional effect size correlation indicates the magnitude of the effect on individual scores of participants' assignment to particular conditions. The contrast correlation obtained from the contrast F or t is, in some cases, the easiest way of estimating the effect size correlation in designs using more than two groups. The alerting correlation is another way of appraising the predictive power of a contrast and can be used to compute the contrast F from published results when all we have are condition means and the omnibus F from an overall analysis of variance. Omnibus Fs, those with more than 1 df in the numerator, are rarely useful in data analytic work since they address unfocused questions, yielding only vague answers. CONCLUSIONS: Asking focused questions using contrasts increases the clarity of our questions and the clarity and statistical power of our answers.

The comprehensive assessment of defense style: measuring defense mechanisms in children and adolescents.

This study introduces the Comprehensive Assessment of Defense Style (CADS), a new method to assess descriptively the defensive behavior of children and adolescents. Parents of 124 children and adolescents referred to a mental health clinic, of 104 nontreated children, and of 15 children whose fathers were treated for posttraumatic stress disorder completed the CADS. Factor analysis of 28 defenses yielded one mature factor, one immature factor of defenses expressed in relations with the environment (other-oriented), and one of defenses expressed in relations with the self (self-oriented). The CADS significantly discriminated between patients and nonpatients. Psychiatric patients used more immature and fewer mature defenses than control subjects, and adolescents used more mature and fewer other-oriented defenses than children. Girls used more mature and fewer other-oriented defenses than boys. The reliability and validity data of the CADS are encouraging. The three defense factors may be implemented for diagnostic and clinical purposes as well as for screening for psychopathology risk in untreated populations.

What harms do young Australians experience in alcohol-use situations?

OBJECTIVE: An insight into the alcohol-related experiences of young students in Perth, Western Australia, with particular emphasis to alcohol-related harm. METHOD: The sample of 2,329 students (female: n = 1,089, male: n = 1,240) is a school-based group selected using cluster sampling, with stratification by socio-economic area and represents 11 to 12 year olds' experiences with alcohol and alcohol-related harm. The SHAHRP survey instrument was developed and pre-tested to measure students' knowledge, attitudes, patterns and context of use, harms associated with the students' own alcohol consumption and harms associated with other people's use of alcohol and incorporates the students' perceptions of alcohol-related harm. RESULTS: Nearly two-thirds of all young people consumed alcohol under adult supervision; nearly 40% of all young males and 34% of all young females drink alcohol in unsupervised situations; and a fifth of young males consumed alcohol alone. Young males start drinking younger and consumed alcohol more regularly than young females, and consumed more alcohol per occasion. In the past 12 months, young males experienced more than five and young females more than three alcohol-related harms associated with their own alcohol consumption. They experienced a similar number of harms associated with other people's use of alcohol. Unsupervised drinkers were nearly seven times more likely to experience alcohol-related harm than supervised drinkers and nearly 13 times more likely to experience alcohol-related harm than non-drinkers. CONCLUSION AND IMPLICATIONS: The results can help inform the development of alcohol education programs for young people.

[Perception of environmental threats by children and adolescents]. / La perception des menaces environnementales par les enfants et les adolescents.

Surveys conducted in Europe and North America over the last 30 years have shown that children and adolescents were particularly worried about the possibilities of nuclear war and unemployment. A study carried out in Montreal among young people of primary or high school level assessed their concerns about the future and inquired about what their priorities would be if they were political leaders. One hundred and twenty young people answered a questionnaire administered by a classmate. Results indicate that worries about environmental issues predominate. In comparison with previous surveys, this study suggests a recent change in the young generation from concerns about nuclear war to worries over ecological problems.

Vale dictum: an editor's view of the field of pediatric psychology and its journal.

Examines activities of Editor of the Journal of Pediatric Psychology for issues published 1988-1992. Articles published during term are analyzed in terms of senior author gender, affiliation, academic rank, grant support, theoretical orientation, population type, population age, article type, and research purpose. Comparisons are made to earlier analysis of article trends in Journal by Elkins and Roberts (1988). A summary is provided of what the Journal reflects about pediatric psychology in terms of clinical practice, scientific research, and professional issues.