Early infant behavioural correlates of social skills in adolescents.

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder typically diagnosed after the second year of life; however, differences in brain structure and function associated with ASD have been ascertained in early infancy. Identifying behavioural markers of ASD risk in early infancy has the potential to facilitate early detection and intervention. OBJECTIVES: We examined associations between infant behaviour and adolescent behaviours associated with ASD. METHODS: Analyses leveraged data available on 370 participants from the New Bedford Cohort, a sociodemographically diverse prospective birth cohort of children born from 1993 to 1998 to mothers residing near the New Bedford Harbor Superfund site in Massachusetts. Longitudinal assessments were used to examine the associations between behaviours when children were approximately 2 weeks old (measured by the Neonatal Behavioral Assessment Scale [NBAS]), and subsequent maladaptive behaviours associated with ASD at approximately 15 years old [measured by the Behavior Assessment System for Children, 2nd Edition-Teacher Rating Scale (BASC-2 TRS) scores which are standardised to a mean (SD) of 50 (10)]. RESULTS: Poorer performance on select individual items and cluster scales of the NBAS was associated with an increase in behaviours associated with ASD in adolescents. Associations were strongest for neonatal measures of self-regulation, response to auditory input, and autonomic nervous system regulation. For example, in covariate-adjusted models, infants with Regulation of State NBAS cluster scores in the lowest tertile (poorest performance) compared to infants with scores in the higher two tertiles had adolescent BASC-2 TRS Developmental Social Disorders T-scores that were 2.9 points higher (95% CI: 0.8, 4.9), indicating more behaviours associated with ASD. CONCLUSION: The NBAS is an established and accessible instrument that assesses a broad range of behaviours in very young infants, and may be a useful tool for newborn assessments of developmental risk, including risk of ASD-associated behaviours.

Information flow during pediatric trauma care transitions: things falling through the cracks.

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams. Several clinical teams (including emergency medicine, surgery, anesthesiology, and pediatric critical care) converge to help support trauma care in the ED; this co-location in the ED can help to support communication, coordination and cooperation of team members. The most severe trauma cases often need surgery in the operating room (OR) and are admitted to the pediatric intensive care unit (PICU). These care transitions in pediatric trauma can result in loss of information or transfer of incorrect information, which can negatively affect the care a child will receive. In this study, we interviewed 18 clinicians about communication and coordination during pediatric trauma care transitions between the ED, OR and PICU. After the interview was completed, we surveyed them about patient safety during these transitions. Results of our study show that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To safely manage the transition of this fragile and complex population, we need to find ways to better manage the information flow during these transitions by, for instance, providing technological support to ensure shared mental models.