Responses to the Strengths and Difficulties Questionnaire predict HbA1c trajectories in children and adolescents with type 1 diabetes: a population-based study.

INTRODUCTION: We aimed to determine whether caregiver responses to the Strengths and Difficulties Questionnaire (SDQ) are predictive of HbA1c trajectory membership in children and adolescents with type 1 diabetes, when adjusting for covariates. RESEARCH DESIGN AND METHODS: For a Danish 2009 national cohort of children and adolescents with type 1 diabetes, we analyzed yearly HbA1c follow-up data during 2010-2020 including sociodemographic data from Danish national registries. Using group-based trajectory modeling and multinomial logistic regression, we tested whether caregiver SDQ scores predicted HbA1c trajectory membership when adjusting for sex, age at diabetes diagnosis, diabetes duration, family structure, and caregiver education. RESULTS: In total, 835 children and adolescents (52% females) with a mean (SD) age of 12.5 (3.3) years, and a mean diabetes duration of 5.2 (3.1) years, were included. Based on 7247 HbA1c observations, four HbA1c trajectories were identified: (1) 'on target, gradual decrease' (26%), (2) 'above target, mild increase then decrease' (41%), (3) 'above target, moderate increase then decrease' (24%), and (4) 'well above target, large increase then decrease' (9%). Higher SDQ total difficulties scores predicted trajectories 3 and 4 (p=0.0002 and p<0.0001, respectively). Regarding the SDQ subscale scores, emotional symptoms predicted trajectories 3 and 4, and conduct problems and hyperactivity/inattention predicted trajectories 2, 3, and 4. Single-parent family and low caregiver education level both predicted trajectories 3 and 4. CONCLUSIONS: Caregiver SDQ responses and sociodemographic information may help detect children and adolescents with type 1 diabetes, who need intensive multidisciplinary medical and psychological interventions.

Associations between disordered eating behaviors and HbA1c in young people with type 1 diabetes: a systematic review and meta-analysis.

BACKGROUND: In type 1 diabetes, disordered eating behaviors (DEBs) can adversely impact HbA1c. Diabetes-adapted DEB questionnaires assess intentional insulin omission, whereas generic questionnaires do not. Given the number of studies describing DEB-HbA1c associations published over the past decade, an updated systematic review is warranted. OBJECTIVE: The study aimed to examine the associations between disordered eating behaviors (DEBs) assessed by generic and diabetes-adapted questionnaires (and subscales) and HbA1c among young people (<29 years) with type 1 diabetes. METHODS: A systematic search was conducted in PubMed, Embase, PsycInfo, and CINAHL databases. Observational studies examining associations between DEB as assessed by questionnaires and HbA1c were included. Publication information, DEB and HbA1c characteristics, and DEB-HbA1c associations were extracted. Hedges' g was calculated for mean HbA1c differences between groups with and without DEB. RESULTS: The systematic search yielded 733 reports, of which 39 reports representing 35 unique studies met the inclusion criteria. Nineteen studies assessing DEB by diabetes-adapted questionnaires (n=5,795) and seven using generic questionnaires (n=2,162) provided data for meta-analysis. For diabetes-adapted questionnaires, DEB was associated with higher HbA1c (g=0.62 CI=0.52; 0.73) with a similar effect size when restricted to validated questionnaires (g=0.61; CI=0.50; 0.73). DEB was not associated with HbA1c for generic questionnaires (g=0.19; CI=-0.17; 0.55), but significantly associated with higher HbA1c for validated generic questionnaires (g=0.32; 95% CI=0.16-0.48). Participant and HbA1c collection characteristics were often inadequately described. CONCLUSION: Diabetes-adapted DEB questionnaires should be used in youth with type 1 diabetes because they capture intentional insulin omission and are more strongly associated with HbA1c than generic DEB questionnaires.

Adherence in Diabetes Questionnaire (ADQ) score as predictor of 11-year HbA1c trajectories in children and adolescents with type 1 diabetes: A population-based longitudinal study.

AIMS: To identify 11-year HbA1c trajectories in children/adolescents with type 1 diabetes and determine whether baseline caregiver- and/or child/adolescent-reported Adherence in Diabetes Questionnaire (ADQ) scores and multiple covariates predict HbA1c trajectory membership. METHODS: For a 2009 population-based cohort of children/adolescents with type 1 diabetes, we analyzed HbA1c follow-up (2010-2020) data from Danish diabetes registries. HbA1c trajectories were identified with group-based trajectory modeling. Using multinomial logistic regression, we tested whether ADQ scores predicted trajectory membership when adjusting for sex, age at diabetes diagnosis, diabetes duration, family structure, and caregiver education. RESULTS: For 671 children/adolescents (10-17 years at baseline) with 5644 HbA1c observations over 11 years, four trajectories/groups were identified: 1) "on target, gradual decrease" (27%), 2) "above target, mild increase then decrease" (39%), 3) "above target, moderate increase then decrease" (25%), and 4) "well above target, large increase then decrease" (9%). Using group one as the reference, lower caregiver-reported ADQ scores predicted group 2, 3, and 4 membership. Lower child/adolescent-reported ADQ scores predicted group 3 and 4 membership. Low caregiver education predicted group 3 and 4 membership. Single-parent status predicted group 4 membership. CONCLUSIONS: ADQ scores and socio-demographics may serve as tools to predict glycemic control in youth with type 1 diabetes.

Overeating, binge eating, quality of life, emotional difficulties, and HbA1c in adolescents with type 1 diabetes: A Danish national survey.

AIMS: To determine 1) the prevalence of symptoms of overeating (OE), subclinical binge eating (SBE) and clinical binge eating (CBE), in adolescents with type 1 diabetes (T1D), and 2) their associations with quality of life (QoL), anxiety, depression, HbA1c, and body mass index standard deviation score (BMISDS). METHODS: In total 506 adolescents (age 12-17 years; mean 14.7 years; girls 49%) from the Danish Registry for Diabetes in Childhood and Adolescence (DanDiabKids) were included. Participants completed questionnaires on disordered eating, QoL, and emotional difficulties. A blood sample was sent for HbA1c determination. BMISDS was determined from the DanDiabKids data. RESULTS: Prevalence rates of OE, SBE, and CBE were 8.4%, 18% and 7.9% respectively. Youth with CBE symptoms scored lowest on generic and diabetes specific QoL, highest on anxiety and depression symptoms, and had a higher HbA1c. Youth with CBE had borderline increased BMISDS. CONCLUSIONS: In a Danish national survey of adolescents with T1D, approximately one-third of participants had overeating or binge eating symptoms, comparable with the numbers in a U.S T2D population. Increased binge eating symptoms associated with lower QoL, higher depression scores, higher anxiety scores, and poorer clinical outcomes. Binge eating symptoms were markers for poor mental and somatic health.

Comparative use of the Ages and Stages Questionnaires in low- and middle-income countries.

AIM: To map the breadth of use of the Ages and Stages Questionnaires (ASQ) in low- and middle-income countries (LMICs) across world regions, and examine procedures for ASQ translation, adaptation, psychometric evaluation, and administration. METHOD: We conducted a review of all original, peer-reviewed studies written in English referencing use of the ASQ in LMICs. We used a consensus rating procedure to classify each article into one of four categories: feasibility study, psychometric study, prevalence study, or research study. RESULTS: We analysed 53 peer-reviewed articles written in English detailing use of the ASQ in LMICs. We found evidence of ASQ use in 23 LMICs distributed across all world regions. The ASQ was translated into 16 languages. Just over half of the studies reported parent completion of the ASQ (50.9%). We identified eight feasibility studies, 12 psychometric studies, and nine prevalence studies. Study type varied by economy and region. INTERPRETATION: Findings suggest broad global use of the ASQ in a range of countries and cultural and linguistic contexts. There is need for further validation studies across all cited regions and countries and in countries ready to begin to design systems for providing universal developmental screening services. WHAT THIS PAPER ADDS: The Ages and Stages Questionnaires (ASQ) has been used in at least 23 low- and middle-income countries (LMICs). The ASQ has been translated into at least 16 languages in LMICs. Over half the identified studies reported parent completion of the ASQ.

Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review.

AIM: The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. METHOD: The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. RESULTS: US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. INTERPRETATION: Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. WHAT THIS PAPER ADDS: General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.

USO COMPARATIVO DE LOS CUESTIONARIOS DE EDADES Y ETAPAS EN LOS ESTADOS UNIDOS Y ESCANDINAVIA: UNA REVISIÓN SISTEMÁTICA: OBJETIVO: El objetivo de esta revisión sistemática fue investigar las prácticas de detección con los Cuestionarios de Edades y Etapas (ASQ) y los Cuestionarios de Edades y Etapas: Social-Emocional (ASQ-SE) en EE. UU. y Escandinavia e identificar lecciones prácticas y oportunidades de investigación. MÉTODO: La revisión se realizó para estudios relacionados con ASQ y ASQ-SE SE en niños desde el nacimiento hasta los 5 años. De nueve bases de datos y 1.689 referencias (publicadas entre 1.988 y 2.018), se incluyeron 127 artículos y se categorizaron utilizando el software en línea Covidence. Las listas de verificación del Programa de Habilidades de Evaluación Crítica se usaron antes de la síntesis de datos. RESULTADOS: Los estudios de EE. UU. principalmente usan ASQ / ASQ-SE para detectar retrasos en poblaciones generales y en riesgo en entornos médicos, lo que aumenta la detección temprana, la referencia de los médicos y las tasas de intervención. Los estudios escandinavos utilizan comúnmente el ASQ / ASQ-SE para monitorear las diferencias de desarrollo y comportamiento en las cohortes basadas en intervención / exposición. El tamizaje previo a la visita (pre-screening) arroja tasas de finalización / retorno del 83% a más del 90%, y favorece la interpretación de los resultados en el mismo día. Cuando se indican derivaciones o interconsultas esta información es beneficiosa, para la coordinación a nivel de sistema de atención o la asignación de un especialista en neurodesarrollo y el comportamiento. INTERPRETACIÓN: Revisamos las lecciones prácticas de implementación. Las oportunidades de investigación incluyen investigar y medir las secciones 'generales' de ASQ / ASQ-SE. Las traducciones en danés, noruego y sueco están disponibles, pero se necesitan estudios actualizados de normalización y validación en toda Escandinavia. Se necesitan ensayos controlados aleatorios para investigar los resultados en cohortes tamizadas versus no tamizadas (pre-screening).

USO COMPARATIVO DOS QUESTIONÁRIOS IDADES E ESTÁGIOS NOS EUA E NA ESCANDINÁVIA: UMA REVISÃO SISTEMÁTICA: OBJETIVO: O objetivo desta revisão sistemática foi investigar as práticas de avaliação com os Questionários Idades e Estágios (QIE) e os Questionários Idades e Estágios: Social-emocional (QIE:SE) nos EUA e na Escandinávia, e identificar lições práticas e oportunidades para pesquisas. MÉTODO: A revisão foi realizada para estudos relacionados ao QIE e QIE:SE em crianças do nascimento aos 5 anos de idade. A partir de nove bases de dados e 1689 referências (publicadas de 1988 a 2018), 127 artigos foram incluídos e categorizados usando o software online Covidence. As listsa do Programa de Habilidades de Avaliação Crítica foram aplicadas antes da síntese de dados. RESULTADOS: Estudos americanos primariamente usam o QIE/QIE:SE para detectar atrasos na população geral e de risco em ambientes médicos, o que aumenta a detecção precoce, encaminhamentos clínicos e intervenções. Estudos escandinavos comumente usam o QIE/QIE:SE para monitorar diferenças desenvolvimentais-comportamentais em coortes de intervenção ou que tiveram alguma exposição. Avaliações pré-visita permitem taxas de finalização/retorno de 83% a mais de 90%, e fomenta a interpretação no mesmo dia. Quando encaminhamentos são indicados, a coordenação do cuidado no sistema com um especialista desenvolvimental-comportamental é benéfica. INTERPRETAÇÃO: Lições para implementação prática são revisadas. Oportunidades de pesquisas incluem investigar e medir as seções gerais do QIE/QIE:SE. As traduções para dinamarquês, norueguês e sueco estão disponíveis, mas estudos atuais de normatização e validação são necessários em toda a Escandinávia. Estudos clínicos randomizados são necessários para investigar os desfechos de coortes avaliadas versus não avaliadas.

Enhancing the algorithm for developmental-behavioral surveillance and screening in children 0 to 5 years.

OBJECTIVE: To determine if the 2006 American Academy of Pediatrics developmental surveillance and screening algorithm is adequate or if revisions are needed. METHODS: A comprehensive literature search was conducted to investigate a clinician's ability to perform developmental-behavioral surveillance in children 0 to 5 years. RESULTS: Even when a broad-band developmental screen is typical, pediatricians should refer when they confidently suspect a delay but be far more suspicious about children who seem asymptomatic. Periodic screening enhances surveillance by improving early detection and early intervention (EI) eligibility rates. Nevertheless, children with concerning screens are not consistently referred and interlinked to EI. Once referred, approximately half are deemed EI-ineligible, even though they typically perform well below average and have numerous, predictive academic and psychosocial risk factors. Meanwhile, clinicians struggle with tracking at-risk children. CONCLUSION: Revisions are needed to optimize early detection, prevention, and monitoring. Greater emphasis is needed on developmental-behavioral promotion and referral care coordination.