ABSTRACT
BACKGROUND: Not all children with acute lymphoblastic leukemia (ALL) were developing in a typical manner prior to diagnosis. Pre-existing developmental vulnerabilities (DV) may be related to long-term neuropsychological sequelae following ALL treatment, yet little is known about the prevalence or nature of prior DV in this population. PROCEDURE: Children with newly diagnosed ALL aged 2-18 years (n = 115) were screened for DV by asking parents about the child's prior developmental history and with the Developmental Profile-3 (DP-3). RESULTS: Twenty-six participants (23% of total sample) screened positive for prior DV, with one or more of the following: delayed early motor and/or language milestones that required intervention (n = 17), prior diagnosis of Down syndrome (n = 3), prior diagnosis of autism spectrum disorder (n = 1), prior diagnosis of attention-deficit/hyperactivity disorder and/or learning disability (n = 6), or prior neurological conditions (n = 5). CONCLUSIONS: A sizable proportion of children with newly diagnosed ALL have pre-morbid DV that could potentially make them more vulnerable to reduced educational opportunities during treatment and neurotoxic late effects following treatment. Identification of the subset of children with ALL and DV is essential to direct early interventions and to study their long-term outcomes.
Subject(s)
Autism Spectrum Disorder/diagnosis , Child Development , Developmental Disabilities/diagnosis , Down Syndrome/diagnosis , Learning Disabilities/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Autism Spectrum Disorder/therapy , Child , Child, Preschool , Developmental Disabilities/therapy , Down Syndrome/therapy , Female , Humans , Learning Disabilities/therapy , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapyABSTRACT
BACKGROUND: Neonatal intensive care unit admission rates are an important birth outcome indicator for Medicaid managed care organizations. OBJECTIVES: To reduce neonatal intensive care unit admission rates by at least 15% and to maintain that reduction through implementation of a quality improvement program. STUDY DESIGN: The organization performed a longitudinal population-based review of its birth outcomes from 1997 through 2003, focusing on neonatal intensive care unit admission rates. The return-on-investment evaluation reflected attributable incremental program costs and resultant savings. METHODS: Interventions included enhanced identification and stratification of high-risk women with the use of a health risk assessment form; outreach through nursing care coordination offering home visits, transportation, support services, social work services, and connection with other community-based organizations; and implementation of a strong informatics structure. RESULTS: Neonatal intensive care unit admission rates decreased from 107.6 per 1000 births in 1998 to 56.7 per 1000 births in 2003. The return on investment from the incremental program enhancements was just over dollars 2 per dollars 1 expended. CONCLUSION: A program that identifies its high-risk pregnant enrollees in a timely fashion, provides outreach using a strong nursing care coordination and social work emphasis, and has an enhanced informatics structure can significantly affect birth outcomes for a Medicaid managed care population.
Subject(s)
Intensive Care, Neonatal/statistics & numerical data , Managed Care Programs , Medicaid , Patient Admission/trends , Health Services Research , Humans , Infant, Newborn , Intensive Care, Neonatal/economicsABSTRACT
OBJECTIVE: To describe the clinical characteristics of children given a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) by expert clinicians and to compare these to the clinical characteristics of children given a diagnosis of autism and Asperger syndrome (AS). METHOD: Two hundred sixteen children with autism, 33 with AS, and 21 with PDD-NOS were compared on measures of level of functioning (communication, daily living and social skills, IQ, and age of acquisition of language) and on various symptoms of autism (impaired communication and reciprocal social interaction and a preference for repetitive and stereotyped activities). RESULTS: In terms of level of functioning measures, the PDD-NOS children had scores that were between those of the children with autism and those of the children with AS. In contrast, the PDD-NOS group had fewer autistic symptoms, especially repetitive stereotyped behaviors, than both the autism and AS groups (chi2 = 11.06, p =.004). Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors. CONCLUSIONS: With some revision to current diagnostic criteria, a more homogenous atypical group with significant impairments in social-communication but fewer repetitive behaviors can be differentiated from the more nonspecific PDD-NOS group. This differentiation may lead to better reliability in diagnosis and to further progress in studies of etiology.
