Adolescent Sleep and Mental Health Across Race/Ethnicity: Does Parent-Child Connectedness Matter?

OBJECTIVE: Sleep is vital for healthy development, yet most adolescents do not meet recommended nightly hours. Although racial/ethnic minorities often experience relatively worse sleep outcomes compared with White peers, little is known about how the sleep-mental health relationship holds across diverse groups or how family relationships affect this association. METHOD: Using data on 8th, 9th, and 11th grade public school respondents to the 2016 Minnesota Student Survey (N = 113,834), we conducted univariate, bivariate, and multivariate analyses to examine whether sleep duration was associated with depressive symptoms, suicide ideation, and suicide attempt, adjusting for sociodemographic covariates. Furthermore, we examined the effect of the parent-child connectedness by sleep interaction on these relationships. Analyses were conducted for 9 racial/ethnic groups collectively and separately. RESULTS: Overall, youth sleep duration and parent-child connectedness were independently associated with reduced rates of depressive symptoms, suicide ideation, and suicide attempt. There was significant interaction between parent-child connectedness and sleep, demonstrating that connectedness magnifies the benefits of the sleep-mental health relationship. Main effects of sleep and parent-child connectedness for mental health were similar for most individual racial/ethnic groups, although magnitudes varied. The connectedness-sleep interaction only remained significant for White and Asian youth on select suicide-related outcomes. CONCLUSION: Despite racial/ethnic differences, adolescent sleep and parent-child connectedness both seem to buffer youth from poor mental health in a large, multiethnic sample. On the whole, these factors demonstrate a synergistic protective effect and reflect promising intervention targets. The extent to which their interactive benefit translates across diverse populations requires additional study.

Importance of Trauma-Informed Practice in Evaluation of Children Diagnosed with Autism Spectrum Disorder.

CASE: As part of a multidisciplinary adoption support clinic, Erin, a 5-year-old girl, adopted approximately 6 months before the clinic visit, presents for postadoption evaluation. Erin was born at full term. Her birth history was significant for reported maternal treatment for liver failure during pregnancy. Her previous medical history included hospitalization for a viral illness at age 2 months, recurrent ear infections, and a fractured forearm. Family history was significant for a maternal history of bipolar disorder, depression, anxiety, borderline personality disorder, and concern for substance abuse; a paternal history of attention-deficit/hyperactivity disorder (ADHD) and depression; and full biological brother with a history of ADHD and oppositional defiant disorder. Erin and her brother lived with their parents until she was approximately 3 years old. At that time, there were concerns for poor hygiene, inconsistent medical care, poor school attendance for her brother, financial instability, and significant neglect. Erin was reportedly confined to her crib for hours at a time. She and her older brother were removed from the home because of concerns for significant neglect and placed into foster care. Approximately 3 months after foster placement, Erin underwent testing because of concerns for abnormal behaviors and possible developmental delays. Symptoms included poor sleep, repetitive behaviors such as head banging, delayed speech that primarily involved grunting, and lack of toilet training. She was hyperactive and aggressive and had poor caregiver attachment. On evaluation, she was small for age, poorly groomed, and easily distracted with poor eye contact and did not tolerate interactions with examiners. Neuropsychological testing consisted of symptom checklists and caregiver interview only because she did not tolerate diagnostic testing. She was diagnosed with autism spectrum disorder and global developmental delay with intellectual and language impairments. Over the following year, Erin was transitioned to a second foster family and was subsequently adopted. She received speech, occupational, and physical therapy, along with trauma-informed therapy. She made significant gains in multiple domains and was able to graduate from trauma-informed therapy after 1 year. On examination, Erin greets you with appropriate eye contact and reports that she is feeling "good." She is verbal and interactive with her brother and parents. She looks to parents for support when asked to participate in the physical examination. She does not display any significant repetitive behaviors. Erin's parents are concerned that her initial diagnoses of autism spectrum disorder and global developmental delay do not accurately reflect her current level of functioning and are afraid she may have been misdiagnosed. How would you proceed with next steps to address these diagnoses?

Genetic developmental disability diagnosed in adulthood: a case report.

BACKGROUND: Developmental disabilities (DD) are an umbrella term for conditions associated with functional impairments in physical, learning, language, or behavior areas. Intellectual disability (ID) is a type of developmental disability that results in delays in cognitive or intellectual functioning, such as reasoning, learning, and problem-solving, and adaptive behaviors including social and practical life skills. DD can be due to a variety of factors, ranging from environmental exposures to genetic mutations, and studies suggest that up to 40% of DDs may be caused by genetic issues. CASE PRESENTATION: In this case study, we present an 18-year-old internationally adopted female Chinese American patient with a known history of developmental delay, intellectual disability, strabismus, and a congenital heart defect who had not been tested for genetic causes of her delay prior to presentation. When evaluated with chromosomal microarray, the patient demonstrated a deletion on the short arm of chromosome 5, an area associated with Cri-du-chat syndrome. This chromosomal deletion was a likely explanation for her history of developmental delays, intellectual disability, and congenital heart defect, in addition to her history of institutionalization and the trauma of multiple caregiver transitions in early childhood. The patient was referred for further evaluation by a geneticist and genetic counselor. CONCLUSIONS: This case highlights that the underlying cause of developmental delay is often multifactorial, and underscores the importance of a full medical evaluation, including genetic testing, for children with intellectual disability. Using this approach, healthcare professionals can identify potential diagnoses and provide more targeted resources to families.