Obesity is an independent risk factor for cancer development following diagnosis of dermatomyositis.

Patients with dermatomyositis (DM) are at an increased risk of cancer development, especially around the time of diagnosis of DM. Obesity is also a risk factor in the general population for cancer development. This study aimed to assess the association between cancer in DM patients with and without obesity as defined by ICD code and BMI data. In this analysis of patients with DM, logistic regression modeling of the odds of cancer outcome was performed for patients with DM and obesity compared to those without obesity, adjusted for age and sex. A total of 12,722 patients with DM were identified, of whom 6,055 had available BMI data. DM patients who were coded obese at any point had significantly higher odds 1.98 (95 % Confidence interval (CI) 1.70, 2.30) of a subsequent cancer diagnosis. This association was also found in the subgroup analysis with available BMI where patients with obesity (BMI ≥30 kg/m2) had an increased odds of cancer 1.23 (1.02, 1.49) when compared to patients with BMI <30 kg/m2 with DM. In time to event analysis any obesity code was associated with a 16 % increased hazard of cancer (adjusted hazard ratio 1.16 [95 % CI 1.02, 1.31]). Overall, the most frequent type of cancer was breast cancer, however patients with DM and obesity had higher frequencies of lymphoma, colorectal, melanoma, uterine, renal cancers compared to patients with DM without obesity.

Higher Odds of Adverse Cutaneous Reactions in Patients With Dermatomyositis Treated With Hydroxychloroquine Compared With Methotrexate.

OBJECTIVE: Hydroxychloroquine (HCQ) use for the treatment of dermatomyositis (DM) has been associated with adverse cutaneous reactions. We applied a new user, active comparator, retrospective design to assess differences in adverse cutaneous reactions or hospitalizations between HCQ and methotrexate (MTX) use among patients with DM. METHODS: We used a national network of data from insurance registries (TriNetX), enrolling patients with two International Classification of Diseases (ICD) codes for DM separated by 6 months or more who had a prescription for either (but not both) HCQ or MTX on or after DM diagnosis. Outcomes were adverse cutaneous reactions (ICD codes) or hospital admission (Current Procedural Terminology (CPT) codes) within 4 months from the prescription dispense date. Logistic regression was used to produce adjusted odds ratios (aORs) and 95% confidence intervals (CIs) comparing outcomes in the HCQ group (n = 1364) and the MTX group (n = 1400), adjusted for age at first DM diagnosis, year of birth, sex, and time from DM diagnosis to first prescription. RESULTS: Overall, we found no significant difference in odds of hospitalization in those taking HCQ (aOR 1.05; 95% CI: 0.79-1.39) compared with those on MTX. Patients with DM on HCQ had 30% higher odds of adverse cutaneous reaction diagnosis compared with patients on MTX (aOR 1.30; 95% CI: 1.02-1.59). Age at DM diagnosis was an effect modifier of this association, with higher odds of adverse cutaneous reaction among patients taking HCQ who were younger at diagnosis. CONCLUSION: Compared with MTX use, HCQ use, especially in younger patients, may result in higher odds of adverse cutaneous reactions.

Are students with disabilities suspended more frequently than otherwise similar students without disabilities?

Students with disabilities (SWD) have been reported to be disproportionately suspended from U.S. schools and so more likely to experience the "school-to-prison pipeline" through suspension's associations with lower academic achievement, dropout, juvenile delinquency, and adult criminality. Yet few studies have estimated SWD's risk of more frequent suspension while simultaneously controlling for potential confounds. Negative binomial regression modeling of suspension count data from a nationally representative and longitudinal sample (N = 6,740) indicated that males, those from lower resourced families, and students attending more economically segregated schools were more frequently suspended. On average, students who are Black received about 1.6 times as many suspensions by the end of 8th grade as otherwise similar White students. In contrast, having a disability by 1st grade was not a risk factor for more frequent suspension by the end of 8th grade while simultaneously accounting for other risk factors (e.g., gender, race/ethnicity, family SES, prior history of externalizing problem behaviors, being from a English-speaking household, school-level economic composition). Students with specific disability conditions (e.g., emotional disturbances, speech or language impairments) were not at increased risk for more frequent suspension. Students with disabilities who are Black, Hispanic, or of other race/ethnicity were not more frequently suspended than SWD who are White.

Kindergarten Children's Executive Functions Predict Their Second-Grade Academic Achievement and Behavior.

Whether and to what extent kindergarten children's executive functions (EF) constitute promising targets of early intervention is currently unclear. This study examined whether kindergarten children's EF predicted their second-grade academic achievement and behavior. This was done using (a) a longitudinal and nationally representative sample (N = 8,920, Mage  = 97.6 months), (b) multiple measures of EF, academic achievement, and behavior, and (c) extensive statistical control including for domain-specific and domain-general lagged dependent variables. All three measures of EF-working memory, cognitive flexibility, and inhibitory control-positively and significantly predicted reading, mathematics, and science achievement. In addition, inhibitory control negatively predicted both externalizing and internalizing problem behaviors. Children's EF constitute promising targets of experimentally evaluated interventions for increasing academic and behavioral functioning.

Eight-Year Latent Class Trajectories of Academic and Social Functioning in Children with Attention-Deficit/Hyperactivity Disorder.

We examined trajectories of academic and social functioning in children with attention-deficit/hyperactivity disorder (ADHD) to identify those who might be at risk for especially severe levels of academic and social impairment over time. We estimated a series of growth mixture models using data from two subsamples of children participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) including those with at least baseline and 96-month data for reading and mathematics achievement (n = 392; 77.3% male; M age = 7.7; SD = 0.8) or social skills ratings from teachers (n = 259; 74.9% male; M age = 7.6; SD = 0.8). We compared latent trajectories for children with ADHD to mean observed trajectories obtained from a local normative (i.e., non-ADHD) comparison group (n = 289; 80.6% male; M age = 9.9; SD = 1.1). Results indicated six latent trajectory classes for reading and mathematics and four classes for teacher social skills ratings. There was not only a relationship between trajectories of inattention symptoms and academic impairment, but also a similarly strong association between trajectory classes of hyperactive-impulsive symptoms and achievement. Trajectory class membership correlated with socio-demographic and diagnostic characteristics, inattention and hyperactive-impulsive symptom trajectories, externalizing behavior in school, and treatment receipt and dosage. Although children with ADHD display substantial heterogeneity in their reading, math, and social skills growth trajectories, those with behavioral and socio-demographic disadvantages are especially likely to display severe levels of academic and social impairment over time. Evidence-based early screening and intervention that directly address academic and social impairments in elementary school-aged children with ADHD are warranted. The ClinicalTrials.gov identifier is NCT00000388.

Late Talkers: A Population-Based Study of Risk Factors and School Readiness Consequences.

Purpose: This study was designed to (a) identify sociodemographic, pregnancy and birth, family health, and parenting and child care risk factors for being a late talker at 24 months of age; (b) determine whether late talkers continue to have low vocabulary at 48 months; and (c) investigate whether being a late talker plays a unique role in children's school readiness at 60 months. Method: We analyzed data from the Early Childhood Longitudinal Study, a population-based sample of 9,600 children. Data were gathered when the children were 9, 24, 48, and 60 months old. Results: The risk of being a late talker at 24 months was significantly associated with being a boy, lower socioeconomic status, being a nonsingleton, older maternal age at birth, moderately low birth weight, lower quality parenting, receipt of day care for less than 10 hr/week, and attention problems. Being a late talker increased children's risk of having low vocabulary at 48 months and low school readiness at 60 months. Family socioeconomic status had the largest and most profound effect on children's school readiness. Conclusions: Limited vocabulary knowledge at 24 and 48 months is uniquely predictive of later school readiness. Young children with low vocabularies require additional supports prior to school entry.

Academic and Social Functioning Associated with Attention-Deficit/Hyperactivity Disorder: Latent Class Analyses of Trajectories from Kindergarten to Fifth Grade.

Children with attention-deficit/hyperactivity disorder (ADHD) are known to exhibit significantly lower academic and social functioning than other children. Yet the field currently lacks knowledge about specific impairment trajectories experienced by children with ADHD, which may constrain early screening and intervention effectiveness. Data were analyzed from a nationally representative U.S. cohort in the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (ECLS-K) for 590 children (72.7 % male) whose parents reported a formal diagnosis of ADHD. Children's math, reading, and interpersonal skills were assessed at 5 time points between kindergarten and fifth grade. Growth mixture model analyses indicated 4 latent trajectory classes for reading, 8 classes for math, and 4 classes for interpersonal skills. Membership in reading and math trajectory classes was strongly related; overlaps with interpersonal skills classes were weaker. Trajectory class membership was correlated with demographic characteristics and behavioral functioning. Children with ADHD display substantial heterogeneity in their reading, math, and interpersonal growth trajectories, with some groups of children especially likely to display relatively severe levels of academic and social impairment over time. Early screening and intervention to address impairment, particularly reading difficulties, among kindergarten students with ADHD is warranted.

Who Receives Speech/Language Services by 5 Years of Age in the United States?

PURPOSE: We sought to identify factors predictive of or associated with receipt of speech/language services during early childhood. We did so by analyzing data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; Andreassen & Fletcher, 2005), a nationally representative data set maintained by the U.S. Department of Education. We addressed two research questions of particular importance to speech-language pathology practice and policy. First, do early vocabulary delays increase children's likelihood of receiving speech/language services? Second, are minority children systematically less likely to receive these services than otherwise similar White children? METHOD: Multivariate logistic regression analyses were performed for a population-based sample of 9,600 children and families participating in the ECLS-B. RESULTS: Expressive vocabulary delays by 24 months of age were strongly associated with and predictive of children's receipt of speech/language services at 24, 48, and 60 months of age (adjusted odds ratio range = 4.32-16.60). Black children were less likely to receive speech/language services than otherwise similar White children at 24, 48, and 60 months of age (adjusted odds ratio range = 0.42-0.55). Lower socioeconomic status children and those whose parental primary language was other than English were also less likely to receive services. Being born with very low birth weight also significantly increased children's receipt of services at 24, 48, and 60 months of age. CONCLUSION: Expressive vocabulary delays at 24 months of age increase children's risk for later speech/language services. Increased use of culturally and linguistically sensitive practices may help racial/ethnic minority children access needed services.

Who Is At Risk for Persistent Mathematics Difficulties in the United States?

We analyzed two nationally representative, longitudinal data sets of U.S. children to identify risk factors for persistent mathematics difficulties (PMD). Results indicated that children from low socioeconomic households are at elevated risk of PMD at 48 and 60 months of age, as are children with cognitive delays, identified developmental delays or disabilities, and vocabulary difficulties. In contrast, children attending preschool either in Head Start or non-Head Start classrooms are at initially lower risk of PMD. Kindergarten-aged children experiencing either low socioeconomic status or mathematics difficulties are at greatest risk for PMD across third, fifth, and eighth grades. Also at risk for PMD between third and eighth grades are children displaying reading difficulties or inattention and other learning-related behaviors problems, children with identified disabilities, and those who are retained. Educationally relevant and potentially malleable factors for decreasing young children's risk for PMD may include increasing children's access to preschool, decreasing their risk of experiencing vocabulary or reading difficulties, and avoiding use of grade retention.

24-Month-Old Children With Larger Oral Vocabularies Display Greater Academic and Behavioral Functioning at Kindergarten Entry.

Data were analyzed from a population-based, longitudinal sample of 8,650 U.S. children to (a) identify factors associated with or predictive of oral vocabulary size at 24 months of age and (b) evaluate whether oral vocabulary size is uniquely predictive of academic and behavioral functioning at kindergarten entry. Children from higher socioeconomic status households, females, and those experiencing higher quality parenting had larger oral vocabularies. Children born with very low birth weight or from households where the mother had health problems had smaller oral vocabularies. Even after extensive covariate adjustment, 24-month-old children with larger oral vocabularies displayed greater reading and mathematics achievement, increased behavioral self-regulation, and fewer externalizing and internalizing problem behaviors at kindergarten entry.

Which Instructional Practices Most Help First Grade Students with and without Mathematics Difficulties?

We used population-based, longitudinal data to investigate the relation between mathematics instructional practices used by 1st grade teachers in the U.S. and the mathematics achievement of their students. Factor analysis identified four types of instructional activities (i.e., teacher-directed, student-centered, manipulatives/calculators, movement/music) and eight types of specific skills taught (e.g., adding two-digit numbers). First-grade students were then classified into five groups on the basis of their fall and/or spring of kindergarten mathematics achievement-three groups with mathematics difficulties (MD) and two without MD. Regression analysis indicated that a higher percentage of MD students in 1st grade classrooms was associated with greater use by teachers of manipulatives/calculators and movement/music to teach mathematics. Yet follow-up analysis for each of the MD and non-MD groups indicated that only teacher-directed instruction was significantly associated with the achievement of students with MD (covariate-adjusted ESs = .05-.07). The largest predicted effect for a specific instructional practice was for routine practice and drill. In contrast, for both groups of non-MD students, teacher-directed and student-centered instruction had approximately equal, statistically significant positive predicted effects (covariate-adjusted ESs = .03-.04). First-grade teachers in the U.S. may need to increase their use of teacher-directed instruction if they are to raise the mathematics achievement of students with MD.

Minorities are Disproportionately Underrepresented in Special Education: Longitudinal Evidence Across Five Disability Conditions.

We investigated whether and to what extent minority children attending elementary and middle schools in the U.S. are over- or under-identified as disabled and so disproportionately represented in special education. To address existing limitations in the field's knowledge base, we (a) analyzed multi-year longitudinal data, (b) used hazard modeling to estimate over-time dynamics of disability identification across five specific conditions, and (c) extensively corrected for child-, family-, and school-level potential confounding variables (e.g., child-level academic achievement and behavior, family-level socioeconomic status, school-level state location). Despite long-standing and on-going federal legislative and policy efforts to reduce minority over-representation in special education, our analyses indicated that this has not been occurring in the U.S. Instead, minority children are less likely than otherwise similar White, English-speaking children to be identified as disabled and so receive special education services. From kindergarten entry to at least the end of middle school, racial and ethnic minority children are less likely than otherwise similar White children to be identified as having (a) learning disabilities, (b) speech or language impairments, (c) intellectual disabilities, (d) health impairments, or (d) emotional disturbances. Language minority children are less likely to be identified as having (a) specific learning disabilities or (b) speech or language impairments.

Racial/ethnic disparities in ADHD diagnosis by kindergarten entry.

BACKGROUND: Whether and to what extent racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis occur by kindergarten entry is currently unknown. We investigated risk factors associated with an ADHD diagnosis by kindergarten entry generally, and specifically whether racial/ethnic disparities in ADHD diagnosis occur by this very early time period. METHODS: Secondary analysis of data from children enrolled in the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a large, nationally representative cohort of U.S. children born in 2001. Data include information from birth certificates, parent and teacher questionnaires, and in-person developmental assessments conducted with children at intervals from 9 months through kindergarten entry. The analytic sample included children enrolled in the ECLS-B at the 60-month assessment (N = 6,550). RESULTS: Black children in the United States were 70% (1 - OR of .30) less likely to receive an ADHD diagnosis than otherwise similar White children. Hispanic children initially appeared to be underdiagnosed for ADHD. However, their disparity with Whites became statistically nonsignificant after controlling for whether a language other than English was primarily spoken in the home. Analyses of kindergarten teacher-reported classroom behavior indicated that neither Black nor Hispanic children displayed less frequent ADHD-related behaviors than Whites. CONCLUSIONS: Although they are not less likely to display ADHD-related behaviors, children who are Black or being raised in households where non-English is primarily spoken are less likely than otherwise similar White children to be diagnosed with ADHD in the US.

Are Minority Children Disproportionately Represented in Early Intervention and Early Childhood Special Education?

We investigated whether and to what extent children who are racial/ethnic minorities are disproportionately represented in early intervention and/or early childhood special education (EC/ECSE). We did so by analyzing a large sample of 48-month-olds (N=7,950) participating in the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative dataset of children born in the U.S. in 2001. Multivariate logistic regression analyses indicate that boys (OR=1.66), children born at very low birthweight (OR=3.98) or with congenital anomalies (OR=2.17), and children engaging in externalizing problem behaviors (OR=1.10) are more likely to be represented in EI/ECSE. Children from low SES households (OR=.48), those displaying greater numeracy or receptive language knowledge (ORs=.96 and .76, respectively), and children being raised in households where a language other than English is primarily spoken (OR=.39) are less likely to be represented in EI/ECSE. Statistical control for these and an extensive set of additional factors related to cognitive and behavioral functioning indicated that 48-month-old children who are Black (OR=.24) or Asian (OR=.32) are disproportionately under-represented in EI/ECSE in the U.S.

The language and literacy development of Head Start children: a study using the Family and Child Experiences Survey database.

PURPOSE: This article provides information about the Head Start Family and Children Experiences Survey (FACES). It also presents the findings of a study that capitalizes on the strengths of the data from FACES to investigate the impact of child and family characteristics, speech-language impairment, and the home literacy environment on the language and early literacy outcomes of children from low-income families. METHOD: Data from the FACES 1997 cohort were used in this study. Variables included in the analysis were child and family characteristics (e.g., age, gender, ethnicity, etc.); parent report of speech-language impairment; frequency of home literacy activities; and children's scores on vocabulary, letter-word identification, and early reading assessments. RESULTS: The results revealed that children's vocabulary abilities in Head Start were affected by maternal education, ethnicity, and the frequency of home literacy activities, and children's letter-word identification abilities were impacted by maternal education and the child's gender and age. Additionally, children's reading abilities in kindergarten were predicted by ethnicity, speech-language impairment, and the home literacy environment, as well as by children's vocabulary and letter-word identification abilities in Head Start. CONCLUSION: The findings demonstrate the unique contributions that the home literacy environment and the presence of speech-language impairment during preschool make in children's early reading outcomes.