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1.
Matern Child Health J ; 24(2): 204-212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31828576

RESUMO

OBJECTIVES: The primary goal was to examine outcomes of Part C early intervention (EI) referrals from a high-risk infant follow-up program and factors associated with success. A secondary aim was to determine how many referred children not evaluated by EI would have likely qualified by either automatically meeting state eligibility criteria with a condition associated with "high-probability" for developmental delays or having test scores evidencing developmental delays. METHODS: Participants included 77 children referred directly to EI from a high-risk infant follow-up program. Scores on the Bayley Scales of Infant and Toddler Development-III, basic demographics, and medical variables were extracted from electronic medical records. Information regarding referral outcomes was gathered via follow-up phone calls to EI programs several months after referral. RESULTS: Results indicate 62% of EI referrals resulted in evaluation, with 69% of those evaluated being found eligible for services. Overall, 34% of referrals resulted in EI enrollment. Of those who were not evaluated, 71% were likely to have qualified based on state eligibility criteria. Follow-up phone call results indicated the majority of families not evaluated (64%) were never successfully contacted by the EI program. CONCLUSIONS: Findings from the present study illustrate the extent of challenges in connecting families with needed EI services and indicate an opportunity for improvement in EI referral processes to increase enrollment for eligible children. Improved communication between referral sources and service providers could support enrollment with detailed documentation of prior testing and explicit reasons for referral. Follow-up calls to confirm receipt of referral may also be necessary.


Assuntos
Deficiências do Desenvolvimento/terapia , Intervenção Educacional Precoce/normas , Encaminhamento e Consulta/normas , Criança , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/psicologia , Intervenção Educacional Precoce/métodos , Intervenção Educacional Precoce/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Washington/epidemiologia
2.
J Autism Dev Disord ; 50(5): 1770-1785, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30810843

RESUMO

Inconsistent findings regarding sex differences in cognition have been found in people with autism spectrum disorder (ASD). This study evaluated sex differences in cognitive-developmental functioning in a large clinical sample of young children diagnosed with ASD. The sample included children 18-68 months of age who received the Mullen Scales of Early Learning (MSEL) through Autism Treatment Network (ATN) sites from 2007 to 2013 (N = 1587, 16.7% female). In this large clinically referred sample of young children with ASD in the United States, no significant differences were found between the sexes for the MSEL Early Learning Composite (ELC) standard score, domain T Scores or age equivalents. These findings persisted when examining different age ranges, cognitive levels and domain profiles.


Assuntos
Transtorno do Espectro Autista/psicologia , Cognição , Caracteres Sexuais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Aprendizagem , Masculino , Estados Unidos
3.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30610100

RESUMO

Children with autism spectrum disorder (ASD) are at risk for self-injurious behaviors that can be difficult to treat in the context of co-occurring low IQ and adaptive skills. Increased prevalence and decriminalization of cannabis in some states have led to more frequent questions for pediatricians about the use of cannabis for difficult-to-treat developmental and behavioral conditions. What do we know about the possible benefits and risks of cannabis use in children with ASD? How should the clinician respond to a parent who expresses interest in cannabis to manage behavior in a child with ASD? Ethical analysis that includes harm reduction, health concerns, and information sharing will be discussed. We present commentary on the ethical implications of cannabis use in children with ASD and severe self-harm behaviors.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/tratamento farmacológico , Pessoal de Saúde/ética , Maconha Medicinal/administração & dosagem , Pais , Transtorno do Espectro Autista/psicologia , Pré-Escolar , Humanos , Masculino , Pais/psicologia
4.
Matern Child Health J ; 21(2): 290-296, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27435728

RESUMO

Objectives To investigate enrollment patterns in Part C Early Intervention (EI) for low birth weight (LBW) infants (≤2500 g). A secondary aim is to characterize LBW infants that are not enrolled in EI, but would qualify by meeting criteria for a condition associated with a "high-probability" for developmental delays (i.e., Intraventricular Hemorrhage grade III or higher, Apgar score of ≤5 at 5 min, and/or birth weight of ≤1200 g). Methods Data were gathered from 165 LBW infants participating in a high-risk infant follow-up program. Developmental assessment was completed. Basic demographic information and data regarding enrollment in EI were collected via parent questionnaire. Medical variables were extracted from each infant's electronic medical record. Results 71.5 % of LBW infants were not enrolled in EI. Factors influencing probability of EI enrollment included birth weight, gestational age, developmental test scores, and insurance status. Of the 107 infants living in Oregon who were not enrolled in EI, 42.1 % would qualify for services due to an early medical condition identified in Oregon as a condition associated with a "high-probability" for developmental delays. Conclusions Less than one third of LBW infants were enrolled in EI by their first visit to a high-risk infant follow-up program. Those infants demonstrating developmental delays and public insurance were more likely to be enrolled. The majority of infants who have readily identifiable medical risk factors that qualify them for EI were not enrolled. This study was limited by the constraints implicated by using a clinical sample.


Assuntos
Desenvolvimento Infantil , Intervenção Médica Precoce/métodos , Recém-Nascido de Baixo Peso , Cuidado Pós-Natal/métodos , Deficiências do Desenvolvimento/prevenção & controle , Intervenção Médica Precoce/normas , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Oregon , Fatores de Risco , Cooperação e Adesão ao Tratamento
5.
J Child Neurol ; 30(6): 735-40, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25117418

RESUMO

The goal was to identify perinatal predictors of early executive dysfunction in preschoolers born very low birth weight. Fifty-seven preschoolers completed 3 executive function tasks: Dimensional Change Card Sort-Separated (inhibition, working memory, and cognitive flexibility), Bear Dragon (inhibition and working memory), and Gift Delay Open (inhibition). Relationships between executive function and perinatal medical severity factors (gestational age, days on ventilation, size for gestational age, maternal steroids, and number of surgeries) and chronological age were investigated by multiple linear regression and logistic regression. Different perinatal medical severity factors were predictive of executive function tasks, with gestational age predicting Bear Dragon and Gift Open; and number of surgeries and maternal steroids predicting performance on Dimensional Change Card Sort-Separated. By understanding the relationship between perinatal medical severity factors and preschool executive outcomes, we can identify children at highest risk for future executive dysfunction, thereby focusing targeted early intervention services.


Assuntos
Desenvolvimento Infantil , Função Executiva , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/psicologia , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/psicologia , Modelos Lineares , Modelos Logísticos , Masculino , Relações Mãe-Filho , Testes Neuropsicológicos , Gravidez , Fatores de Risco
6.
Res Autism Spectr Disord ; 8(9): 1121-1133, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-25221619

RESUMO

Aggressive behavior problems (ABP) are frequent yet poorly understood in children with Autism Spectrum Disorders (ASD) and are likely to co-vary significantly with comorbid problems. We examined the prevalence and sociodemographic correlates of ABP in a clinical sample of children with ASD (N = 400; 2-16.9 years). We also investigated whether children with ABP experience more intensive medical interventions, greater impairments in behavioral functioning, and more severe comorbid problems than children with ASD who do not have ABP. One in four children with ASD had Child Behavior Checklist scores on the Aggressive Behavior scale in the clinical range (T-scores ≥ 70). Sociodemographic factors (age, gender, parent education, race, ethnicity) were unrelated to ABP status. The presence of ABP was significantly associated with increased use of psychotropic drugs and melatonin, lower cognitive functioning, lower ASD severity, and greater comorbid sleep, internalizing, and attention problems. In multivariate models, sleep, internalizing, and attention problems were most strongly associated with ABP. These comorbid problems may hold promise as targets for treatment to decrease aggressive behavior and proactively identify high-risk profiles for prevention.

7.
Early Hum Dev ; 90(10): 587-93, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25127288

RESUMO

BACKGROUND: Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers. AIMS: The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW. SUBJECTS: A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study. OUTCOME MEASURES: VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence - Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions. STUDY DESIGN: Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender. RESULTS: Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon. CONCLUSION: Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.


Assuntos
Desenvolvimento Infantil/fisiologia , Função Executiva/fisiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Relações Mãe-Filho/psicologia , Comportamento Verbal/fisiologia , Pré-Escolar , Feminino , Humanos , Masculino , Testes Psicológicos , Estatísticas não Paramétricas , Ensino/métodos , Gravação em Vídeo
8.
Early Hum Dev ; 89(9): 699-704, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23773306

RESUMO

BACKGROUND: Parental "scaffolding" behavior has been associated with developmental outcomes in at-risk children. AIMS: Because there are limited empirical data regarding how scaffolding is associated with emotion-based developmental skills, the purpose of this study was to compare associations between maternal verbal scaffolding and toddler emotion regulation, including fewer displays of negative affect and increased contentment and enjoyment during play, in toddlers born preterm and full term. STUDY DESIGN: This study was a cross-sectional cohort design. Maternal and toddler behavior was assessed during 5 min of videotaped free play with standardized toys. SUBJECTS: 131 toddlers (18-22 months) and their mothers were included (77 born preterm; 54 born full term). OUTCOME MEASURES: Toddler emotion regulation, negative affect, and dyadic mutual enjoyment were coded from videotaped play. RESULTS: The association between maternal scaffolding and emotion regulation was different for dyads with a toddler born preterm versus full term, wherein the association was positive for toddlers born preterm and non-significant for toddlers born full term. Similarly, the association between maternal scaffolding and negative affect was different for the two groups: negative for toddlers born preterm and non-significant for toddlers born full term. Finally, the association between maternal scaffolding and mutual enjoyment was positive for toddlers born preterm and non-significant for toddlers born full term. CONCLUSIONS: Our findings highlight early differences in mother-child interactive style correlates of children born preterm compared to those born full term. Maternal scaffolding behavior may be uniquely associated with emotion regulation and a positive dyadic encounter for toddlers born preterm.


Assuntos
Emoções , Recém-Nascido Prematuro/psicologia , Recém-Nascido de muito Baixo Peso/psicologia , Comportamento Materno , Comportamento Verbal , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Relações Mãe-Filho/psicologia , Jogos e Brinquedos/psicologia
9.
J Child Neurol ; 26(5): 586-92, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21285034

RESUMO

Research suggests that regional structural differences can be associated with the neurodevelopmental impairments faced by children born very low birth weight. However, most studies have used magnetic resonance imaging (MRI) during the neonatal period or during adolescence. The current study used structural MRI to examine relationships between regional volume differences in toddlers (18-22 months adjusted age) born very low birth weight (n = 16) and full-term (n = 10) and neurodevelopmental outcomes, including cognition, language, and early executive functioning. Compared with the full-term group, the very low birth weight group had larger third ventricles and smaller cerebral white matter, thalamus, hippocampus, cerebellum white matter, and anterior cingulate volume. Additionally, a significant interaction was found between language and early executive function scores and cerebral white matter volumes between groups, suggesting that young children born very low birth weight can have different trajectories in the growth and development of overall brain structure.


Assuntos
Encéfalo/crescimento & desenvolvimento , Encéfalo/patologia , Desenvolvimento Infantil , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Imagem por Ressonância Magnética , Nascimento Prematuro/patologia , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Recém-Nascido , Desenvolvimento da Linguagem , Masculino , Tamanho do Órgão
10.
Acta Paediatr ; 98(4): 660-3, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19154525

RESUMO

AIM: Early working memory is emerging as an important indicator of developmental outcome predicting later cognitive, behavioural and academic competencies. The current study compared early working memory in a sample of toddlers (18-22 months) born very low birth weight (VLBW; n = 40) and full term (n = 51) and the relationship between early working memory, mental developmental index (MDI), and maternal communication in both samples. METHODS: Early working memory, measured by object permanence; Bayley mental developmental index; and maternal communication, coded during mother-toddler play interaction, were examined in 39 toddlers born VLBW and 41 toddlers born full term. RESULTS: Toddlers born VLBW were found to be 6.4 times less likely to demonstrate attainment of object permanence than were toddlers born full term, adjusting for age at testing. MDI and maternal communication were found to be positively associated with attainment of object permanence in the VLBW group only. CONCLUSION: The difference found in the early working memory performance of toddlers born VLBW, compared with those born full term, emphasizes the importance of assessing early working memory in at-risk populations, while the maternal communication finding highlights potential targets of intervention for improving working memory in toddlers born VLBW.


Assuntos
Comunicação , Recém-Nascido de muito Baixo Peso/fisiologia , Memória/fisiologia , Relações Mãe-Filho , Estudos de Casos e Controles , Desenvolvimento Infantil/fisiologia , Cognição , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso/psicologia , Testes Neuropsicológicos , Prognóstico
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