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1.
JAMA Pediatr ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32150241
2.
JAMA Pediatr ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32065615

RESUMO

Importance: Universal developmental screening is widely recommended, yet studies of the accuracy of commonly used questionnaires reveal mixed results, and previous comparisons of these questionnaires are hampered by important methodological differences across studies. Objective: To compare the accuracy of 3 developmental screening instruments as standardized tests of developmental status. Design, Setting, and Participants: This cross-sectional diagnostic accuracy study recruited consecutive parents in waiting rooms at 10 pediatric primary care offices in eastern Massachusetts between October 1, 2013, and January 31, 2017. Parents were included if they were sufficiently literate in the English or Spanish language to complete a packet of screening questionnaires and if their child was of eligible age. Parents completed all questionnaires in counterbalanced order. Participants who screened positive on any questionnaire plus 10% of those who screened negative on all questionnaires (chosen at random) were invited to complete developmental testing. Analyses were weighted for sampling and nonresponse and were conducted from October 1, 2013, to January 31, 2017. Exposures: The 3 screening instruments used were the Ages & Stages Questionnaire, Third Edition (ASQ-3); Parents' Evaluation of Developmental Status (PEDS); and Survey of Well-being of Young Children (SWYC): Milestones. Main Outcomes and Measures: Reference tests administered were Bayley Scales of Infant and Toddler Development, Third Edition, for children aged 0 to 42 months, and Differential Ability Scales, Second Edition, for older children. Age-standardized scores were used as indicators of mild (80-89), moderate (70-79), or severe (<70) delays. Results: A total of 1495 families of children aged 9 months to 5.5 years participated. The mean (SD) age of the children at enrollment was 2.6 (1.3) years, and 779 (52.1%) were male. Parent respondents were primarily female (1325 [88.7%]), with a mean (SD) age of 33.4 (6.3) years. Of the 20.5% to 29.0% of children with a positive score on each questionnaire, 35% to 60% also received a positive score on a second questionnaire, demonstrating moderate co-occurrence. Among younger children (<42 months), the specificity of the ASQ-3 (89.4%; 95% CI, 85.9%-92.1%) and SWYC Milestones (89.0%; 95% CI, 86.1%-91.4%) was higher than that of the PEDS (79.6%; 95% CI, 75.7%-83.1%; P < .001 and P = .002, respectively), but differences in sensitivity were not statistically significant. Among older children (43-66 months), specificity of the ASQ-3 (92.1%; 95% CI, 85.1%-95.9%) was higher than that of the SWYC Milestones (70.7%; 95% CI, 60.9%-78.8%) and the PEDS (73.7%; 95% CI, 64.3%-81.3%; P < .001), but sensitivity to mild delays of the SWYC Milestones (54.8%; 95% CI, 38.1%-70.4%) and of the PEDS (61.8%; 95% CI, 43.1%-77.5%) was higher than that of the ASQ-3 (23.5%; 95% CI, 9.0%-48.8%; P = .012 and P = .002, respectively). Sensitivity exceeded 70% only with respect to severe delays, with 73.7% (95% CI, 50.1%-88.6%) for the SWYC Milestones among younger children, 78.9% (95% CI, 55.4%-91.9%) for the PEDS among younger children, and 77.8% (95% CI, 41.8%-94.5%) for the PEDS among older children. Attending to parents' concerns was associated with increased sensitivity of all questionnaires. Conclusions and Relevance: This study found that 3 frequently used screening questionnaires offer adequate specificity but modest sensitivity for detecting developmental delays among children aged 9 months to 5 years. The results suggest that trade-offs in sensitivity and specificity occurred among the questionnaires, with no one questionnaire emerging superior overall.

3.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31727860

RESUMO

BACKGROUND AND OBJECTIVES: Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment. METHODS: We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC). RESULTS: A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided. CONCLUSIONS: Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.


Assuntos
Desenvolvimento Infantil/fisiologia , Pediatria/normas , Papel do Médico , Guias de Prática Clínica como Assunto/normas , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pediatria/tendências , Inquéritos e Questionários/normas , Estados Unidos/epidemiologia
5.
Glob Pediatr Health ; 6: 2333794X19852021, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211185

RESUMO

Background. Integration of autism screening into primary care practice in Saudi Arabia is not well established. Objectives. To evaluate the feasibility and effectiveness of implementing the Arabic Modified Checklist for Autism in Toddlers (M-CHAT) in a primary care practice at John Hopkins Aramco Healthcare Center in Saudi Arabia. Method. The Arabic version of M-CHAT was distributed to caregivers of 1207 toddlers (16-32 months) from January to December 2014. Feasibility was assessed by measuring the proportion of visits with M-CHAT completed, and reports of workflow challenges and provider satisfaction. The effectiveness of screening was evaluated based on the number of referrals for autism evaluation and autism identification rates. Results. Total M-CHAT completion rate was 89% (1078 out of 1207 child-specific visits). Those identified as low risk (n = 951; 88%) were reassured and followed routinely. Those screening positive (n = 127; 12%) were referred for diagnostic assessment. Twelve (1% of toddlers screened) were diagnosed with autism at a mean age of 24 months. In addition, positive M-CHAT detected speech delay and social anxiety. Providers acknowledged their satisfaction with the M-CHAT implementation process; the main challenge was communicating to families the importance of screening. Referrals for diagnostic evaluations increased from 23 to 43 cases in the first year, and 35 in the second year. Conclusion. Implementation of the autism screening using the Arabic M-CHAT is feasible and effective in a primary care setting in Saudi Arabia. Sustaining the implementation of developmental screening in practice requires staff engagement and systematic monitoring of the impact of change.

6.
Clin Pediatr (Phila) ; 58(7): 761-769, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30913896

RESUMO

Pediatric anxiety disorders are highly prevalent, but tend to go undetected as pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of child anxiety disorders. The novel training was completed in a group-based format or via an online, asynchronous training program. Pediatric residents from 2 residency programs (n = 63) participated and completed pre- and posttraining surveys evaluating attitudes about previous training, knowledge about child anxiety, perceived evaluation skills, and responses to clinical vignettes. Most residents (81%) reported they did not receive enough prior training in the presentation of anxiety disorders in young children. Residents' knowledge and perceived evaluation skills increased posttraining. On the vignette-based assessment, residents demonstrated increased sensitivity with regard to interference, diagnosis, and referral urgency. Despite some challenges with participation, results provide preliminary evidence that brief training programs could be an effective way to improve resident education.


Assuntos
Transtornos de Ansiedade/diagnóstico , Educação de Pós-Graduação em Medicina , Pediatria/educação , Competência Clínica , Currículo , Estudos de Viabilidade , Feminino , Humanos , Internato e Residência , Masculino , Inquéritos e Questionários , Gravação em Vídeo
7.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30642952

RESUMO

BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a "snowball" method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States' legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.


Assuntos
Relações Pai-Filho , Pai/psicologia , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
J Dev Behav Pediatr ; 40(1): 60-71, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247388

RESUMO

BACKGROUND: There is growing awareness and exposure in both the medical community and the lay media about the characteristics and complex needs of individuals who believe that their gender identity does not match their birth sex. Despite research and lay publications about teens with gender dysphoria and those who identify as transgender, little guidance is available regarding young (prepubertal) children with questions about their gender identity. Although many terms are used to describe these children, we have chosen to describe them as "gender nonconforming" (GNC). OBJECTIVE: Primary care and developmental-behavioral pediatric providers are often the first professionals with whom young gender nonconforming children and their families discuss their concerns about their emerging gender identity. It is important, therefore, that pediatric providers be knowledgeable about the dilemmas, conflicts, and choices that are typical of these children and their families to guide them appropriately. OVERVIEW: In this special article, we present observations, informed by clinical experience, an emerging body of research, and a developmental-behavioral pediatric framework, of the complex needs of prepubertal gender nonconforming children and their families and an approach to their care. The article begins by outlining the cognitive and biological bases for gender identity development, as well as the natural history of gender nonconforming preferences and behaviors. It then sets the context for understanding the care of GNC children as an area in which developmentally sophisticated providers can play a crucial role in support of the complex developmental patterns and need for advocacy in multiple settings among these children.


Assuntos
Disforia de Gênero , Guias de Prática Clínica como Assunto , Minorias Sexuais e de Gênero , Pessoas Transgênero , Criança , Pré-Escolar , Disforia de Gênero/diagnóstico , Disforia de Gênero/epidemiologia , Disforia de Gênero/terapia , Humanos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos
9.
J Dev Behav Pediatr ; 39(3): 254-258, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29570569

RESUMO

OBJECTIVE: Autism screening is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention at ages 18 and 24 months. Popular screening tests have been validated for the age range of 16 to 30 months. However, only a minority of children with autism spectrum disorder (ASD) are identified by age 3 years, and many are not identified until after they enter school. Thus, we aimed to measure the sensitivity and specificity of 2 available screening tests for ASDs in children older than 30 months. METHODS: We assessed the sensitivity and specificity of 2 ASD screening tools administered to parents of children who were referred to a developmental clinic between the ages of 16 and 48 months: the Modified Checklist for Autism in Toddlers (M-CHAT) and the Parent's Observations of Social Interactions (POSI), which is a component of a comprehensive screening instrument called, the Survey of Well-being of Young Children. RESULTS: Both the M-CHAT and the POSI had acceptable sensitivity (≥75%) among children across the age range studied. Their specificity was limited by the fact that the study was conducted in a developmental referral clinic. CONCLUSION: Two readily available screening tools, the POSI and the M-CHAT, have acceptable sensitivity in evaluating risk for autism in children at least to age 48 months. Further research should investigate their sensitivity and specificity when used in primary care settings.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Testes Neuropsicológicos/normas , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sensibilidade e Especificidade
11.
Clin Pediatr (Phila) ; 56(11): 1023-1031, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28449589

RESUMO

The inadequacy of mental health and developmental services for children is a widely recognized and growing problem. Although a variety of solutions have been proposed, none has been generally successful or feasible. This research describes models of colocation that have evolved in primary care settings in Massachusetts and reports on pediatricians' and their colocated colleagues' impressions of their benefits and challenges. Pediatricians in 18 practices that included a colocated mental health/developmental specialist (MH/DS) were identified through a survey administered through the state American Academy of Pediatrics Chapter, and interviewed. Practices varied widely in the professional expertise/training and roles of the MH/DSs, communication among providers, and financial arrangements. The majority of pediatricians and MH/DSs reported being pleased with their colocated arrangements, despite the costs rarely being supported by billing revenues. This study suggests that further development of such systems hold promise to meet the growing need for accessible pediatric mental and developmental health care.


Assuntos
Desenvolvimento Infantil , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/terapia , Pediatria/métodos , Criança , Pré-Escolar , Comportamento Cooperativo , Humanos , Massachusetts , Atenção Primária à Saúde/métodos
12.
J Dev Behav Pediatr ; 38 Suppl 1: S9-S11, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28141708

RESUMO

CASE: An 8-year 8-month-old biological female who self-identifies as a boy, Ricardo is brought by his mother for a well-child check to his new pediatrician. Ricardo and his mother report that he is doing well, but have concerns about the upcoming changes associated with puberty. Ricardo states that he is particularly afraid of developing breasts. His mother asks about obtaining a referral to a specialist who can provide "hormone therapy" to delay puberty.Ricardo was adopted from Costa Rica at the age of 2 as a healthy girl named "Angela." From the age of 3, he displayed clear preference for male gender-associated clothes, toys, and games. At age 5, his mother sought care for hyperactivity and sleep problems. He was diagnosed with attention-deficit hyperactivity disorder and sleep onset disorder at age 6, and his symptoms have been well controlled with Adderall and melatonin.Ricardo lives with his parents who are accepting and supportive of his gender preference. He sees a therapist who has experience with gender dysphoria. For the past years, he has attended school as male, with the confidential support of administrators at his elementary school.


Assuntos
Disforia de Gênero/terapia , Criança , Feminino , Disforia de Gênero/psicologia , Humanos , Masculino , Pais , Pediatria/normas , Atenção Primária à Saúde/normas
13.
Am J Prev Med ; 51(4 Suppl 2): S106-18, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27498167

RESUMO

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.


Assuntos
Terapia Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Serviços Preventivos de Saúde/economia , Atenção Primária à Saúde/tendências , Humanos , Poder Familiar , Patient Protection and Affordable Care Act , Normas Sociais , Estados Unidos
15.
Clin Pediatr (Phila) ; 55(14): 1305-1317, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26965032

RESUMO

An online survey was distributed via snowball sampling and resulted in responses from 61 gay fathers raising children in 2 states. Fathers reported on the barriers they experienced and the pathways they took to becoming parents. They reported also on experiences of stigma directed at them and their children, especially from family members, friends, and people in religious institutions. Despite these difficulties they reported that they engaged actively in parenting activities and that their child(ren)'s well-being was consistent with national samples.


Assuntos
Relações Pai-Filho , Pai/psicologia , Homossexualidade Masculina/psicologia , Poder Familiar/psicologia , Adolescente , Adulto , California , Criança , Pré-Escolar , Feminino , Felicidade , Humanos , Lactente , Masculino , Saúde Mental , Estigma Social , Tennessee , Adulto Jovem
16.
Clin Pediatr (Phila) ; 55(2): 150-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26016838

RESUMO

A small pilot program of 9 youth 13 to 18 years old with high-functioning autism spectrum disorder (ASD) or Asperger's syndrome assessed the feasibility, acceptability, and potential efficacy of an individualized mentoring program. Youth met weekly for 6 months with trained young adult mentors at a local boys and girls club. Participants reported improvements in self-esteem, social anxiety, and quality of life. Participants, parents, mentors, and staff reported that the program improved participants' social connectedness. Although the pilot study was small, it provides preliminary data that mentoring for youth with ASD has promise for increasing self-esteem, social skills, and quality of life.


Assuntos
Transtorno do Espectro Autista/psicologia , Mentores/psicologia , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Relações Interpessoais , Masculino , Mentores/estatística & dados numéricos , Satisfação Pessoal , Projetos Piloto , Qualidade de Vida/psicologia , Autoimagem , Estudantes/estatística & dados numéricos , Universidades
17.
J Dev Behav Pediatr ; 36(6): 471-83, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26154718

RESUMO

OBJECTIVE: Children whose parents do not speak English experience significant disparities in the identification of developmental delays and disorders; however, little is known about the availability and validity of translations of developmental screeners. The goal was to create a map of the scientific evidence regarding translations of the 9 Academy of Pediatrics-recommended screening instruments into languages other than English. METHODS: The authors conducted a systematic search of Medline and PsycINFO, references of identified articles, publishers' Web sites, and official manuals. Through evidence mapping, a new methodology supported by AHRQ and the Cochrane Collaboration, the authors documented the extent and distribution of published evidence supporting translations of developmental screeners. Data extraction focused on 3 steps of the translation and validation process: (1) translation methods used, (2) collection of normative data in the target language, and (3) evidence for reliability and validity. RESULTS: The authors identified 63 distinct translations among the 9 screeners, of which 44 had supporting evidence published in peer-reviewed sources. Of the 63 translations, 35 had at least some published evidence regarding translation methods used, 28 involving normative data, and 32 regarding reliability and/or construct validity. One-third of the translations found were of the Denver Developmental Screening Test. Specific methods used varied greatly across screeners, as did the level of detail with which results were reported. CONCLUSION: Few developmental screeners have been translated into many languages. Evidence map of the authors demonstrates considerable variation in both the amount and the comprehensiveness of information available about translated instruments. Informal guidelines exist for conducting translation of psychometric instruments but not for documentation of this process. The authors propose that uniform guidelines be established for reporting translation research in peer-reviewed journals, similar to those for clinical trials and studies of diagnostic accuracy.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários/normas , Tradução , Humanos
18.
Am Psychol ; 69(4): 332-43, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24820683

RESUMO

Despite an early interest in pediatrics among psychologists and a natural partnership between psychology and pediatrics, psychologists' impact on services for children in primary care settings could be much greater than it is. The purpose of this article is to describe the special contributions of pediatric psychologists and pediatricians in the development of comprehensive, integrated systems of health care for children; the importance of health behavior change as a preventive measure in the lives of children and adolescents; and how psychologists, through their leadership in clinical, research, and advocacy efforts, can harness the important resources of family relationships to promote the health of children.


Assuntos
Comportamento Cooperativo , Pediatria/normas , Atenção Primária à Saúde/normas , Psicologia da Criança/normas , Humanos
19.
J Dev Behav Pediatr ; 35(4): 301-3, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24748011

RESUMO

CASE: An 8-year 8-month-old biological female who self-identifies as a boy, Ricardo is brought by his mother for a well-child check to his new pediatrician. Ricardo and his mother report that he is doing well, but have concerns about the upcoming changes associated with puberty. Ricardo states that he is particularly afraid of developing breasts. His mother asks about obtaining a referral to a specialist who can provide "hormone therapy" to delay puberty.Ricardo was adopted from Costa Rica at the age of 2 as a healthy girl named "Angela." From the age of 3, he displayed clear preference for male gender-associated clothes, toys, and games. At age 5, his mother sought care for hyperactivity and sleep problems. He was diagnosed with attention-deficit hyperactivity disorder and sleep onset disorder at age 6, and his symptoms have been well controlled with Adderall and melatonin.Ricardo lives with his parents who are accepting and supportive of his gender preference. He sees a therapist who has experience with gender dysphoria. For the past years, he has attended school as male, with the confidential support of administrators at his elementary school.


Assuntos
Pessoas Transgênero/psicologia , Criança , Feminino , Humanos , Masculino , Procedimentos de Readequação Sexual/normas
20.
Appl Psychophysiol Biofeedback ; 39(2): 99-107, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24737038

RESUMO

Neurofeedback (NFB) is an emerging treatment for children with autism spectrum disorder (ASD). This pilot study examined the feasibility of NFB for children with ASD. Ten children ages 7-12 with high functioning ASD and attention difficulties received a NFB attention training intervention. A standardized checklist captured feasibility, including focus during exercises and academic tasks, as well as off-task behaviors. Active behaviors and vocalizations were the most frequent off-task behaviors. Positive reinforcement and breaks including calm breathing exercises were the most common supports. Low motivation was associated with higher feasibility challenges, yet parental involvement and accommodations were helpful. This pilot study shows that it is feasible to conduct NFB sessions with children with high functioning autism and attention difficulties.


Assuntos
Transtorno Autístico/terapia , Neurorretroalimentação , Atenção , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários , Resultado do Tratamento
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