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1.
J Pediatr Endocrinol Metab ; 35(1): 29-38, 2022 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706403

RESUMO

OBJECTIVES: To examine sleep and behavior problems in children with type 1 Diabetes Mellitus (T1DM) compared to nondiabetic controls in a bridging country between east and west and to evaluate the interaction of sleep on behavior problems, maternal sleep, and maternal depressive symptoms. METHODS: The study included children with T1DM (4-12 years old) and age/sex-matched healthy controls. Parents completed the Children Sleep Habits Questionnaire (CSHQ), Children Behavior Checklist/4-18 (CBCL/4-18), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and a study-specific sociodemographic questionnaire. Clinical parameters regarding T1DM were collated from medical records. RESULTS: Participants included 75 children with T1DM and 49 controls. Based on CSHQ results 65.3% of all participants in both groups had sleep problems. Children with T1DM slept less and had higher daytime sleepiness problems than controls (p=0.024, p=0.008, respectively). No association was found between CSHQ or sleep duration and mode of diabetes treatment (pump, multiple daily injections) or glycemic control. CSHQ correlated with maternal PSQI (r=0.336 p=0.004) and BDI (r=0.341 p=0.004) in children with T1DM, but there was no association amongst controls. Children with T1DM had higher internalizing problems compared to controls. CSHQ and BDI correlated with internalizing, externalizing, and the total scores of the CBCL/4-18 in children with T1DM (R2=0.260 p<0.001; R2=0.207 p<0.001, R2=0.381 p<0.001 respectively). In controls, only BDI was associated with internalizing, externalizing, and the total scores of the CBCL/4-18. CONCLUSIONS: Children with T1DM should be evaluated for sleep pattern and quality at follow-up, to identify those at risk for behavior problems and improve maternal life quality. Large longitudinal studies are necessary to assess the effect of new diabetes treatment modalities on sleep.


Assuntos
Transtornos do Comportamento Infantil/etiologia , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/psicologia , Comportamento Problema , Transtornos do Sono-Vigília/etiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Saúde Mental
2.
J Pediatr ; 241: 188-195.e3, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34571019

RESUMO

OBJECTIVE: To assess the relation between leisure screen time and emotional and behavioral problems in Spanish children aged 4-14 years. STUDY DESIGN: This cross-sectional study used a representative sample of children aged 4-14 years included in the 2017 Spanish National Health Survey (n = 4073). Emotional and behavioral problems of children were assessed through the parent-report Strengths and Difficulties Questionnaire. Daily leisure screen time in minutes was categorized as 0-59, 60-119, 120-179, and ≥180. We calculated adjusted prevalence ratios (aPR) and their 95% CIs of being at risk of developing emotional and behavioral problems. Associations were adjusted for potential confounding variables. RESULTS: Children spending 180 minutes or more of daily leisure screen time compared with children spending less than 1 hour were more likely to be at risk of developing emotional and behavioral problems: aPR≥180: 2.19 (95% CI 1.53-3.14), emotional symptomology: aPR≥180: 2.09 (95% CI 1.37-3.18), conduct problems aPR≥180: 1.85 (95% CI 1.34-2.54), peer problems aPR≥180: 1.78 (95% CI 1.15-2.75), and to behave less prosocially: aPR≥180: 2.20 (95% CI 1.43-3.37). CONCLUSIONS: We have found significant associations between daily leisure screen time and emotional and behavioral problems in Spanish children between 6 and 14 years of age. However, these findings should be confirmed in cohort studies, so institutions might consider including screen time as a new risk factor for children.


Assuntos
Sintomas Afetivos/etiologia , Transtornos do Comportamento Infantil/etiologia , Atividades de Lazer/psicologia , Comportamento Problema/psicologia , Tempo de Tela , Adolescente , Sintomas Afetivos/epidemiologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Risco , Espanha
3.
Eur Child Adolesc Psychiatry ; 31(3): 519-527, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33624130

RESUMO

There is growing evidence that insufficient sleep has negative effects on the mental health of children. The aim of this study is to examine the associations between device-measured sleep duration and internalizing and externalizing problems in 8-year-old children. The study is a secondary analysis of data from the Childhood Obesity Project conducted in five European countries. Nocturnal sleep duration was measured with the SenseWear™ Armband 2. Parents rated their child's internalizing and externalizing problems on the Child Behaviour Checklist. Behaviour scores were dichotomized at the 90th percentile based on sex- and country-specific z-scores. Logistic regression models were applied to test the associations between sleep duration and behaviour. Data were available for 406 8-year-old children. The average sleep duration was 9.25 h per night (SD: 0.67) with 1464 nights measured in total. The sleep duration recommendation of the American Academy of Sleep Medicine for school-aged children (9-12 h) was met by 66.7% of children. One hour of additional sleep per night significantly reduced the risk of having internalizing problems (adjusted OR = 0.51; 95% CI 0.29-0.91). Children who adhered to the sleep duration recommendation had a lower risk for internalizing problems (adjusted OR = 0.45; 95% CI 0.21-0.99). Sleep duration and externalizing problems showed no significant association. Longer sleep duration was associated with a reduced risk of having internalizing problems but not externalizing problems. Results highlight that it is important to ensure adequate sleep duration throughout primary-school years for the optimal emotional health of children. Trial registration number: NCT00338689. Registered: June 19, 2006.


Assuntos
Transtornos do Comportamento Infantil , Obesidade Pediátrica , Comportamento Problema , Transtornos do Sono-Vigília , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Feminino , Humanos , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Comportamento Problema/psicologia , Sono , Transtornos do Sono-Vigília/psicologia
4.
Prenat Diagn ; 42(2): 278-286, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34907545

RESUMO

OBJECTIVE: To analyse prenatal work-up, associated anomalies and postnatal outcomes of foetuses with cerebral lateral ventricular width 9-9.9 mm. METHOD: This retrospective, observational, case-control study included 121 foetuses with initial presentation of isolated cerebral lateral ventricular width 9-9.9 mm detected during routine ultrasound scans, 21-24 weeks' gestation, in a tertiary referral centre, January 2001-December 2018. Controls included 123 foetuses with lateral ventricular width <9 mm measured under the same parameters. Clinical characteristics, obstetrical history, ultrasound findings, prenatal work-up and pregnancy outcomes were collected from medical records. Information about postnatal functional and neurodevelopmental sequelae were obtained from telephone-based questionnaires. RESULTS: The study group had more males (82/116 (70.6%) versus 65/123 (52.8%), p = 0.004), more prenatal testing, including brain magnetic resonance imaging (28/116 (24.1%) versus 0/123 (0%), p < 0.001), echocardiography (46/116 (39.7%) versus 15/123 (12.2%), p < 0.001) and targeted anomaly scans (102/116 (87.9%) versus 1/123 (0.008%), p < 0.001). Long-term follow-up did not reveal more neurodevelopmental sequelae compared to controls. Gender-based analysis found more males with ventricular dilatation 9-9.9 mm treated for developmental delay compared to females with similar findings (15/82 (18.2%) versus 1/34 (2.9%), p = 0.010). CONCLUSION: Foetuses with 9-9.9 mm cerebral lateral ventricular width versus <9 mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Ventrículos Cerebrais/anormalidades , Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adolescente , Estudos de Casos e Controles , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidrocefalia/complicações , Hidrocefalia/congênito , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Gravidez , Prognóstico , Estudos Retrospectivos
5.
Int J Mol Sci ; 22(23)2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34884752

RESUMO

Human and animal studies have elucidated the apparent neurodevelopmental effects resulting from neonatal anesthesia. Observations of learning and behavioral deficits in children, who were exposed to anesthesia early in development, have instigated a flurry of studies that have predominantly utilized animal models to further interrogate the mechanisms of neonatal anesthesia-induced neurotoxicity. Specifically, while neonatal anesthesia has demonstrated its propensity to affect multiple cell types in the brain, it has shown to have a particularly detrimental effect on the gamma aminobutyric acid (GABA)ergic system, which contributes to the observed learning and behavioral deficits. The damage to GABAergic neurons, resulting from neonatal anesthesia, seems to involve structure-specific changes in excitatory-inhibitory balance and neurovascular coupling, which manifest following a significant interval after neonatal anesthesia exposure. Thus, to better understand how neonatal anesthesia affects the GABAergic system, we first review the early development of the GABAergic system in various structures that have been the focus of neonatal anesthesia research. This is followed by an explanation that, due to the prolonged developmental curve of the GABAergic system, the entirety of the negative effects of neonatal anesthesia on learning and behavior in children are not immediately evident, but instead take a substantial amount of time (years) to fully develop. In order to address these concerns going forward, we subsequently offer a variety of in vivo methods which can be used to record these delayed effects.


Assuntos
Anestesia Geral/efeitos adversos , Neurônios GABAérgicos/fisiologia , Ácido gama-Aminobutírico/fisiologia , Anestesia Geral/métodos , Animais , Animais Recém-Nascidos , Apoptose , Encéfalo/citologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Fenômenos Eletrofisiológicos , Humanos , Lactente , Recém-Nascido , Interneurônios/fisiologia , Deficiências da Aprendizagem/etiologia , Modelos Neurológicos , Neuroimagem , Síndromes Neurotóxicas/etiologia
6.
Sci Rep ; 11(1): 22182, 2021 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772976

RESUMO

High levels of persistent organic pollutants (POPs) and heavy metals are found in Arctic populations. POP and heavy metals are linked to impaired cognitive development. This study examined associations between prenatal POP and metals exposure and problematic child behavior using the Strength and Difficulties Questionnaire (SDQ). POPs and metals were measured in 102 pregnant Greenlandic women. During follow-up at 3-5 years, parents answered an assisted questionnaire including children's SDQ scores. Associations were analyzed using linear and logistic regression analyses and adjusted for maternal plasma cotinine, educational level and age at delivery. In the adjusted analyses, the medium tertile of hexachlorobenzene (ß = 3.06, p = 0.010), ß-hexachlorocyclohexane (ß = 3.58, p = 0.004) and trans-nonachlor (ß = 2.06, p = 0.082) were positively associated with SDQ scores. The continuous cis-nonachlor (OR = 1.09, p = 0.079), dichloro-diphenyl-dichloroethylene (OR = 1.01, p = 0.077), trans-nonachlor (OR = 1.01, p = 0.091), and sum Organochlorine-Pesticides (OR = 1.00, p = 0.094) were positively associated with abnormal SDQ score and the continuous mirex (OR = 1.28, p = 0.096), oxychlordane (OR = 1.04, p = 0.066), and trans-nonachlor (OR = 1.02, p = 0.071) with abnormal hyperactivity score. We found no consistent evidence of associations between polychlorinated biphenyls, perfluoroalkylated substances and heavy metals and problematic behavior. Prenatal organochlorine pesticide exposure associated significantly with problematic behavior in 3-5 year old children.


Assuntos
Comportamento Infantil , Exposição Ambiental/efeitos adversos , Exposição Materna/efeitos adversos , Metais Pesados/efeitos adversos , Poluentes Orgânicos Persistentes/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Biomarcadores/sangue , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Estudos de Coortes , Feminino , Groenlândia/epidemiologia , Humanos , Masculino , Razão de Chances , Gravidez , Vigilância em Saúde Pública , Inquéritos e Questionários
7.
Ital J Pediatr ; 47(1): 223, 2021 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-34742324

RESUMO

Television studies have shown that some negative effects of screens could depend on exposure time, but more importantly on the characteristics of the child, the type of content viewed, and the context in which it is viewed. Studies on newer screens show that these factors are still valid but new ones now play a negative role: portable screens increase the duration of exposure and lowered the age at which exposure begins. More worryingly, new screen persuasive designs and dark patterns largely used incite more frequent use, attracting the attention of children and parents, resultantly interfering deeply in parent/child relationships. In this text we suggest that current academic recommendations have to be more broadly shared but also that new recommendations are needed: especially to advise parents not to let their screen interactions compete with real interactions with their child which are the core of learnings (especially language) and emotional regulations but also of their security.


Assuntos
Desenvolvimento Infantil , Cognição , Televisão , Criança , Transtornos do Comportamento Infantil/etiologia , Computadores de Mão , Relações Familiares , Humanos , Transtornos do Desenvolvimento da Linguagem/etiologia , Transtornos do Sono-Vigília/etiologia
8.
Nutrients ; 13(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34579057

RESUMO

Maternal periconceptional diets have known associations with proper offspring neurodevelopment. Mechanisms for such associations include improper energy/nutrient balances between mother and fetus, as well as altered offspring epigenetics during development due to maternal nutrient and inflammatory status. Using a comprehensive food frequency questionnaire and assessing offspring temperament with the Infant-Toddler Social and Emotional Assessment (n = 325, mean age = 13.9 months), we sought to test whether a maternal periconceptional diet characterized by high glycemic loading (MGL) would affect offspring temperament using adjusted ordinal regression. After limiting false discovery to 10%, offspring born to mothers in tertile 3 of glycemic loading (referent = tertile 1) were more likely to be in the next tertile of anxiety [OR (95% CI) = 4.51 (1.88-11.07)] and inhibition-related behaviors [OR (95% CI) = 3.42 (1.49-7.96)]. Male offspring were more likely to exhibit impulsive [OR (95% CI) = 5.55 (1.76-18.33)], anxiety [OR (95% CI) = 4.41 (1.33-15.30)], sleep dysregulation [OR (95% CI) = 4.14 (1.34-13.16)], empathy [6.68 (1.95-24.40)], and maladaptive behaviors [OR (95% CI) = 9.86 (2.81-37.18)], while females were more likely to exhibit increased anxiety-related behaviors [OR (95% CI) = 15.02 (3.14-84.27)]. These associations persisted when concurrently modeled with the maternal-Mediterranean dietary pattern. In a subset (n = 142), we also found MGL associated with increased mean methylation of the imprint control region of SGCE/PEG10. In conclusion, these findings highlight the importance of maternal dietary patterns on offspring neurodevelopment, offering avenues for prevention options for mothers.


Assuntos
Dieta/efeitos adversos , Carboidratos da Dieta/efeitos adversos , Carga Glicêmica , Comportamento do Lactente , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Transtornos do Comportamento Infantil/etiologia , Metilação de DNA , Ansiedade ao Tratamento Odontológico/etiologia , Feminino , Carga Glicêmica/fisiologia , Humanos , Comportamento Impulsivo , Lactente , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Fatores Sexuais , Temperamento
9.
J Pediatr ; 239: 175-181.e2, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34461062

RESUMO

OBJECTIVE: To evaluate the odds of a behavioral health diagnosis among youth with differences of sex development (DSD) or congenital adrenal hyperplasia (CAH) compared with matched controls in the PEDSnet database. STUDY DESIGN: All youth with a diagnosis of DSD (n = 1216) or CAH (n = 1647) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables (1:4) with controls (n = 4864 and 6588, respectively) using multivariable logistic regression. The likelihood of having behavioral health diagnoses was examined using generalized estimating equations. RESULTS: Youth with DSD had higher odds of a behavioral health diagnosis (OR, 1.7; 95% CI, 1.4-2.1; P < .0001) and neurodevelopmental diagnosis (OR, 1.7; 95% CI, 1.4, 2.0; P < .0001) compared with matched controls. Youth with CAH did not have an increased odds of a behavioral health diagnosis (OR, 1.0; 95% CI, 0.9, 1.1; P = .9) compared with matched controls but did have higher odds of developmental delay (OR, 1.8; 95% CI, 1.4, 2.4; P < .0001). CONCLUSIONS: Youth with DSD diagnosis have higher odds of a behavioral health or neurodevelopmental diagnosis compared with matched controls. Youth with CAH have higher odds of developmental delay, highlighting the need for screening in both groups.


Assuntos
Hiperplasia Suprarrenal Congênita/psicologia , Transtornos do Desenvolvimento Sexual/psicologia , Transtornos Mentais/etiologia , Adolescente , Hiperplasia Suprarrenal Congênita/complicações , Estudos de Casos e Controles , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Bases de Dados Factuais , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Transtornos do Desenvolvimento Sexual/complicações , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Razão de Chances , Pontuação de Propensão , Fatores de Risco
10.
Riv Psichiatr ; 56(4): 205-210, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34310578

RESUMO

BACKGROUND: The SARS-CoV-2 pandemic forced parents and children to modify their habits with a radical change in the family routine and consequent increase in psychological stress. Children with a neurodevelopmental disorder (NDDs) are particularly vulnerable to new and unexpected situations; moreover, the parents of these children generally show high levels of psychological stress due to the greater commitment that this condition imposes on them. The aim of this study is to evaluate the disease status of NDDs children before and during SARS-CoV-2 pandemic and to evaluate the psychological effects related to measures of social distancing on these children and their families. MATERIALS AND METHODS: Seventy-one children with NDDs, were enrolled in this study and followed up at the Child Neuropsychiatry Unit of the University Hospital Consortium Corporation Polyclinic of Bari (Italy) along with their parents. Parents were evaluated before national lockdown (baseline) and recontacted during the SARS-CoV-2 emergency almost after a year. The changes in emotional/behavioral problems of children and parenting stress before and during the SARS-CoV-2 pandemic were assessed with Child Behaviour CheckList (CBCL) and Parent Stress Index - short form (PSI). RESULTS: The analysis of the emotional and behavioral problems of children with NDDs did not show statistically significant differences between the before and during the SARS-CoV-2 pandemic period. The evaluations conducted on parents highlights an increase in parental stress during the pandemic. Significant differences (p<0.05) were found in three subscales: Parenting Distress (PD) scale, Dysfunctional Interaction Parent-Child (P-CDI) scale and Defensive responding scale (DF). CONCLUSIONS: This study highlights the increase in parental stress and a more difficult parent-child interaction with NDDs in the period of lockdown due to the pandemic; identification of these risk targets can be useful for interventions in similar situations. Therefore, it is necessary to provide caregivers information to manage and overcome challenges experienced during a pandemic and providing psychological support for caregivers of children with NDDs.


Assuntos
COVID-19/psicologia , Transtornos do Neurodesenvolvimento/psicologia , Pandemias , Pais/psicologia , SARS-CoV-2 , Adolescente , Cuidadores/psicologia , Criança , Comportamento Infantil , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/psicologia , Emoções , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Itália/epidemiologia , Masculino , Relações Pais-Filho , Sistemas de Apoio Psicossocial , Quarentena , Índice de Gravidade de Doença , Isolamento Social , Estresse Psicológico/etiologia
11.
J Korean Med Sci ; 36(25): e184, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34184439

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. METHODS: Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. RESULTS: During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency. CONCLUSION: During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.


Assuntos
COVID-19/epidemiologia , Meios de Comunicação de Massa , Pandemias , Pais/psicologia , Psicologia da Criança , SARS-CoV-2 , Instituições Acadêmicas , Isolamento Social , Adulto , Índice de Massa Corporal , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Cuidado da Criança , Depressão/epidemiologia , Depressão/etiologia , Educação à Distância , Exercício Físico , Feminino , Humanos , Renda , Atividades de Lazer , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Relações Pais-Filho , Utilização de Procedimentos e Técnicas , Quarentena , República da Coreia/epidemiologia , Comportamento Sedentário , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Apoio Social , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários
12.
Clin Neurol Neurosurg ; 207: 106748, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34182237

RESUMO

PURPOSE: Some children with microcephaly experienced severe social emotional deficits during their 1-2 years of age. Cranial expansion is generally not used in these cases. Our aim is to assess whether such operation is effective to improve their social emotional status, and thereby boosting their functional development in selected cases with such condition. METHODS: A retrospective cohort review in microcephalic cases who had undergone cranial expansion in Shanghai Children's Hospital since Jun. 2016 to Jun. 2017 with at least 12 months follow-up was conducted. Inclusion and exclusion criteria were set for the selection of the target patients in the current study. Our study focused on the changes of social emotional status (evaluated by The Infant-Toddler Social and Emotional Assessment, ITSEA) and functional development (applying neurodevelopmental questionnaire) pre- and 12 months post-op in these cases. RESULTS: A total of 14 cases were included in the current study. On the basis of a 2-cm enlargement during surgery(1 cm advancement of fronto-orbital rim on each side), HC continued to increase at an average of 0.5 cm in one year after the procedure in these cases, making its corresponding standard deviation improve from -4.5 to -3.4. Among those 14 cases, 11 (78.6%) showed improvement in all of these four domains in ITSEA at 12 months post-op. Scores were significantly better at 12 months post-op with p < 0.01 compared with those in domains of internalizing behavior and dysregulation behavior pre-operatively. Improvement was observed with p < 0.05 in domains of externalizing behavior and social-emotional competence as well. With regard to functional development, 8 cases (57.1%) were revealed improvement in all of these three sections of motor, speech and cognitive function in the questionnaire, 5 (35.7%) concluded partially upgraded in 1 or 2 sections. Only one (7.1%) showed no change during the follow-up. No surgery-related complications were recorded in the current study. CONCLUSION: When progressive copper-beaten sign is revealed in their serial skull X-rays, microcephalic cases with social emotional deficits in their 1-2 years of age could benefit from cranial expansion surgery with regard to improving their social emotional status and functional development.


Assuntos
Microcefalia/cirurgia , Crânio/cirurgia , Expansão de Tecido/métodos , Transtornos do Comportamento Infantil/etiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Microcefalia/complicações , Estudos Retrospectivos
13.
Epilepsia ; 62(6): 1401-1415, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33951195

RESUMO

OBJECTIVE: This study was undertaken to expand the phenotypic and genetic spectrum of CLCN4-related epilepsy and to investigate genotype-phenotype correlations. METHODS: We systematically reviewed the phenotypic and genetic spectrum of newly diagnosed and previously reported patients with CLCN4-related epilepsy. Three novel variants identified in four patients reported in this study were evaluated through in silico prediction and functional analysis by Western blot, immunofluorescence, and electrophysiological measurements. RESULTS: Epilepsy was diagnosed in 54.55% (24/44) of individuals with CLCN4-related disorders and was drug-resistant in most cases. Of 24 patients, 15 had epileptic encephalopathy and four died at an early age; 69.57% of patients had seizure onset within the first year of life. Myoclonic seizures are the most common seizure type, and 56.25% of patients presented multiple seizure types. Notably, seizure outcome was favorable in individuals with only one seizure type. All patients showed intellectual disability, which was severe in 65.22% of patients. Additional common features included language delay, behavioral disorders, and dysmorphic features. Five patients benefitted from treatment with lamotrigine. Most variants, which were mainly missense (79.17%), were inherited (70.83%). Whereas frameshift, intragenic deletion, or inherited variants were associated with milder phenotypes, missense or de novo variants led to more severe phenotypes. All evaluated CLCN4 variants resulted in loss of function with reduced ClC-4 currents. Nonetheless, genotype-phenotype relationships for CLCN4-related epilepsy are not straightforward, as phenotypic variability was observed in recurrent variants and within single families. SIGNIFICANCE: Pathogenic CLCN4 variants contribute significantly to the genetic etiology of epilepsy. The phenotypic spectrum of CLCN4-related epilepsy includes drug-resistant seizures, cognitive and language impairment, behavioral disorders, and congenital anomalies. Notably, the mutation type and the number of seizure types correlate with the severity of the phenotype, suggesting its use for clinical prognosis. Lamotrigine can be considered a therapeutic option.


Assuntos
Canais de Cloreto/genética , Epilepsia/genética , Epilepsia/psicologia , Adolescente , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Criança , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/genética , Eletroencefalografia , Epilepsias Mioclônicas/epidemiologia , Epilepsias Mioclônicas/genética , Epilepsia/epidemiologia , Feminino , Mutação da Fase de Leitura , Deleção de Genes , Variação Genética , Genótipo , Humanos , Lamotrigina/uso terapêutico , Transtornos da Linguagem/etiologia , Imageamento por Ressonância Magnética , Masculino , Mutação de Sentido Incorreto , Fenótipo , Convulsões/fisiopatologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-33850037

RESUMO

OBJECTIVE: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a severe immune-mediated disorder. We aim to report the neurologic features of children with PIMS-TS. METHODS: We identified children presenting to a large children's hospital with PIMS-TS from March to June 2020 and performed a retrospective medical note review, identifying clinical and investigative features alongside short-term outcome of children presenting with neurologic symptoms. RESULTS: Seventy-five patients with PIMS-TS were identified, 9 (12%) had neurologic involvement: altered conciseness (3), behavioral changes (3), focal neurology deficits (2), persistent headaches (2), hallucinations (2), excessive sleepiness (1), and new-onset focal seizures (1). Four patients had cranial images abnormalities. At 3-month follow-up, 1 child had died, 1 had hemiparesis, 3 had behavioral changes, and 4 completely recovered. Systemic inflammatory and prothrombotic markers were higher in patients with neurologic involvement (mean highest CRP 267 vs 202 mg/L, p = 0.05; procalcitonin 30.65 vs 13.11 µg/L, p = 0.04; fibrinogen 7.04 vs 6.17 g/L, p = 0.07; d-dimers 19.68 vs 7.35 mg/L, p = 0.005). Among patients with neurologic involvement, these markers were higher in those without full recovery at 3 months (ferritin 2284 vs 283 µg/L, p = 0.05; d-dimers 30.34 vs 6.37 mg/L, p = 0.04). Patients with and without neurologic involvement shared similar risk factors for PIMS-TS (Black, Asian and Minority Ethnic ethnicity 78% vs 70%, obese/overweight 56% vs 42%). CONCLUSIONS: Broad neurologic features were found in 12% patients with PIMS-TS. By 3-month follow-up, half of these surviving children had recovered fully without neurologic impairment. Significantly higher systemic inflammatory markers were identified in children with neurologic involvement and in those who had not recovered fully.


Assuntos
COVID-19/complicações , Inflamação/complicações , Doenças do Sistema Nervoso/etiologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Adolescente , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , COVID-19/patologia , COVID-19/psicologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Inflamação/patologia , Imageamento por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/psicologia , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/patologia , Síndrome de Resposta Inflamatória Sistêmica/psicologia , Trombose/sangue , Trombose/etiologia
15.
Int J Psychol ; 56(5): 739-744, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33754361

RESUMO

The present study aimed at exploring the relationship between parenting stress and children's problematic behaviour in the families of 99 children aged 8-11 years. Parenting stress was assessed by parents, using the Parenting Stress Index, and children's problematic behaviour was assessed by teachers, using the Strengths and Difficulties Questionnaire. A moderation regression analysis showed a conditioning effect of paternal parenting stress in the relationship between maternal parenting stress and children's problematic behaviour. In the presence of high levels of paternal parenting stress, the relationship between maternal parenting stress and children's problematic behaviour was significant and strong (p = .01). When paternal parenting stress levels were low, the relationship between maternal parenting stress and children's problematic behaviour was not significant (p = .49). The results underlined that paternal parenting stress may buffer the relationship between maternal parenting stress and children's problematic behaviour. Clinical implications are discussed.


Assuntos
Comportamento Infantil , Pai/psicologia , Mães/psicologia , Poder Familiar/psicologia , Comportamento Problema , Estresse Psicológico , Adulto , Criança , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Pediatr ; 235: 170-177, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33548261

RESUMO

OBJECTIVES: To examine whether adverse childhood experiences (ACEs) and physical punishment (ie, spanking) are unique risk factors for behavior problems in early childhood, and whether ACEs moderate the associations of spanking with child behavior problems. STUDY DESIGN: We conducted prospective, longitudinal analyses on 2380 families in the Fragile Families and Child Wellbeing Study. Mothers reported outcomes of externalizing and internalizing behavior problems at age 5 years; and the main predictors, ACEs and spanking, at age 3 years. ACEs included 9 items: physical abuse, emotional abuse, physical neglect, emotional neglect, mother's exposure to intimate partner violence, parental mental health problem, parental substance use, parental incarceration, and parental death. Multilevel models examined the associations between ACEs, spanking, and behavior problems, and the moderating effect of ACEs in the associations of spanking with behavior problems. Analyses were adjusted for preexisting behavior problems, demographics, and neighborhood conditions. RESULTS: ACEs (ß = 0.028; P < .001) and spanking (ß = 0.041; P < .001) at 3 years were unique risk factors for increased externalizing behavior problems at 5 years, after controlling for covariates. The magnitude of the associations of ACEs and spanking with externalizing behavior were statistically indistinguishable. ACEs did not moderate the association between spanking and externalizing behavior. CONCLUSIONS: ACEs and spanking have similar associations in predicting child externalizing behavior. Results support calls to consider physical punishment as a form of ACE. Our findings also underscore the importance of assessing exposure to ACEs and physical punishment among young children and providing appropriate intervention to children at risk.


Assuntos
Experiências Adversas da Infância , Transtornos do Comportamento Infantil , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Humanos , Pais , Pediatras , Estudos Prospectivos
17.
Epilepsy Behav ; 117: 107851, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33640564

RESUMO

Though it is wellknown that psychiatric concerns are common in children with epilepsy, factors predicting such problems are not well understood. The present investigation studied rates of parent-reported psychological concerns in clinically referred children with epilepsy. Further, it investigated differences in psychological distress across epilepsy subtypes (i.e., focal, generalized, mixed), relationships with epilepsy severity variables, gender, and lateralization of seizure foci. The parents of 170 children and adolescents (ages 6-18 years, 78 girls, 92 boys) completed the Child Behavior Checklist (CBCL). Scale elevation frequencies (T-scores ≥ 65) were calculated and Chi square analyses examined rates of elevations between epilepsy groups. Internalizing problems (32.4%) were more common than externalizing problems (17.1%) for the sample, with attention problems being the most common concern across all epilepsy types (48.8%). While there were no significant relationships between epilepsy severity variables and CBCL broadband scales, the Total Problems scale was inversely related to intellectual functioning (r = -0.174, p = 0.023). Rates of anxiety and depression did not differ across epilepsy subtypes and no gender differences were found. Those with left-sided epilepsy had higher rates of externalizing problems (33.2%) than those with right (14.0%; χ2[1, 88] = 4.55, p = 0.03), with rule-breaking behaviors (15.4%) being more common in left-hemisphere epilepsy (15.4% versus 2.3%; χ2[1,88] = 4.66, p = 0.03). In summary, while no significant differences were found across epilepsy groups, the current study adds to the literature regarding lateralization effects and mood/behavior, with more externalizing problems in those with left hemisphere epilepsy.


Assuntos
Transtornos do Comportamento Infantil , Epilepsia , Adolescente , Criança , Transtornos do Comportamento Infantil/etiologia , Emoções , Epilepsia/complicações , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Pais , Convulsões
18.
Neurotoxicol Teratol ; 83: 106947, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33412243

RESUMO

BACKGROUND: Prenatal exposure to environmental chemicals has been associated with Autism Spectrum Disorder (ASD) symptoms in some, but not all, studies, but most research has not accounted for other childhood behavior problems. OBJECTIVES: To evaluate the specific associations of prenatal phthalate exposures with ASD symptoms in children (ages 3-6) accounting for other behavior problems, and to assess sex differences in these associations. METHODS: We measured phthalate metabolites in prenatal urine samples. Mothers completed the Social Responsiveness Scale-2nd edition (SRS-2) to assess child ASD symptoms and the Child Behavior Checklist (CBCL) to assess general behavior problems. We assessed associations of the sum of di-(2-ethylhexyl) phthalate metabolites, monobutyl phthalate, mono-isobutyl phthalate, and monoethyl phthalate (mEP) with ASD symptoms, adjusting for other behavior problems, using linear regression models (n=77). RESULTS: Most associations were null, and the sample size limited power to detect associations, particularly in the stratified analyses. After adjusting for internalizing and externalizing problems from the CBCL, ASD symptoms increased for each doubling of prenatal mEP concentration among boys only. CONCLUSIONS: Further investigation of maternal prenatal urinary phthalate metabolite concentrations and ASD symptoms while adjusting for other behavioral problems is warranted.


Assuntos
Transtorno do Espectro Autista/etiologia , Disruptores Endócrinos/toxicidade , Ácidos Ftálicos/toxicidade , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto , Criança , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Estudos de Coortes , Disruptores Endócrinos/administração & dosagem , Disruptores Endócrinos/urina , Feminino , Humanos , Modelos Lineares , Masculino , Michigan , Ácidos Ftálicos/administração & dosagem , Ácidos Ftálicos/urina , Gravidez , Efeitos Tardios da Exposição Pré-Natal/urina , Fatores de Risco , Adulto Jovem
19.
Dev Neurorehabil ; 24(6): 361-367, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33478304

RESUMO

Understanding the long-term medical and developmental outcomes for children who survive abusive head trauma (AHT) is important to ensure necessary supports and services are available. This study examined the retrospective global and specific medical and developmental outcomes of 55 children with AHT who were treated at The Children's Hospital at Westmead. Global outcomes were assessed using the Kings Outcome Scale of Childhood Head Injury (KOSCHI). Five years post-injury, one child had died and two had made a complete recovery. Forty-five children (81.8%) had a moderate or severe disability, an increase from 64.5% at acute discharge. At follow-up, the main impairments were behavioral problems (53%), vision impairment (44%), fine motor difficulties (26%), gross motor problems (26%), communication problems (24%) and 16% had seizures. A Spearman's Rank correlation revealed that only 41% of variance in KOSCHI scores five years post-injury could be accounted for KOSCHI scores at the time of acute discharge (rs(55) = 0.638, p < .001), and many children's presentation was worse at follow-up. Therefore, all children presenting with AHT need long term follow up regardless of early indications of good recovery.


Assuntos
Maus-Tratos Infantis , Transtornos do Comportamento Infantil/etiologia , Traumatismos Craniocerebrais/complicações , Convulsões/etiologia , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos
20.
Pediatr Res ; 89(3): 540-548, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32454516

RESUMO

BACKGROUND: Providing optimal pain relief is a challenging task when caring for premature infants. The aim of this study was to compare the long-term cognitive, motor, and behavioral outcomes of preterm infants before and after the implementation of a pain and sedation protocol. In addition, we investigated whether the increased opiate administration resulting after the implementation process had an impact on these outcomes. METHODS: Cognitive outcomes were evaluated using the Kaufman Assessment Battery for Children (KABC), neuromotor examinations were based on Amiel-Tison, and behavioral outcomes were assessed using the parent-reported Child Behavior Checklist (CBCL). RESULTS: One hundred extremely preterm infants were included in the study (control group, n = 53; intervention group, n = 47). No significant differences were found in cognitive and motor outcomes at preschool age. However, every increase in the cumulative opiate exposure for each 100 mg/kg was weakly significantly associated with a higher risk for autism spectrum features (adjusted odds ratio (aOR) = 1.822, 95% confidence interval (CI) [1.231-2.697]; P = 0.03) and withdrawn behavior (aOR = 1.822, 95% CI [1.231-2.697]; P = 0.03) at preschool age. CONCLUSION: Increased neonatal cumulative opiate exposure did not alter cognitive and motor outcomes but may represent a risk factor for autism spectrum and withdrawn behavior at preschool age. IMPACT: The implementation of a protocol for the management of pain and sedation in preterm infants resulted in increased cumulative opiate exposure. Our study adds further evidence that increased neonatal opiate exposure did  not alter cognitive and motor outcomes but may yield a potential risk factor for autism spectrum disorders and withdrawn behavior at preschool age. A vigilant use of opiates is recommended. Further studies are needed looking for novel pain management strategies and drugs providing optimal pain relief with minimal neurotoxicity.


Assuntos
Analgésicos Opioides/efeitos adversos , Lactente Extremamente Prematuro/psicologia , Manejo da Dor , Dor/psicologia , Analgésicos Opioides/uso terapêutico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Criança , Comportamento Infantil , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Desenvolvimento Infantil , Pré-Escolar , Protocolos Clínicos , Cognição , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Hipnóticos e Sedativos/uso terapêutico , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Destreza Motora , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/etiologia , Testes Neuropsicológicos , Manejo da Dor/efeitos adversos , Psicologia da Criança
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