Discrimination and mental health of Somali immigrants in North America: a longitudinal study from 2013 to 2019.

PURPOSE: Immigrant mental health is closely linked to the context of reception in the receiving society, including discrimination; past research has examined this relationship only cross-sectionally. This longitudinal study examines the relationships between discrimination and mental health among Somali immigrants living in North America from 2013 to 2019. METHODS: Data for 395 participants (mean age 21 years at Time 1) were collected through the four-wave Somali Youth Longitudinal Study in four cities: Boston, MA, Minneapolis, MN, Lewiston/Portland, ME, and Toronto, ON. Latent linear and quadratic growth models were used to predict mental health symptoms over time and discrimination's role in these changes. RESULTS: PTSD and anxiety symptoms decreased from 2013 to 2015 and subsequently increased. Depression was static from 2013 to 2015, worsening thereafter. Increases in discrimination predicted increases in mental health symptomatology at all timepoints. CONCLUSION: This study provides support for discrimination's toxic impact on mental health and suggests that recent increases in discrimination may have contributed to worsening mental health among Somali immigrants living in North America.

The pediatric dermatology psychosocial screen: Promoting psychosocial coping and early identification of mental illness in pediatric dermatology patients.

BACKGROUND/OBJECTIVES: The psychosocial impact of pediatric skin conditions can be difficult to assess accurately. There is currently no way to formally screen and provide stepped care specifically for psychosocial dysfunction or mental illness during dermatology clinics. The Psychosocial Screening Tool for Pediatric Dermatology (PDPS) was designed to identify patients in need of psychosocial support and to promote multidisciplinary care. METHODS: The PDPS was studied at Boston Children's Hospital outpatient dermatology clinics. A pilot study was conducted with 16 participants to assess language and applicability. The validation study included 105 participants aged 8-19 years. Participants completed the PDPS, the Children's Depression Index 2 Short (CDI-2 Short), and three subscales of the Behavior Assessment System for Children 2 (BASC-2) to assess content validity. Model fit from confirmatory factor analysis was evaluated using the root-mean-square error of approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). RESULTS: Proper model fit and criterion validity were demonstrated through positively correlating the PDPS and the CDI-2 Short (CFI = 0.972, TLI = 0.969, RMSEA 5.3%) and BASC-2 subscales (RMSEA = 7.2%, CFI = 0.975, TLI = 0.969). Patient resilience was positively correlated with higher scores in each psychosocial domain. CONCLUSIONS: The PDPS is an effective screening tool for resilience versus need for early behavioral/mental health intervention in dermatology patients aged 8-19. The PDPS identifies psychosocial dysfunction and problems patients may not disclose otherwise (bullying, self-harm, social supports, neurodermatitis, and body dysmorphic disorder). Additionally, patients can directly indicate interest in various psychosocial health resources on the PDPS, guiding practitioners in providing comprehensive care.

Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic.

Despite an overall decrease in utilization of emergency departments during COVID-19 (Hartnett et al. in MMWR Morb Mortal Wkly Rep. 69(23):699-704, 2020), US pediatric emergency departments experienced an increase in mental health visits for children and adolescents (Leeb et al. in MMWR Morb Mortal Wkly Rep. 69(45):1675-80, 2020). Simultaneously, individuals with eating disorders reported increasing symptomology (Termorshuizen et al. in Int J Eat Disord. 53(11):1780-90, 2020). This study compares Emergency Department utilization at a pediatric quaternary-level care center by patients with eating disorders during the pandemic (March-Dec 2020) vs March-Dec 2019. We hypothesize that there was an increase in presentation of patients with eating disorders. An Informatics for Integrating Biology and the Bedside query of the electronic medical record system identified patients with eating disorder diagnoses per ICD9/ICD10 codes aged 6-23 who presented to the Emergency Department between March 1st and December 31st of 2020 and 2019. Subsequent retrospective chart review was carried out. Patients were excluded from analysis if the presenting problem was not directly related to the eating disorder. During March-Dec 2019, 0.581% percent of all patients presented to the Emergency Department due to an eating disorder. During the same time frame in 2020, however, that percentage increased to 1.265%. Statistical significance was corrected using a Benjamini-Hochberg analysis. Despite a 66.5% decline in overall visits to the Emergency Department, the percentage of patients presenting with eating disorders doubled during the pandemic. During the pandemic, the total time spent awaiting placement significantly increased, and the number of patients identifying as transgender and/or nonbinary increased. Our data support the hypothesis that eating disorder presentation increased during the pandemic.

Does a Cusp Catastrophe Explain the Relationship Between School Size and Academic Achievement? Evidence from the Kingdom of Saudi Arabia.

The evidence regarding the relationship between school size and academic achievement is unequivocal as studies have provided support for both linear and nonlinear analytical means. Specifically, we hypothesized that the relationship between high school achievement as measured by the GPA and aptitude is best described by a cusp catastrophe model when simultaneously accounting for the contribution of school size. This hypothesis is based on the premise that as school size increases beyond a functionally optimal size, for a given level in the asymmetry variable (aptitude), high school students' achievement is expected to become discontinuous, erratic, and reach chaotic behavioral levels. Data were collected from 52,854 students who were educated in 547 schools in the Kingdom of Saudi Arabia. Using Cobb's conceptualization of the cusp catastrophe results indicated that school size defined as the number of students distorts the relationship between aptitude and GPA suggesting an optimal number of students associated with increases in achievement as a function of aptitude. This finding was also replicated using the student-to-teacher ratio as a bifurcation term. It is concluded that the role of school size is complex and requires the engagement of additional analytical methodologies.

Incorporating Cleft Lip Simulation Into a "Bootcamp-Style" Curriculum.

INTRODUCTION: The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures. METHODS: By revisiting principles of adult learning theory, the authors created a "bootcamp-style" cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by "operating" on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. A self-assessment survey was taken before and after each component of the session, including a self-confidence survey to conclude the session. Anthropometric measures of lip/nasal symmetry were assessed. RESULTS: Sixteen trainees participated in the program. Little increase in self-assessed knowledge/skill was seen after the lecture, but significant increases in most aspects of cleft lip repair were seen after simulation. The greatest increase in self-assessment was seen for the program as a whole, with significant differences across all aspects of the self-assessment. Higher levels of training were associated with both higher self-assessment scores and better lip symmetry. Regardless of level of training, all participants strongly agreed that simulation helped them actively engage in learning and should be a required aspect of training, whereas 94% (n = 15) thought simulation was much more effective than standard preparation alone. CONCLUSIONS: This pilot curriculum illustrates a mechanism to incorporate lessons from adult learning theory into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.

Civic development and antisocial attitudes/behaviors among Somali immigrants: Change over one year.

Objectives: Understanding how immigrant young adults engage with civic society over time is critical to understanding and fostering healthy development and healthy democracies. The present study examines how civic engagement and antisocial attitudes/behavior of Somali young adult immigrants (ages 18-30, N = 498) in four North American regions co-occur, and change over time. Method: Using latent transition analyses, we examine latent classes of young adult males and females in relation to political and nonpolitical civic engagement and dimensions of antisocial attitudes/behavior and stability of these classes over 1 year. Results: Distinct latent classes were identified that remained consistent over time. Rates and patterns in latent class transitions varied along civically engaged/antisocial dimensions and also by gender. Conclusions: Antisocial attitudes/behavior can coexist with civic engagement. For males, sense of belonging to both Somali and American/Canadian communities was associated with lower levels of antisocial attitudes/behavior. Movement away from, or into, antisocial attitudes/behavior differs by gender and can happen either in the presence or absence of civic engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alignment of a Language Instrument Scores to CEFR Levels: Methodological and Empirical Considerations.

The purpose of the present report was to assess congruence between a language-based national examination (termed English placement test - EPT) and the Common European Framework of Reference for Languages (CEFR) levels. To this end, a series of methodological steps were put forth to accumulate evidence suggesting that language performance based on the EPT instrument can be split onto meaningful subgroups based on theoretical (expert judgement on difficulty level and CEFR correspondence) and empirical considerations (i.e., how well these levels and subgroups emerged). Participants were 2642 high school graduates who took on the EPT instrument as part of their entry criteria to the university and for the purposes of the present study only the structure subscale is presented. Items were classified as reflecting specific CEFR levels and a person-based analysis attempted to classify individuals sharing the same behavioral patterns. Results using a latent class analysis (LCA) indicated that a Pre-A1, an A1 an A2 a B1 and a B2 levels were present with regard to the structure domain of language. Results showed a strong alignment between the EPT structure domain and CEFR guidelines using various methodological approaches.

Using Confidence Intervals of the Item and Test Information Functions to Test Differential Item and Test Functioning: Visual and Statistical Analyses.

The purpose of the present paper was twofold: (a) to use 95% confidence intervals of the item and test information functions as a means of visualizing differences between groups on the information provided at the item and test levels, and, (b) to statistically compare item and test information functions as a method for evaluating differential item and differential test functioning. Participants were 2,305 high school students who took a Mathematics National entrance examination in Saudi Arabia. Item and test information functions, conditional standard errors of measurement and reliability were estimated for both males and females. Differences between groups became evident when plotting 95% confidence intervals of the item and test information functions and the visual findings were confirmed using population-based Z-tests of point estimates using a Monte-Carlo simulation. It was concluded that differential group behavior at the item and test levels can be evidenced using information functions and inferential tests of significance can be constructed using the bootstrap distribution. The current procedure involves both item difficulties and discrimination indices and provides increased sensitivity over the traditional methods relying on item difficulties only.

Validation of Response Similarity Analysis for the Detection of Academic Cheating: An Experimental Study.

The purpose of the present study was to evaluate various analytical means to detect academic cheating in an experimental setting. The omega index was compared and contrasted given a gold criterion of academic cheating which entailed a discrepant score between two administrations using an experimental study with real test takers. Participants were 164 elementary school students who were administered a mathematics exam followed by an equivalent mock exam under conditions of strict and relaxed, invigilation, respectively. Discrepant scores were defined as exceeding 7 responses in any direction (correct or incorrect), based on what was expected due to chance. Results indicated that the omega index was successful in capturing more than 39% of the cases who exceeded the conventional plus or minus 7 discrepancy criteria. It is concluded that the response similarity analysis may be an important tool in detecting academic cheating.

Longitudinal stability of pre-reading skill profiles of kindergarten children: implications for early screening and theories of reading.

Research suggests that early identification of developmental dyslexia is important for mitigating the negative effects of dyslexia, including reduced educational attainment and increased socioemotional difficulties. The strongest pre-literacy predictors of dyslexia are rapid automatized naming (RAN), phonological awareness (PA), letter knowledge, and verbal short-term memory. The relationship among these constructs has been debated, and several theories have emerged to explain the unique role of each in reading ability/disability. Furthermore, the stability of identification of risk based on these measures varies widely across studies, due in part to the different cut-offs employed to designate risk. We applied a latent profile analysis technique with a diverse sample of 1215 kindergarten and pre-kindergarten students from 20 schools, to investigate whether PA, RAN, letter knowledge, and verbal short-term memory measures differentiated between homogenous profiles of performance on these measures. Six profiles of performance emerged from the data: average performers, below average performers, high performers, PA risk, RAN risk, and double-deficit risk (both PA and RAN). A latent class regression model was employed to investigate the longitudinal stability of these groups in a representative subset of children (n = 95) nearly two years later, at the end of 1st grade. Profile membership in the spring semester of pre-kindergarten or fall semester of kindergarten was significantly predictive of later reading performance, with the specific patterns of performance on the different constructs remaining stable across the years. There was a higher frequency of PA and RAN deficits in children from lower socioeconomic status (SES) backgrounds. There was no evidence for the IQ-achievement discrepancy criterion traditionally used to diagnose dyslexia. Our results support the feasibility of early identification of dyslexia risk and point to the heterogeneity of risk profiles. These findings carry important implications for improving outcomes for children with dyslexia, based on more targeted interventions.

Rasch analysis of the Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT) item bank for children and young adults with spinal muscular atrophy.

INTRODUCTION: In this study we evaluated the suitability of a caregiver-reported functional measure, the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), for children and young adults with spinal muscular atrophy (SMA). METHODS: PEDI-CAT Mobility and Daily Activities domain item banks were administered to 58 caregivers of children and young adults with SMA. Rasch analysis was used to evaluate test properties across SMA types. RESULTS: Unidimensional content for each domain was confirmed. The PEDI-CAT was most informative for type III SMA, with ability levels distributed close to 0.0 logits in both domains. It was less informative for types I and II SMA, especially for mobility skills. Item and person abilities were not distributed evenly across all types. CONCLUSIONS: The PEDI-CAT may be used to measure functional performance in SMA, but additional items are needed to identify small changes in function and best represent the abilities of all types of SMA. Muscle Nerve 54: 1097-1107, 2016.

A pediatric epilepsy diagnostic tool for use in resource-limited settings: A pilot study.

OBJECTIVE: It is estimated that nearly 80% of the 50 million people affected with epilepsy globally live in regions where specialist care and diagnostic tests are scarce and care is often delivered through a primary health provider with limited training. To improve diagnostic accuracy of the history and physical examination, we developed and piloted a questionnaire to discriminate between focal versus generalized epilepsy, with the future goal to guide medication choices. METHODS: Through literature review and retrospective chart review of 75 children with epilepsy at Boston Children's Hospital, a 15-item questionnaire was developed. Simple motor seizures were excluded for the purposes of this questionnaire. The questionnaire was then translated in local dialects and prospectively validated at Muhimbili National Hospital in Dar Es Salaam, Tanzania, and University Teaching Hospital in Lusaka, Zambia. Children 6months-18years of age with suspected or active epilepsy were identified, and a nonphysician administered the questionnaire to the patient's caregiver. Next, each patient was evaluated by a pediatric neurologist blinded to the questionnaire results, and together with locally obtained but remotely interpreted EEG, an electroclinical diagnosis was made. The questionnaire data were compared with this clinical gold standard. RESULTS: A total of 59 children participated: 28 from Tanzania and 31 from Zambia. Sixteen patients were excluded: 5 were excluded because of incomplete data, and 11 did not meet criteria for epilepsy based on initial screening questions. Of the remaining 43 patients, 28 had focal or multifocal epilepsy (65%), and 15 (35%) had generalized epilepsy. The questionnaire had a sensitivity of 78% and positive predictive value of 81.5%. Data were analyzed using a Rasch model, testing the questionnaire's internal consistency, reliability, and its discriminative validity in classifying focal versus generalized epilepsy against an electroclinical diagnosis. The mean epilepsy score for focal epilepsy was 0.084 logits compared with -1.147 logits for generalized epilepsy, demonstrating a large effect size [F (1, 41)=13.490, p<0.001]. CONCLUSIONS: Our questionnaire provides a straightforward method to improve diagnostic accuracy, and could assist in bridging the diagnostic gap in pediatric epilepsy in resource-limited settings. This tool was specifically designed to be easily implemented by any healthcare provider. This pilot study prompts broader prospective validation in additional settings for further refinement, and for performance assessment of impact on provider's practice, ability to guide medication choices, and ultimately improve treatment outcomes in resource-limited regions.

Using Structural Equation Modeling to Assess Functional Connectivity in the Brain: Power and Sample Size Considerations.

The present study assessed the impact of sample size on the power and fit of structural equation modeling applied to functional brain connectivity hypotheses. The data consisted of time-constrained minimum norm estimates of regional brain activity during performance of a reading task obtained with magnetoencephalography. Power analysis was first conducted for an autoregressive model with 5 latent variables (brain regions), each defined by 3 indicators (successive activity time bins). A series of simulations were then run by generating data from an existing pool of 51 typical readers (aged 7.5-12.5 years). Sample sizes ranged between 20 and 1,000 participants and for each sample size 1,000 replications were run. Results were evaluated using chi-square Type I errors, model convergence, mean RMSEA (root mean square error of approximation) values, confidence intervals of the RMSEA, structural path stability, and D-Fit index values. Results suggested that 70 to 80 participants were adequate to model relationships reflecting close to not so close fit as per MacCallum et al.'s recommendations. Sample sizes of 50 participants were associated with satisfactory fit. It is concluded that structural equation modeling is a viable methodology to model complex regional interdependencies in brain activation in pediatric populations.

Ought-approach versus ought-avoidance: nonlinear effects on arousal under achievement situations.

The present study examines the dimensions of oughts under a nonlinear perspective. Ought-approach and ought-avoidance have been proposed as two different dimensions of oughts, which have an opposite effect on subjects' arousal level under achievement situation. The change in arousal level measured by heart rates per minute (HRPM) was modeled as cusp catastrophe by implementing the two dimensions of oughts as the control parameters: the ought-approach as the asymmetry and the ought-avoidance as the bifurcation factor. The cusp model was proved by far superior from the three alternative linear models and provided the empirical evidence that the two dimensions of oughts are distinct and are associated with different processes. The ought-avoidance dimension being the bifurcation factor acts in a destructive manner by introducing nonlinearity and uncertainty in the self-regulation process (with regard to HRPM). The interpretation of the model is provided and implications are discussed.

School emphasis on academic success: the role of principal qualifications.

The purpose of the present study was to relate a principal's qualifications with a school's emphasis on academic success. Participants were n = 206 principals of respective schools in Saudi Arabia that took part in the study as a function of the TIMSS-2019 assessment. Principals were administered the eleven-item "School Emphasis on Academic Success" scale. A binary covariate defining low and high principal qualifications was computed. The Multiple Indicators Multiple Causes (MIMIC) model was involved with the latent means of both a general and three specific factors being regressed on the covariate to evaluate latent mean differences across differentially qualified principals. Furthermore, each one of the instrument's indicators was regressed on the principal covariate to evaluate the presence of Differential Item Functioning (DIF) or in other words additional effects due to item content. Results indicated a significant omnibus effect for the general factor only, with highly qualified principals holding significantly more positive beliefs about how parents, teachers, and students feel about their school's emphasis on academic success. Further analyses at the item level indicated that "teacher expectations" were the single item presenting a DIF effect with highly qualified principals having stronger beliefs about their teacher's expectations of student success over and above the latent factor mean. Results are discussed on how they inform educational policy and practice.

Physical and Pharmacologic Restraint in Hospitalized Children With Autism Spectrum Disorder.

OBJECTIVES: Children with autism spectrum disorder (ASD) have high rates of cooccurring conditions and are hospitalized longer and more frequently than children without ASD. Little is known about use of involuntary physical or pharmacologic restraint in hospitalized children with ASD. This study compares use of restraint because of violent or self-injurious behavior during inpatient pediatric hospitalization in children with ASD compared with typical peers. METHODS: This retrospective cohort study examines electronic health records of all children aged 5 to 21 years admitted to a pediatric medical unit at a large urban hospital between October 2016 and October 2021. Billing diagnoses from inpatient encounters identified ASD and cooccurring diagnoses. Clinical orders identified physical and pharmacologic restraint. Propensity score matching ensured equivalency between ASD and matched non-ASD groups on demographic factors. Logistic regression determined the odds of restraint in children with ASD compared with children without ASD, controlling for hospitalization factors and cooccurring diagnoses. RESULTS: Of 21 275 hospitalized children, 367 (1.7%) experienced restraint and 1187 (5.6%) had ASD. After adjusting for reason for admission, length of stay, and cooccurring mental health, developmental, and behavioral disorders, children with ASD were significantly more likely to be restrained than children without ASD (odds ratio 2.3, 95% confidence interval 1.6-3.4; P < .001). CONCLUSIONS: Hospitalized children with ASD have significantly higher odds of restraint for violent or self-injurious behavior compared with children without ASD after accounting for reason for admission, length of hospitalization and cooccurring diagnoses. Work is needed to modify the hospital environment for children with ASD to reduce behavioral dysregulation and restraint.

Types and Predictors of Service use Among Young Children Recommended to Receive Intensive Services After Initial Autism Spectrum Disorder Diagnosis.

Intensive services are recommended for young children with autism spectrum disorder (ASD). Limited research on service receipt in states with mandated ASD-specific service coverage suggests that it remains low, and factors associated with intensity are unclear. Participants were 206 children from the Boston Outcomes of Autism in Toddlers study living in states with autism mandates, diagnosed with ASD through a multidisciplinary consultation at 12-36 months, and recommended to receive at least 20 h of services weekly. Outcome measures were caregiver-reported receipt of total and ASD-specific services within 18 months of ASD diagnosis. Separate negative binomial regression models were run for each outcome, with covariates of child adaptive and cognitive functioning, age, gender, household income, primary insurance, and maternal educational level. The sample was 83% male with a mean age of 24.5 months at ASD diagnosis. Mean Vineland adaptive behavior composite and Bayley cognitive standard scores were 73 and 81, respectively. 90% of children received ASD-specific services. The median intensities for total and ASD-specific services were 22 and 17 h weekly respectively, with 44% of the participants receiving at least 20 h of ASD-specific services weekly. Adjusted regression models found significant associations between lower adaptive scores and increased total and ASD-specific service receipt. Children in insurance-mandated states received a high intensity of intervention after clinical ASD diagnosis. Lower child adaptive functioning was associated with increased service receipt, while socioeconomic factors were not associated. Additional research in other regions and mandate-ineligible populations is needed.

Knowledge assessment tool for pediatric parenteral nutrition: A validation study.

BACKGROUND: Parenteral nutrition (PN) is a high-risk medication, and its prescription and administration requires extensive training. Difficulties inherent with bedside teaching have made teaching these concepts challenging. Currently, no knowledge assessment tools with validity evidence exist to test the effectiveness of new PN teaching interventions. We sought to develop and provide validity evidence for a pediatric PN knowledge test to measure the effectiveness of future teaching interventions. METHODS: We created a multiple-choice question knowledge assessment tool that underwent content validation by PN experts and was emailed to potential participants. We evaluated the knowledge assessment tool for factorial validity, internal consistency reliability, and discriminant validity. RESULTS: We enrolled 103 medical students (40%), residents and fellow trainees (55%), and attending physicians (5%) into the study between October 2021 and October 2022. Five of the 30 questions performed poorly based on their nonsignificant contribution to the primary aim of assessing pediatric PN knowledge. Following the exclusion of those questions, the knowledge assessment tool demonstrated an acceptable model fit, and the root mean squared error of approximation was <5%. The omega coefficient was 0.829, indicating acceptable levels of reliability, and using an analysis of variance test (ANOVA) demonstrated significant differences between groups, showing good discrimination between levels of experience (F[2, 80] = 39.002; P < 0.001). CONCLUSION: We have developed and provided validity evidence for a multiple-choice question knowledge test that may be used by educators and programs to evaluate knowledge of pediatric PN in physicians and trainees.

Profiles of Autistic Youth with and Without Co-occurring Behavioral Health and Neurodevelopmental Disorders: A Latent Class Analysis.

OBJECTIVE: Autism spectrum disorder (ASD) diagnosis relies on clinical observation and documentation, but the presence of comorbidities can affect diagnostic validity across clinicians and exacerbate access to timely care. This study used latent class analysis to optimize subgroup identification based on functional level and associated comorbidities using the Behavior Assessment System for Children, Third Edition (BASC-3), and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), in a pediatric population referred for autism evaluation. METHODS: This retrospective study reviewed clinical data extracted over a 3-year period (2018-2021). A latent class analysis was used to explore the presence of latent groups guided by the likelihood ratio test and fit indices. Additional analyses contrasted ASD and non-ASD groups on the BASC-3 and Vineland-3 variables. RESULTS: There were 191 included participants (mean age 65.9 months, 76.4% male), of whom over half (60.7%) had an ASD diagnosis. Using 185 cases, the exploratory latent class analysis showed the emergence of 4 distinct subgroups. Composition of classes varied on ASD diagnosis, neurodevelopmental difficulties, behavioral health concerns, and intellectual disability. When contrasting ASD and non-ASD groups, significant between-group differences were observed across Vineland-3 variables and BASC-3 adaptive skills subscales indicating poorer social and adaptive functioning. CONCLUSION: Latent class analysis of commonly used behavioral and adaptive measures can help distinguish between subgroups of pediatric patients referred for ASD evaluations and assist in triage of cases based on severity.

Validation of factor structure of the neurodevelopmental parent report for outcome monitoring in down syndrome: confirmatory factor analysis.

Introduction: The Neurodevelopmental Parent Report for Outcome Monitoring (ND-PROM), initially developed to monitor developmental and behavioral functions in children with autism spectrum disorder (ASD), assesses symptoms across a wide range of domains relevant in Down syndrome (DS). Methods: Psychometric properties of ND-PROM were assessed in 385 individuals with DS and 52 with a combined diagnosis of DS and ASD (DS+ASD), whose caregivers completed the ND-PROM questionnaire for a clinical visit in a specialized Down syndrome program at a tertiary pediatric hospital. Confirmatory factor analysis was conducted to evaluate the internal structure validity of the ND-PROM. Measurement invariance was assessed, with a comparison group of 246 individuals with ASD, and latent mean differences between the DS and ASD-only groups, as well as the combined DS+ASD groups, were assessed. Results: Findings support the existence of the 12 clinically-derived factors in the DS population: Expressive Language, Receptive Language, Adaptive skills/Toileting, Social Emotional Understanding, Social Interaction, Independent Play, Sensory Processes, Challenging Behaviors, Impulse/ADHD, and Mental Health. Differences in response patterns of development and behaviors were observed between those with DS and those with ASD, including those with DS having higher abilities in nonverbal communication, social emotional understanding, and social interaction, and fewer restricted and repetitive behaviors and interests, impulsivity or ADHD symptoms, and mental health concerns compared to those with ASD. Individuals in the DS+ASD group had more difficulties with expressive and receptive language, nonverbal and social communication, social interaction, independent play, and adaptive skills than either the DS-only group or the ASD-only groups. Discussion: The ND-PROM has a desirable factor structure and is a valid and clinically useful tool that captures a range of distinct and independent areas of developmental and behavioral functioning in DS, for individuals with and without an ASD diagnosis.