Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study.

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.

This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. In 2016, we recorded 1440 h of video among 10 TV channels. We used the PAHO Nutrient Profile Model to identify 'critical nutrients' (e.g. sodium) whose excessive consumption is associated with Non-Communicable Chronic Diseases (e.g. hypertension). We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters, premium offers, brand benefit claims and health-related claims. In Guatemala, foods that exceeded one critical nutrient had a high probability of using promotional characters, premium offers and health-related claims than foods without any excess in critical nutrients. However, in Costa Rica health-related claims had a high probability of appearing with foods that exceeded ≥2 critical nutrients. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing.

Phenotype of 7q11.23 duplication: A family clinical series.

Duplication 7q11.23 syndrome is the reciprocal of Williams-Beuren deletion syndrome. Studies have reported a recognizable phenotype, including autism, intellectual disability, speech, and language delay, social anxiety, and behavioral difficulties in these individuals. Previous studies revealed a variety of craniofacial abnormalities, brain malformations, and cardiac abnormalities, including aortic dilation. This patient series evaluates five family members aged 2 months to 35 years, all with confirmed 7q11.23 duplication syndrome. All had characteristic craniofacial findings and joint hyperextensibility, and three experienced broken bones/fractures with minimal trauma. Other features included frequent headaches, sleep problems, hydrocephalus, and in two of the children, mildly dilated aortic root, and ascending aorta. Psychological test results reveal borderline to low average nonverbal cognitive abilities and speech and language delays. All five family members with 7q11.23 syndrome meet criteria for autism spectrum disorder. Adaptive functioning is impaired for all four children, but higher for the children's father. The infant shows developmental delays in language and motor skills, but some improvements in reciprocal social behaviors over time. Two children exhibit hyperactivity and inattention, and the father and second youngest child exhibit anxiety. This family clinical series contributes to the growing literature on the phenotype of 7q11.23 microduplication syndrome across the age range. Physicians are encouraged to urge focused medical surveillance and intensive early intervention targeting speech-language and social reciprocity. © 2016 Wiley Periodicals, Inc.

PARALLEL MODELS OF ASSESSMENT: INFANT MENTAL HEALTH AND THERAPEUTIC ASSESSMENT MODELS INTERSECT THROUGH EARLY CHILDHOOD CASE STUDIES.

Therapeutic Assessment (TA; S.E. Finn & M.E. Tonsager, 1997; J.D. Smith, 2010) is a collaborative, semistructured model that encourages self-discovery and meaning-making through the use of assessment as an intervention approach. This model shares core strategies with infant mental health assessment, including close collaboration with parents and caregivers, active participation of the family, a focus on developing new family stories and increasing parents' understanding of their child, and reducing isolation and increasing hope through the assessment process. The intersection of these two theoretical approaches is explored, using case studies of three infants/young children and their families to illustrate the application of TA to infant mental health. The case of an 18-month-old girl whose parents fear that she has bipolar disorder illustrates the core principles of the TA model, highlighting the use of assessment intervention sessions and the clinical approach to preparing assessment feedback. The second case follows an infant with a rare genetic syndrome from ages 2 to 24 months, focusing on the assessor-parent relationship and the importance of a developmental perspective. Finally, assessment of a 3-year-old boy illustrates the development and use of a fable as a tool to provide feedback to a young child about assessment findings and recommendations.

Autism assessment in children with optic nerve hypoplasia and other vision impairments.

AIM: This study examined the utility of standard autism diagnostic measures in nine children (aged 5-9y) with severe vision impairment and a range of social and language functioning. METHOD: The Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview, Revised (ADI-R) were systematically modified and used to assess symptoms of autism in children with vision less than or equal to 20/800, the majority of whom had optic nerve hypoplasia. The results of the assessments, including analysis of symptom patterns, were compared with expert autism diagnoses. RESULTS: Modified autism measures demonstrated good agreement with clinical diagnoses. Symptoms found to be most and least reliable in discriminating autism from behaviors common to most children with congenital vision impairment are described. Comparisons of current behavior with parent-reported behaviors from a younger age suggested that some symptoms of autism in very young children who are congenitally blind may improve with age. INTERPRETATION: The ADOS and ADI-R are useful for clinical assessment and for advancing research efforts to understand autism symptoms in children with vision impairment. However, some autistic symptoms in very young children may change over time, and developmental changes should be closely monitored.

Broad Developmental Screening Misses Young Children With Social-Emotional Needs.

Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.

Developmental Screening and Referrals: Assessing the Influence of Provider Specialty, Training, and Interagency Communication.

Previous studies have shown that different provider approaches, amount of familiarity with the referral and screening process, and level of interagency communication can increase or decrease the likelihood of caregivers completing a recommended referral to early intervention (EI). We surveyed 60 family practitioners and pediatricians at 2 primary care clinics to assess these factors. Pediatricians were more likely than family practitioners to report using, evaluating, and discussing the results of developmental screens. Providers with more experience and recent training expressed more confidence in their ability to describe the EI system to families. Most providers expressed a lack of confidence in their own agency to complete referrals or EI to provide follow-up. The knowledge gaps and communication problems identified in this study could serve as a basis for future interventional work.

Parent-Reported Strengths in Children with Autism Spectrum Disorders at the Time of an Interdisciplinary Diagnostic Evaluation.

OBJECTIVE: Parents of children with autism spectrum disorders (ASD) often focus on concerns in discussions with health care providers. However, studying child strengths and positive parental attributions is an emerging area of focus and not often highlighted in many studies with children with ASD. The objective of this study was to identify parent-reported strengths in a sample of children with ASD. METHODS: This was a qualitative study of parent report of strengths in clinical notes with children between the ages 3 and 8 presenting for a team diagnostic evaluation and meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-Text Revision (TR) or DSM-V diagnostic criteria for ASD. The reported child's strengths were qualitatively analyzed, coded, and clustered into themes. RESULTS: Ninety-eight charts were reviewed. Five meta-themes of strengths were identified: Personality Characteristics, Social Personality, Cognitive Functioning, Behavioral Characteristics/Coping Mechanisms, and Skills. On average, parents reported more strengths in the Cognitive Functioning and Personality Characteristics meta-themes. CONCLUSION: Pediatricians have a unique opportunity to discuss parental positive perceptions of children with ASD and to learn about their strengths.

Aggression in Autism Spectrum Disorder: Supporting the Entire Family.

CASE: Juanita is a 13-year-old non-verbal Latina girl with autism spectrum disorder, moderate intellectual disability, and a seizure disorder whose aggressive behaviors toward her parents have significantly worsened over the past few months.Juanita's monolingual Spanish-speaking parents are here today for medication management at her primary care clinic. The parents report that Juanita pinches them, pulls their hair, and hits her head with her fists. Her aggression toward them is usually triggered by feelings of frustrations, leaving her parents feeling like they have to walk on eggshells around her and have led to differing parenting styles. Her father reports that he tries to avoid getting her upset and prefers to watch TV with her, whereas her mother takes on the day-to-day caretaking. Although he wants to take a more active role in parenting Juanita, when he tries, Juanita becomes more aggressive and reacts violently toward him.During the visit, Juanita keeps her eyes downcast, is withdrawn, and some strain is noted between her parents. While speaking to them, Juanita's mother chimes in and reports that she considers herself the primary caregiver and the one who knows her daughter the best. She often dismisses Juanita's father's reporting, saying that "he doesn't know what really is going on." When Juanita is taken to the restroom by her mother, her father tearfully reports that he feels that it may be best for everyone that he leaves the family because of Juanita's worsening aggression toward him and the toll it is taking on his marriage. How would you approach her management?

Brief Report: Recruitment and Retention of Minority Children for Autism Research.

Given the underrepresentation of ethnic minorities in health research (Heiat et al. in Arch Int Med 162(15):1-17, 2002; Kelly et al. in J Nat Med Assoc 97:777-783, 2005; United States Department of Health and Human Services. Monitoring adherence to the NIH policy on the inclusion of women and minorities as subjects in clinical research. http://orwh.od.nih.gov/research/inclusion/reports.asp , 2013), this study evaluated promising strategies to effectively recruit Latinos into genetic research on autism spectrum disorders (ASD). The study included 97 children, aged 5-17 years, with ASD; 82.5 % of the participants were identified as Latino/Hispanic. Traditional and culture-specific recruitment and retention strategies were compared between the Latino and non-Latino groups. Culture-specific, parent-centered approaches were found to be successful in engaging and retaining Latino participants for research involving genetic testing.

How sex of children with autism spectrum disorders and access to treatment services relates to parental stress.

Parents of children with autism spectrum disorders (ASD) experience higher levels of stress in comparison to parents of neurotypical children and consequently are more susceptible to negative health and social outcomes (Dunn et al., 2001). However, less is known about how individual child characteristics impact stress levels in parents of children with ASD. In this study, we examined the relationship between individual characteristics (i.e., sex) of children with ASD and parental stress. Access to comprehensive treatment services was also examined as a contributing factor to parental stress. Parenting stress was higher for parents of girls than for parents of boys, and for parents of girls (but not boys) fewer services predicted higher parental distress. Findings highlight the importance of providing parents of girls with ASD with more tailored support.