Douglas Lee Vanderbilt

All Publications

• Cumulative Opioid Exposures in the First Year of Life and Cognitive Neurodevelopment in High-Risk Infants. Hospital pediatrics Keane, O. A., Ourshalimian, S., Lakshmanan, A., Ross, P., Kim, E., Lee, H. C., Hintz, S. R., Nguyen, N., Ing, M., Kaplan, C., Mirzaian, C. B., Vanderbilt, D., Anand, K. S., Kelley-Quon, L. I. 2026

  Abstract

  High-risk infants with significant neonatal-perinatal morbidities often require opioids, but prolonged exposures can impair neurodevelopment. We evaluated the effect of cumulative opioid exposures in the first year of life, measured by morphine milligrams equivalents (MME), on neurodevelopment.A retrospective cohort of high-risk infants younger than 1 year admitted to a tertiary children's hospital from 2010 to 2020 was identified. International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/ICD-10) codes for congenital heart disease surgery, medical and surgical necrotizing enterocolitis, extremely low birth weight, very low birth weight, hypoxemic ischemic encephalopathy, extracorporeal membrane oxygenation, and thoracoabdominal surgery identified high-risk infants. Cumulative MME received over all hospitalizations in the first year of life were calculated alongside benzodiazepine dosing and neurodevelopmental scores at 18 months or older. Neurodevelopmental impairment was defined as a score more than 1 SD from the standardized mean. Multivariable linear regressions adjusted for demographics and comorbidities.Overall, 330 high-risk infants were identified, and 70.6% demonstrated neurodevelopmental impairment. Cumulative MME negatively correlated with cognitive (P < .001), motor (P < .001), and language (P = .004) scores. On multivariable linear regression, increasing MME was significantly associated with decreasing cognitive (P < .001) scores but not motor or language scores.Higher cumulative opioid exposure in the first year of life was associated with reduced cognitive scores at 18 months or older, independent of comorbidities. Opioid stewardship initiatives extended to high-risk infants may further optimize long-term neurodevelopment.

  View details for DOI 10.1542/hpeds.2025-008965

  View details for PubMedID 42604745

• Developmental Profiles of Young Children Referred for Concern for Autism Spectrum Disorder: DBPNet Study. Journal of autism and developmental disorders Roizen, N., Friedman, S., Vanderbilt, D., Cacia, J., Fussell, J., Hansen, R., Hofer, J., Sideridis, G., Stein, R. E., Barbaresi, W. 2026; 56 (8): 3288-3294

  Abstract

  The aim of this study was to compare differences in cognitive, adaptive, and language function in young children referred for concerns for autism spectrum disorder (ASD) who are diagnosed with ASD vs those not diagnosed with ASD (no ASD). This prospective diagnostic study of 349 children < 6 years of age, with 250 diagnosed with ASD and 99 with no ASD, was conducted at 8 diagnostic centers. There were no differences in cognition between those diagnosed with ASD and those with no ASD. As compared to those with no ASD, children with ASD had significantly lower language and adaptive functioning. Children with no ASD had language and adaptive functioning similar to their cognitive function. Differences between developmental domains were also compared within the ASD and no ASD groups. There were no differences between any 2 areas of function in the no ASD group. However, there were significant differences within the ASD group, with cognitive function significantly higher than both language function and adaptive function. This study suggests that a discrepancy between adaptive and language skills beyond that expected based on cognitive function should heighten concern for ASD. Beyond the categorical diagnosis of ASD, it is important to assess all these developmental domains to develop comprehensive plans for interventions.

  View details for DOI 10.1007/s10803-025-06777-0

  View details for PubMedID 40120017

  View details for PubMedCentralID PMC13391734

• Association of maternal primary language with neurodevelopmental outcomes in high-risk infants JOURNAL OF PERINATOLOGY Nghiem, N., Gomez, M., Vu, M. H., Deavenport-Saman, A., Vanderbilt, D., Lakshmanan, A., Wang, S., Boodaghian, A., Mirzaian, C. B. 2025; 45 (12): 1722-1728

  Abstract

  Examine whether maternal primary language (English or a minoritized language) is associated with differences in infant developmental outcomes.This retrospective cohort study included 253 infants from a high-risk infant follow-up clinic at a quaternary care center in the U.S. who underwent developmental evaluation at 6, 12, and 24 months corrected age. The Bayley Scales, 3rd and 4th editions, were used to assess development.At 6- and 12-month visits, the minoritized-language group had significantly lower scores than the English-language group in cognitive, language, and motor domains. By the 24-month visit, the minoritized-language group appeared to catch up in cognitive and motor domains but a significant difference in language skills persisted.Our findings indicate disparities in developmental outcomes, particularly in language skills at 24 months corrected age, based on maternal primary language, underscoring the need for further research to inform targeted interventions to address these disparities.

  View details for DOI 10.1038/s41372-025-02438-3

  View details for Web of Science ID 001583128200001

  View details for PubMedID 41023169

  View details for PubMedCentralID PMC12717000

• The Coexistence of Adverse Childhood Experiences, Positive Childhood Experiences, and Parent-reported Attention-deficit/Hyperactivity Disorder Severity: National Survey of Children's Health JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Hong, S., Vu, M. H., Vanderbilt, D., Yin, L., Imagawa, K., Deavenport-Saman, A. 2025; 46 (5): e468-e474

  Abstract

  Children with higher adverse childhood experiences (ACEs) experience more severe parent-reported attention-deficit/hyperactivity disorder (ADHD). Positive childhood experiences (PCEs) help to build resilience and mitigate the impact of ACEs on ADHD. Prior studies have measured the 2 constructs as independent factors, but no research has examined their combined influence on children with ADHD. The first aim was to categorize children with different levels of parent-reported ADHD severity into classes based on shared characteristics of ACE and PCE promoters. The second aim was to examine the relationship between the classes and ADHD severity.Participants included children 6 to 17 years with data on the 2019 National Survey of Children's Health ADHD severity questionnaire (n = 19,715; weighted n = 49,149,269). Latent class analysis (LCA) identified subgroups of children experiencing patterns among PCE promoters and ACEs, which were measured as independent variables in an adjusted ordinal regression model to estimate their composite effects on ADHD severity.Using LCA, one class belonging to children with low ACEs and high PCE promoters (class 1) and another belonging to children with high ACEs and low PCE promoters (class 2) were identified. Class 2 was 2.2 times more likely to have more severe ADHD (aOR 2.2; 95% confidence interval, 1.8-2.6).Findings suggest ACEs and PCE promoters do not operate independently; children with high ACEs had low PCE promoters and had more severe parent-reported ADHD. Clinicians should consider actively screening for the presence of ACEs and PCEs in all children, especially those with high ADHD severity, and build strong alliances with families.

  View details for DOI 10.1097/DBP.0000000000001395

  View details for Web of Science ID 001595617800013

  View details for PubMedID 40633056

  View details for PubMedCentralID PMC12404043

• High-Risk Infant Developmental Outcome Is Associated with Medical Complexity and Neighborhood Opportunity JOURNAL OF PEDIATRICS Yeo, E. N., Young, N. D., Cleveland III, J. C., Simon, T. D., Vanderbilt, D. L., Espinoza, J., Mirzaian, C. B., Alderete, T. L. 2025; 279: 114433

  Abstract

  To assess how medical complexity and neighborhood opportunity jointly affect cognitive, motor, and language Bayley Scales of Infant Development. Secondary objectives involved identifying the factors contributing to developmental disparities across diverse racial and ethnic groups.Electronic health records from a Southern California high-risk infant follow-up clinic were analyzed for 440 infants from 2014 through 2023 who had either had neonatal intensive care unit stays, prematurity, very low birth weight, or developmental delay risk. Medical complexity was categorized using the Pediatric Medical Complexity Algorithm into complex chronic (CC), noncomplex chronic, or nonchronic (NC). Neighborhood opportunity was assessed using the Child Opportunity Index 2.0. Developmental progress was tracked from ages 4 to 35.6 months.Of the cohort, 56% were male, and 67% were born prematurely, with 143 NC, 115 noncomplex chronic, and 182 CC cases. Developmental scores showed a progressive decline with increased medical complexity. Infants who were CC had lower cognitive (β = -15.20, P < .001, 95% CI -18.75, -11.7), motor (β = -20.50, P < .001, 95% CI -24.25, -16.8), and language scores (β = -11.88, P < .001, 95% CI = -15.13 to -8.6) compared with infants who were NC. Lower Child Opportunity Index score was linked with decreased language scores (β = -0.07, P = .005, 95% CI 0.01-0.12) but not cognitive or motor scores.In high-risk infants, the adverse effects of medical complexities on developmental outcomes exceeded those of prematurity and additionally varied according to child neighborhood opportunity.

  View details for DOI 10.1016/j.jpeds.2024.114433

  View details for Web of Science ID 001420157300001

  View details for PubMedID 39672373

  View details for PubMedCentralID PMC11903178

• Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement. Pediatrics Klass, P., Miller-Fitzwater, A., High, P. C. 2024; 154 (6)

  Abstract

  Reading together often with infants and young children strengthens their relationships with parents and caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents and caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading, beginning at birth and continuing at least through kindergarten, as a strategy for supporting parents and caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create nurturing and stimulating home environments. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."

  View details for DOI 10.1542/peds.2024-069090

  View details for PubMedID 39342414

• Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report. Pediatrics Klass, P., Mendelsohn, A. L., Hutton, J. S., Dunlap, M., Anderson, A. T., High, P. C., Navsaria, D. 2024; 154 (6)

  Abstract

  Early literacy promotion in pediatric primary care supports parents and caregivers in reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the American Academy of Pediatrics as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.

  View details for DOI 10.1542/peds.2024-069091

  View details for PubMedID 39342415

• Characteristics of Young Children Associated with Diagnostic Utility of the Autism Diagnostic Observation Schedule: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Fussell, J. J., Stein, R. E., Friedman, S., Hansen, R., Roizen, N., Sideridis, G., Vanderbilt, D., Barbaresi, W. 2024; 46 (1): e10-e16

  Abstract

  The aim of this study is to identify characteristics of children for whom a developmental-behavioral pediatrician's (DBP) diagnostic impressions of autism spectrum disorder (ASD) or non-ASD were changed by Autism Diagnostic Observation Schedule (ADOS) results.A prospective study of children 1½ to <6 years consecutively referred to 8 sites for possible ASD. Cognitive/developmental, language, and adaptive testing varied, as each site followed its usual clinical approach. DBPs documented diagnosis as ASD or non-ASD and their degree of diagnostic certainty (1-10) pre- and post-ADOS. Cases where DBP diagnostic impression did not change after ADOS administration ("Stable Group," n = 314) were compared with those for whom it did change ("Changed Group," n = 35), followed by matched random sample comparisons.There were no significant differences in child characteristics (age, gender, race, ethnicity, insurance, caregiver education) between the Stable and Changed groups. DBPs' diagnostic certainty was significantly lower, both pre- and post-ADOS, in the Changed versus Stable group. Change was associated with milder symptoms of ASD and less impaired language. In an age- and gender-matched comparison, significant differences remained for diagnostic certainty and severity of social communication impairments. Cognitive scores were significantly higher in the Changed Group. Because of significantly higher caregiver education and a trend toward more privately insured children among the Changed Group, samples (n = 35 each) were then matched on those characteristics, revealing the same differences for diagnostic certainty, severity of ASD symptoms, and language skills.Young children with milder ASD symptoms and less impaired language may benefit most from the administration of the ADOS.

  View details for DOI 10.1097/DBP.0000000000001332

  View details for PubMedID 39620995

• Attention-Deficit/Hyperactivity Disorder in Medication Treated Preschool-Age Children Without and With Autism Spectrum Disorder: A Developmental-Behavioral Research Network Study. Journal of developmental and behavioral pediatrics : JDBP Friedman, S. L., Shults, J., Barbaresi, W., Bax, A., Cacia, J., Deavenport-Saman, A., LaRosa, A., Loe, I. M., Mittal, S., Vanderbilt, D. L., Blum, N., Harstad, E. 2024; 45 (4): e372-e377

  Abstract

  The study objective was to compare preschool children with attention-deficit/hyperactivity disorder without autism spectrum disorder (ADHD - ASD) with those with ADHD and ASD (ADHD + ASD), treated with stimulant or alpha-2-agonist (A2A) medications.Retrospective electronic health record review of 497 children from 7 developmental behavioral pediatrics research network sites. Children were younger than 72 months when treated with medication for ADHD from January 1, 2013, to January 7, 2017. We analyzed differences in children with ADHD - ASD versus ADHD + ASD treated with stimulants or A2As, including demographics, coexisting conditions, medication effectiveness, medication, discontinuation factors, and adverse effects.Of the 497 preschool-age children with ADHD, 389 had ADHD - ASD and 108 had ADHD + ASD. No statistically significant differences were found in demographics between the groups. At baseline, ADHD + ASD group reported more sleep problems. For the ADHD - ASD group, stimulant medication was significantly more effective than A2As; no significant differences were found in medication effectiveness of stimulants versus A2As for the ADHD + ASD group. Children with ADHD - ASD experienced more appetite suppression and stomachaches on stimulants. No associations were found between ASD status and rates of common adverse effects for children initiated on A2As.We found more similarities than differences when comparing ADHD - ASD preschool-age children with those with ADHD + ASD. For children with ADHD - ASD, stimulant medications were significantly more effective than A2As. Overall, there was notable overlap in presentation, response to medication, coexisting conditions, and effectiveness of medication classes.

  View details for DOI 10.1097/DBP.0000000000001286

  View details for PubMedID 40928807

• Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study. Journal of developmental and behavioral pediatrics : JDBP Wallis, K. E., Kennelly, A., Wozniak, S. N., Craig, S., Flaherty, C. M., Cacia, J., Christiansen, A., Cordero, L., Ortiz, P., Kellom, K. S., Stefanski, K. 2024; 45 (4): e378-e383

  Abstract

  Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic.We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed).A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83).At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.

  View details for DOI 10.1097/DBP.0000000000001290

  View details for PubMedID 39259268

• Challenges and Opportunities in High-Risk Infant Follow-Up: Progress from the 2022 Networking Session at the Pediatric Academic Societies. The Journal of pediatrics Neel, M. L., Bora, S., Brachio, S. S., Duncan, A., Vanderbilt, D., Benninger, K., Kendrick-Allwood, S., Maitre, N. L. 2024; 270: 113971

  View details for DOI 10.1016/j.jpeds.2024.113971

  View details for PubMedID 38479638

• Similar early intervention referral rates following in-person administration of the Bayley Scales of Infant and Toddler Development, 4th Edition versus Telehealth Administration of the Developmental Assessment in Young Children, 2nd Edition in the high-risk infant population EARLY HUMAN DEVELOPMENT Ke, J. C., Rezvan, P., Vanderbilt, D., Mirzaian, C. B., Deavenport-Saman, A., Smith, B. A. 2024; 190: 105971

  Abstract

  Infants with prematurity, low birthweight, and medical comorbidities are at high risk for developmental delays and neurodevelopmental disabilities and require close monitoring. Due to the COVID-19 pandemic, high-risk infant follow-up (HRIF) programs have adapted to perform developmental assessments via telehealth.Describe the referral rates to initiate, continue, or increase/add early intervention (EI) therapies based on in-person use of the Bayley Scales of Infant and Toddler Development, 4th Edition (BSID-IV) or telehealth use of the Developmental Assessment in Young Children, 2nd Edition (DAYC-2).A retrospective chart review was conducted on 203 patients seen in the HRIF program at an academic medical center in Southern California. Patients were divided into in-person (BSID-IV) and telehealth (DAYC-2) assessment groups. Statistical analyses were performed to describe demographic characteristics, medical information, and referral rates for EI therapies by the types of visits.The in-person and telehealth groups demonstrated similar demographic and clinical characteristics and comparable referral rates for initiating EI therapies. Telehealth patients already receiving therapies were recommended to increase/add EI therapies at a higher rate compared to in-person patients.The BSID-IV is widely used to assess for developmental delays in the high-risk infant population, but in-person administration of this tool poses limitations on its accessibility. Telehealth administration of an alternative tool, such as the DAYC-2, can lead to similar EI referral rates as in-person administration of the BSID-IV. Increased use of telehealth developmental assessments can promote timely detection of developmental delays and minimize gaps in healthcare access.

  View details for DOI 10.1016/j.earlhumdev.2024.105971

  View details for Web of Science ID 001186257500001

  View details for PubMedID 38367589

  View details for PubMedCentralID PMC12412277

• Hyperactivity and Impulsivity Symptoms Mediate the Association Between Adverse Childhood Experiences and Reading Achievement: A LONGSCAN Cohort Study CHILD PSYCHIATRY & HUMAN DEVELOPMENT Kallman, J., Mamey, M., Vanderbilt, D. L., Imagawa, K., Schonfeld, D. J., Deavenport-Saman, A. 2025; 56 (5): 1337-1348

  Abstract

  Adverse Childhood Experiences (ACEs) include various childhood stressors that can negatively impact the health and well-being of children. ACEs are associated with poor academic achievement. Attention is strongly associated with academic achievement, and there is a graded relationship between ACEs exposure and subsequent development of parent-reported ADHD; however, it is unclear whether ADHD symptoms mediate the relationship between ACEs and academic achievement. This study tested a model of mediation by ADHD symptoms between ACEs and academic achievement (measured by reading score). This retrospective cohort analysis utilized data from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN), a data consortium exploring the impact of child maltreatment (n = 494). There were relatively even numbers of male and female child participants, and the majority of caregivers were either non-Hispanic White or Black. Path analyses were modeled for ACEs as a sum score and separately for individual ACE exposures, with number of symptoms of Inattention (IN) and Hyperactivity/Impulsivity (H/I) as mediators, and academic achievement as the outcome, adjusting for covariates. ACEs were highly prevalent in this sample (M = 5.10, SD = 1.90). After retaining significant covariates, significant direct associations (P < .05) were seen between ACE sum score and IN (β = .14) and H/I (β = .21), and between H/I and reading score (β=-.14). A higher ACE score was associated with lower reading scores through variation in H/I, but not IN. H/I mediated the relationship between ACEs and reading score in this high-risk population, providing new insight into relationships between ACEs and academic achievement, which can inform interventions.

  View details for DOI 10.1007/s10578-023-01655-1

  View details for Web of Science ID 001130303900001

  View details for PubMedID 38141152

  View details for PubMedCentralID 6248156

• Addressing Early Education and Child Care Expulsion. Pediatrics Williams, P. G., Yogman, M. 2023; 152 (5)

  Abstract

  An important goal of early childhood education is teaching emotional self-regulation within the context of a safe, stable, nurturing environment. Expulsion of young children ignores underlying emotional and behavioral concerns, disproportionately affects children of color (Black or Hispanic), males, children with disabilities, and socioeconomically disadvantaged populations, and has long-term consequences on educational and life success. Addressing implicit bias and providing child mental health consultation (psychologists, social workers, developmental behavioral pediatricians, child psychiatrists, and child neurologists) to child care providers can prevent expulsion. Pediatricians and other providers within the medical home play an important part in preventing expulsion. However, pediatricians need more training in early childhood mental health and in understanding how systemic racism and implicit bias lead to preschool expulsion in children of color. By identifying children at risk for expulsion because of poverty, racial discrimination, toxic stress, insecure attachment, or history of trauma, the pediatrician can connect families with community resources that may ameliorate these effects. Pediatricians can provide information on social-emotional development in early childhood, promote positive parent-child relationships, and model and discuss age-appropriate and developmentally appropriate behavior management. Pediatricians can also guide parents toward high-quality child care programs that use mental health consultation and developmentally appropriate activities, both of which lessen the chance of child expulsion. Furthermore, behavioral health providers integrated into the medical home can provide consultation to child care providers on managing patients. These recommendations are consistent with our knowledge of early child brain development and support the current tenets of the American Academy of Pediatrics regarding the pediatrician's role in building resilience and buffering toxic stress to promote optimal child development.

  View details for DOI 10.1542/peds.2023-064049

  View details for PubMedID 37899732

• Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study JOURNAL OF ATTENTION DISORDERS Han, J., Koser, K., Mamey, M., Vanderbilt, D. L., Schonfeld, D. J., Yin, L., Deavenport-Saman, A. 2024; 28 (2): 127-138

  Abstract

  To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation.This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates.Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents.These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.

  View details for DOI 10.1177/10870547231205028

  View details for Web of Science ID 001095186400001

  View details for PubMedID 37905519

• Receipt of Behavioral Therapy in Preschool-Age Children with ADHD and Coexisting Conditions: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Mittal, S., Bax, A., Blum, N. J., Shults, J., Barbaresi, W., Cacia, J., Deavenport-Saman, A., Friedman, S., LaRosa, A., Loe, I. M., Tulio, S., Vanderbilt, D., Harstad, E., DBPNet Steering Committee, DBPNet Steering Committee 2023

  Abstract

  OBJECTIVE: Practice guidelines from the American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics recommend evidence-based behavioral therapy (BT) as first-line treatment for preschool-age children with ADHD, prior to medication initiation. Thus, this study's objective is to present the frequency of physician-documented receipt of BT in preschool-age children with ADHD prior to medication initiation and to determine factors associated with receipt BT receipt.METHODS: This retrospective medical record review was conducted across 7 Developmental Behavioral Pediatrics Research Network (DBPNet) sites. Data were abstracted for children <72 months old seen by a DBP clinician and initiated on ADHD medication between 1/1/2013-7/1/2017. From narrative text of the medical records, BT receipt was coded as: parent training in behavior management (PTBM), Applied Behavior Analysis (ABA), other, or did not receive.RESULTS: Of the 497 children in this study; 225 children (45%) had reported receipt of any BT prior to ADHD medication initiation, with 15.9% (n = 79) receiving PTBM. Children with co-existing diagnoses of ASD or disruptive behavior disorder were more likely to receive BT than children without co-existing conditions (59.3% vs 69.0% vs 30.6%). There was significant site variability in reported receipt of BT, ranging from 22.4% to 74.1%, and sex and insurance were not associated with BT rates.CONCLUSION: The percentage of children with documented receipt of any BT, and particularly PTBM, was low across all sites and co-existing conditions. These findings highlight the universal need to increase receipt of evidence-based BT for all young children with ADHD.

  View details for DOI 10.1097/DBP.0000000000001216

  View details for PubMedID 37751569

• Do Externalizing and Internalizing Symptoms Moderate Medication Response in Preschool Attention-Deficit/Hyperactivity Disorder? A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Blum, N. J., Shults, J., Barbaresi, W., Bax, A., Cacia, J., Deavenport-Saman, A., Friedman, S., Loe, I. M., Mittal, S., Vanderbilt, D., LaRosa, A., Harstad, E. 2023; 44 (7): e447-e454

  Abstract

  This study aimed to determine whether parent ratings of attention-deficit/hyperactivity disorder (ADHD) symptom severity or externalizing symptoms (EXT) or internalizing symptoms (INT) moderate response to stimulants (STIM) and alpha-2 adrenergic agonists (A2As) in preschool ADHD.Health records for children treated with medication for ADHD and with parent rating scale data available (N = 309; age <72 months) were reviewed at 7 Developmental-Behavioral Pediatric Research Network sites. Severity of ADHD was defined as the number of ADHD symptoms occurring often or very often on DSM-IV-based parent rating scales. EXT or INT from standardized rating scales were categorized as T score <60, 60 to <70, or ≥70. Ordinal logistic regression models predicting response to medication were calculated.The median (interquartile range) age at ADHD diagnosis was 59 (54-65) months. One hundred eighty-three participants had ADHD symptom severity, and 195 had EXT or INT data. ADHD severity was not associated with medication response. Both EXT and INT were associated with medication response but with significant medication class by EXT/INT interactions. Children with higher EXT were less likely to respond to STIM, with percentage of nonresponders for T-score categories <60, 60 to <70, and ≥70 being 3.6%, 25.7%, and 33.3% (p = 0.016) and, for A2As, being 60%, 50%, and 33.3% (p = 0.55), respectively. A similar pattern was observed for INT categories: STIM 19.4%, 22.5%, and 50.0% (p = 0.002) and A2As 42.3%, 30%, and 42.3% (p = 0.48), respectively.For preschool ADHD, low ratings of EXT or INT are associated with a high likelihood of response to STIM. By contrast, response rates to STIM and A2As are more similar for children with high levels of EXT or INT.

  View details for DOI 10.1097/DBP.0000000000001209

  View details for PubMedID 37696030

• "She Is Stand-Offish Like That": Black Adults' Recognition of Child Behaviors Associated with Autism Spectrum Disorder JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Ashby, D., Yin, L., Jones, F., Wright, A., Williams, H., Williams, C., Deavenport-Saman, A., Vanderbilt, D., Solomon, O. 2023; 44 (7): E486-E492

  Abstract

  The purpose of this study is to identify the sociocultural factors in the Black community that contribute to a delay in identification of Black children with autism spectrum disorder (ASD).Four focus groups with parents of typically developing children were conducted at 2 Black Churches using a community-partnered participatory research approach and the socioecological model. Participants completed sociodemographic surveys, viewed CDC Autism Training Videos of Black children with ASD, and reported on their behavioral observations. Focus groups were audio recorded and transcribed. Thematic data analysis was conducted using NVivo software.At the individual level, participants interpreted ASD-associated behaviors as a problem of timing of developmental milestones in the course of normative development rather than a sign of a disorder and positive and negative characteristics. At the interpersonal level, the role of grandparents and extended family was important for monitoring child development. At the organizational level, racial concordance with health care providers was seen as critical because of historical mistrust. At the community level, fear of racism and child protective services and inequitable care emerged. At the policy level, there were concerns about access to affordable, high-quality care.This study provides insight into the sociocultural factors in the faith-based Black community that may contribute to a delay in identification of Black children with ASD. Health care professionals need additional training to effectively serve Black children and families in the face of historical mistrust and health care inequity.

  View details for DOI 10.1097/DBP.0000000000001205

  View details for Web of Science ID 001065801300006

  View details for PubMedID 37556597

• Exploring Racial and Ethnic Differences in Parent-Reported Strengths in Children with Autism Spectrum Disorder JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES Johnson, K., Deavenport-Saman, A., Mamey, M., Sabapathy, T., Schrager, S. M., Vanderbilt, D. L. 2024; 11 (3): 1643-1650

  Abstract

  Several studies have demonstrated racial/ethnic differences in parental concerns in children with autism spectrum disorder (ASD). However, no studies have investigated racial/ethnic differences in parent-reported strengths. The purpose of this study was to explore racial/ethnic differences in parent-reported strengths in children with ASD.This was a retrospective cross-sectional study investigating the relationship between parent-reported strengths and race/ethnicity at the time of an ASD diagnosis. Parent-reported strengths were qualitatively clustered into themes, and theme frequencies were quantitatively examined for relationships to race/ethnicity.Parents of Caucasian children reported a mean of 5.00 (SD = 2.17) total strengths compared to 3.75 (SD = 2.32) among Hispanic/Latinx children, 3.36 (SD = 1.43) among Asian/PI children, and 3.91 (SD = 2.05) among children from other races/ethnicities. Bivariate linear regression analyses indicated that Asian/PI, Hispanic, and other child race/ethnicity, compared to Caucasian child race/ethnicity, were associated with significantly fewer parent-reported total strengths. Asian/PI and Hispanic child race/ethnicity were associated with significantly fewer personality strengths, while maternal education was associated with a greater number of personality strengths.This study found racial and ethnic differences in parent-reported strengths in children with ASD. Further, higher levels of maternal education influenced total, personality, and behavioral strengths. Receipt of a greater number of child services was also associated with a greater number of behavioral strengths.

  View details for DOI 10.1007/s40615-023-01639-w

  View details for Web of Science ID 000999514600001

  View details for PubMedID 37261713

  View details for PubMedCentralID 4500845

• Barcoding, linear and nonlinear analysis of full-day leg movements in infants with typical development and infants at risk of developmental disabilities: Cross-sectional study. Infancy : the official journal of the International Society on Infant Studies Deng, W., Marmelat, V., Vanderbilt, D. L., Gennaro, F., Smith, B. A. 2023; 28 (3): 650-666

  Abstract

  Traditional methods do not capture the multidimensional domains and dynamic nature of infant behavioral patterns. We aim to compare full-day, in-home leg movement data between infants with typical development (TD) and infants at risk of developmental disabilities (AR) using barcoding and nonlinear analysis. Eleven infants with TD (2-10 months) and nine infants AR (adjusted age: 2-14 months) wore a sensor on each ankle for 7 days. We calculated the standard deviation for linear variability and sample entropy (SampEn) of leg acceleration and angular velocity for nonlinear variability. Movements were also categorized into 16 barcoding states, and we calculated the SampEn and proportions of the barcoding. All variables were compared between the two groups using independent-samples t-test or Mann-Whitney U test. The AR group had larger linear variability compared to the TD group. SampEn was lower in the AR group compared to TD group for both acceleration and angular velocity. Two barcoding states' proportions were significantly different between the two groups. The results showed that nonlinear analysis and barcoding could be used to identify the difference of dynamic multidimensional movement patterns between infants AR and infants with TD. This information may help early diagnosis of developmental disabilities in the future.

  View details for DOI 10.1111/infa.12537

  View details for PubMedID 36921012

  View details for PubMedCentralID PMC10257934

• Does ADHD Severity, Externalizing, or Internalizing Symptoms Moderate Medication Response in Preschool Aged Children with ADHD? A DBPNet Study Blum, N. J., Shults, J., Cacia, J., Barbaresi, W., Mittal, S., Loe, I., Deavenport-Saman, A., Bax, A., Friedman, S., Vanderbilt, D., LaRosa, A., Harstad, E. LIPPINCOTT WILLIAMS & WILKINS. 2023: E168

  View details for Web of Science ID 001002197500056

• Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-Age ADHD: A DBPNet Study. The Journal of pediatrics Loe, I. M., Blum, N. J., Shults, J., Barbaresi, W., Bax, A., Cacia, J., Deavenport-Saman, A., Friedman, S., LaRosa, A., Mittal, S., Vanderbilt, D., Harstad, E. 2023

  Abstract

  To characterize and compare the type and frequency of a range of common and uncommon adverse effects (AE) associated with α-2 adrenergic agonist (A2A) and stimulant treatment of ADHD at preschool-age. To evaluate the impact of age on common AE.Retrospective electronic medical record review of children <72 months of age (N=497) evaluated at outpatient developmental-behavioral pediatric (DBP) practices at 7 US academic medical centers within the Developmental-Behavioral Pediatrics Research Network (DBPNet). Data on AE were abstracted for children who had treatment initiated by DBP with an A2A or stimulant medication between January 2013 and July 2017; follow-up was complete by February 2019.A2A and stimulants had distinctive AE profiles. A2A compared with stimulants had a higher proportion with daytime sleepiness and headaches; stimulants had significantly higher proportions for most other AE, including moodiness/irritability, difficulty with sleep, appetite suppression, stomachaches, skin picking/repetitive behaviors, withdrawn behavior, and weight loss. Younger age was associated with disruptive behavior and difficulty with sleep.Stimulants had a higher rate of most AE compared with A2A. AE profiles, together with efficacy, should inform clinical decision-making. Prospective randomized clinical trials are needed to fully compare efficacy and AE profiles of A2A and stimulants.

  View details for DOI 10.1016/j.jpeds.2023.01.004

  View details for PubMedID 36649794

• Clinician Diagnostic Certainty and the Role of the Autism Diagnostic Observation Schedule in Autism Spectrum Disorder Diagnosis in Young Children. JAMA pediatrics Barbaresi, W., Cacia, J., Friedman, S., Fussell, J., Hansen, R., Hofer, J., Roizen, N., Stein, R. E., Vanderbilt, D., Sideridis, G. 2022; 176 (12): 1233-1241

  Abstract

  Autism spectrum disorder (ASD) affects 1 in 44 children. The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured observation developed for use in research but is considered a component of gold standard clinical diagnosis. The ADOS adds time and cost to diagnostic assessments.To evaluate consistency between clinical diagnosis (index ASD diagnosis) and diagnosis incorporating the ADOS (reference standard ASD diagnosis) and to examine clinician and child factors that predict consistency between index diagnoses and reference standard diagnoses.This prospective diagnostic study was conducted between May 2019 and February 2020. Developmental-behavioral pediatricians (DBPs) made a diagnosis based on clinical assessment (index ASD diagnosis). The ADOS was then administered, after which the DBP made a second diagnosis (reference standard ASD diagnosis). DBPs self-reported diagnostic certainty at the time of the index diagnoses and reference standard diagnoses. The study took place at 8 sites (7 US and 1 European) that provided subspecialty assessments for children with concerns for ASD. Participants included children aged 18 months to 5 years, 11 months, without a prior ASD diagnosis, consecutively referred for possible ASD. Among 648 eligible children, 23 refused, 376 enrolled, and 349 completed the study. All 40 eligible DBPs participated.ADOS administered to all child participants.Index diagnoses and reference standard diagnoses of ASD (yes/no).Among the 349 children (279 [79.7%] male; mean [SD] age, 39.9 [13.4] months), index diagnoses and reference standard diagnoses were consistent for 314 (90%) (ASD = 250; not ASD = 64) and changed for 35. Clinician diagnostic certainty was the most sensitive and specific predictor of diagnostic consistency (area under curve = 0.860; P < .001). In a multilevel logistic regression, no child or clinician factors improved prediction of diagnostic consistency based solely on clinician diagnostic certainty at time of index diagnosis.In this prospective diagnostic study, clinical diagnoses of ASD by DBPs with vs without the ADOS were consistent in 90.0% of cases. Clinician diagnostic certainty predicted consistency of index diagnoses and reference standard diagnoses. This study suggests that the ADOS is generally not required for diagnosis of ASD in young children by DBPs and that DBPs can identify children for whom the ADOS may be needed.

  View details for DOI 10.1001/jamapediatrics.2022.3605

  View details for PubMedID 36251287

  View details for PubMedCentralID PMC9577880

• Correlation between performance and quantity/variability of leg exploration in a contingency learning task during infancy INFANT BEHAVIOR & DEVELOPMENT Deng, W., Sargent, B., Havens, K., Vanderbilt, D., Rosales, M., Pulido, J., Mataric, M. J., Smith, B. A. 2023; 70: 101788

  Abstract

  Quantity and quality of motor exploration are proposed to be fundamental for infant motor development. However, it is still not clear what types of motor exploration contribute to learning. To determine whether changes in quantity of leg movement and/or variability of leg acceleration are related to performance in a contingency learning task, twenty 6-8-month-old infants with typical development participated in a contingency learning task. During this task, a robot provided reinforcement when the infant's right leg peak acceleration was above an individualized threshold. The correlation coefficient between the infant's performance and the change in quantity of right leg movement, linear variability, and nonlinear variability of right leg movement acceleration from baseline were calculated. Simple linear regression and multiple linear regression were calculated to explain the contribution of each variable to the performance individually and collectively. We found significant correlation between the performance and the change in quantity of right leg movement (r = 0.86, p < 0.001), linear variability (r = 0.71, p < 0.001), and nonlinear variability (r = 0.62, p = 0.004) of right leg movement acceleration, respectively. However, multiple linear regression showed that only quantity and linear variability of leg movements were significant predicting factors for the performance ratio (p < 0.001, adjusted R2 = 0.94). These results indicated that the quantity of exploration and variable exploratory strategies could be critical for the motor learning process during infancy.

  View details for DOI 10.1016/j.infbeh.2022.101788

  View details for Web of Science ID 000900781900010

  View details for PubMedID 36399847

• Leg Movement Rate before and after a Caregiver-Provided Intervention for Infants at Risk of Developmental Disability: A Pilot Study. Physical & occupational therapy in pediatrics Rosales, M. R., Deng, W., Nishiyori, R., Vanderbilt, D. L., Smith, B. A. 2022; 42 (3): 259-274

  Abstract

  Our purpose was to assess daily leg movement rate before and after a caregiver-provided in-home intervention for infants at risk for developmental disability. We also assessed adherence and quality of caregiver-child interaction.Twelve infants, at risk for developmental disabilities, and their caregivers participated in an intervention focused on increasing leg movements. Intervention started between 3- and 6-months corrected age and ended once the infant was able to sit independently or at 9 months corrected age, whichever occurred first. Infants were assessed monthly.Infants at risk for developmental disabilities who were moving less than 1200 leg movements per hour awake at the start of the intervention increased their daily leg movement rate following the intervention (Median [range]: pre-1047 [506-1056], post- 1104 [655-1359], p = 0.040). Additionally, the caregivers had a high adherence (Median: 89%, Range: 11.43%-329.17%) and good quality of caregiver-child interaction (Median NCAST total: 46, Range: 34-59); and maintained similar amounts of adherence (p = 0.575) and quality of caregiver-child interaction (p = 0.432) throughout the intervention.This study provides preliminary evidence that leg movement rate has the potential to be used as an outcome measure to assess an infant's progress and motor practice during an intervention.

  View details for DOI 10.1080/01942638.2021.1986615

  View details for PubMedID 34641749

• Factor Analysis of the Einstein Neonatal Neurobehavioral Assessment Scale in Infants with Congenital Heart Disease and Healthy Controls. Journal of child neurology Tran, N. N., Desai, J., Votava-Smith, J. K., Brecht, M. L., Vanderbilt, D. L., Panigrahy, A., Mackintosh, L., Brady, K. M., Peterson, B. S. 2022; 37 (10-11): 851-863

  Abstract

  Background: Administration of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) can be time-consuming, and items can be highly correlated. We aimed to determine: (1) its factor analytic structure; (2) the validity of the factor structure; and (3) the associations of physiologic measures with factor scores. Methods: A factor analysis reduced 21 ENNAS items into 5 factors in 57 congenital heart disease (CHD) and 35 healthy infants. Multiple linear regressions examined the association of factor scores with group, gestational age, and physiologic variables. Results: 5-factor solution: 1 (Orienting Reflex), 2 (Extensor Axial Tone), 3 (Primitive Reflexes), 4 (Flexor Tone), 5 (Reflexive Tone Around Extremity Joints). Moderate to strong evidence supported: face, discriminant, and construct validity of these factors, with Factor 2 having the strongest. Conclusions: Components of Factor 2 may provide similar information about neonatal development, thus reducing the time for and burden of administration for researchers and clinicians.

  View details for DOI 10.1177/08830738221115982

  View details for PubMedID 35918821

  View details for PubMedCentralID PMC9561959

• Trial of Erythropoietin for Hypoxic-Ischemic Encephalopathy in Newborns. The New England journal of medicine Wu, Y. W., Comstock, B. A., Gonzalez, F. F., Mayock, D. E., Goodman, A. M., Maitre, N. L., Chang, T., Van Meurs, K. P., Lampland, A. L., Bendel-Stenzel, E., Mathur, A. M., Wu, T., Riley, D., Mietzsch, U., Chalak, L., Flibotte, J., Weitkamp, J., Ahmad, K. A., Yanowitz, T. D., Baserga, M., Poindexter, B. B., Rogers, E. E., Lowe, J. R., Kuban, K. C., O'Shea, T. M., Wisnowski, J. L., McKinstry, R. C., Bluml, S., Bonifacio, S., Benninger, K. L., Rao, R., Smyser, C. D., Sokol, G. M., Merhar, S., Schreiber, M. D., Glass, H. C., Heagerty, P. J., Juul, S. E., HEAL Consortium, Juul, S. E., Wu, Y. W., Heagerty, P. J., Ahmad, K. A., Baserga, M., Bendel-Stenzel, E., Benninger, K. L., Chalak, L., Chang, T., Flibotte, J., Gonzalez, F. F., Lampland, A. L., Maitre, N. L., Mathur, A. M., Mayock, D. E., Merhar, S., Mietzsch, U., Poindexter, B. B., Rao, R., Riley, D., Smyser, C. D., Sokol, G. M., Van Meurs, K. P., Weitkamp, J., Wu, T., Yanowitz, T. D., Agthe, A. G., Andescavage, N., Bonifacio, S., Chapman, R., Dysart, K., Eichenwald, E., Engelstad, L., Ferriero, D. M., Gano, D., Glass, H. C., Henderson, C., Hintz, S., Ho, E., Isaza, N., Jackson, C., Jackson, L., Johnson, Y., Lawrence, R., Machie, M., Mahmood, B., Massaro, A., Miller, C., Morris, E. A., Morris, H. F., Naik, M., Nedrelow, J., Neumaier, J. R., O'Donnell, B., Rogers, E. E., Sanchez, P. J., Shepherd, J., Thomas, J., Tsuchida, T., Vesoulis, Z., Vijayamadhavan, V., Winter, S., Bataglia, K., Batterson, N., Bernstein, B., Blankenship, S., Burrows, F., Christopher, L., Corrales, A., Cunningham, S., D'Agostino, J. A., DeAnda, M., DeBattista, A., Demauro, S. B., Drury, G., Duncan, A. F., ElTers, N., Neis Farrell, C., Fierro, M., Forero, N., Frey, C., Blanc Friedman, K., Friedman, S., Fuller, J., George, T., Gerdes, M., German, A., German, K., Gogliotti, S., Goldenshteyn, M., Goode, R. H., Haman, M., Hawthorne, C., Hay, A., Hayden, Y., Heyne, R., Hines, A., Hoffman, C., Hutchon, B., Jensen, E., Johnson, B., Keener, K., Kramer, A., Krueger, C., Lawrence, A., Lee, M., Lehman, K., Liebowitz, M., Liggett, M., Lorenzi-Quigley, L., Lundequam, P., Malmud, E., McCall, S., McHugh, K., Morshedzadeh, G., Mouvery, A. L., Myers, E., Natarajan, N., Neel, M. L., Nelin, M. A., Oakes, C., Patel, J., Pietruszewski, L., Plummer, E., Powers, D. A., Rapoport, R., Rauda, H., Rick, L., Scott, L., Siqveland, E., Slaughter, L. A., Stonebraker, L., Stout, K., Stuart, A., Taylor, H., Tolentino-Plata, K., Vanderbilt, D., Vecchiarelli, J., Vierling, A. N., Wager, N., Watkins, D., Wing, S., Wolfe-Christensen, C., Zorn, E., Autelli, V., Baker, S., Ball, B., Barton, A., Bassett, K., Cole Bledsoe, L., Boyle, F., Clopp, B., Corry, K., Drummond, M., Dudley, J., Espinoza, A., Esposito, I., Feltner, J., Fine, D., Fisher, M., Gossett, A., Grisby, C., Hauge, S., Houston, K., Kaletka, B., Kleinman, S., Kohlleppel, K., Lee, L., Li, P., McGowan, M., Nelson, K., Nikirk, S., O'Kane, A., Oskoui, T., Purnell, J., Rakow, H., Rau, C., Reichert, E., Rogers, T., Roth, E., Sepulveda, P., Silvia, A., Stacey, S., Strait, E., Thomas, D., Toda-Eng, B., Weinberg, D. D., Wells, S., Widmayer, A., Worwa, C., Wuertz, S., Yarnell, A., Ziolkowski, K., Comstock, B. A., Heagerty, P. J., Konodi, M. A., Nefcy, C., Ballard, R., Goodman, A. M., Schreiber, M. D., Kuban, K. C., Lowe, J. R., O'Shea, T. M., Bluml, S., McKinstry, R. C., Panigrahy, A., Wisnowski, J. L., Bammler, T., Numis, A. L. 2022; 387 (2): 148-159

  Abstract

  BACKGROUND: Neonatal hypoxic-ischemic encephalopathy is an important cause of death as well as long-term disability in survivors. Erythropoietin has been hypothesized to have neuroprotective effects in infants with hypoxic-ischemic encephalopathy, but its effects on neurodevelopmental outcomes when given in conjunction with therapeutic hypothermia are unknown.METHODS: In a multicenter, double-blind, randomized, placebo-controlled trial, we assigned 501 infants born at 36 weeks or more of gestation with moderate or severe hypoxic-ischemic encephalopathy to receive erythropoietin or placebo, in conjunction with standard therapeutic hypothermia. Erythropoietin (1000 U per kilogram of body weight) or saline placebo was administered intravenously within 26 hours after birth, as well as at 2, 3, 4, and 7 days of age. The primary outcome was death or neurodevelopmental impairment at 22 to 36 months of age. Neurodevelopmental impairment was defined as cerebral palsy, a Gross Motor Function Classification System level of at least 1 (on a scale of 0 [normal] to 5 [most impaired]), or a cognitive score of less than 90 (which corresponds to 0.67 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition.RESULTS: Of 500 infants in the modified intention-to-treat analysis, 257 received erythropoietin and 243 received placebo. The incidence of death or neurodevelopmental impairment was 52.5% in the erythropoietin group and 49.5% in the placebo group (relative risk, 1.03; 95% confidence interval [CI], 0.86 to 1.24; P=0.74). The mean number of serious adverse events per child was higher in the erythropoietin group than in the placebo group (0.86 vs. 0.67; relative risk, 1.26; 95% CI, 1.01 to 1.57).CONCLUSIONS: The administration of erythropoietin to newborns undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy did not result in a lower risk of death or neurodevelopmental impairment than placebo and was associated with a higher rate of serious adverse events. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT02811263.).

  View details for DOI 10.1056/NEJMoa2119660

  View details for PubMedID 35830641

• Association of Coexisting Conditions, Attention-Deficit/Hyperactivity Disorder Medication Choice, and Likelihood of Improvement in Preschool-Age Children: A Developmental Behavioral Pediatrics Research Network Study. Journal of child and adolescent psychopharmacology Deavenport-Saman, A., Vanderbilt, D. L., Harstad, E., Shults, J., Barbaresi, W., Bax, A., Cacia, J., Friedman, S., LaRosa, A., Loe, I., Mittal, S., Blum, N. 2022

  Abstract

  Objectives: To determine whether conditions coexisting with attention-deficit/hyperactivity disorder (ADHD) in preschool-age children are associated with choice of stimulants or alpha-2 adrenergic agonists (A2As) and/or likelihood of improvement in ADHD symptoms. Methods: A retrospective electronic health record review of 497 children from 7 Developmental Behavioral Pediatrics Research Network (DBPNet) sites. Children were <72 months when treated with medication for ADHD from January 1, 2013 to July 1, 2017. We abstracted coexisting conditions, initial medication prescribed, and whether the medication was associated with improvement in symptoms. Analysis of improvement was adjusted for clustering by clinician and site. Results: The median (interquartile range) child age at the time of initiation of ADHD medication was 62 (54-67) months. The most common coexisting conditions included language disorders (40%), sleep disorders (28%), disruptive behavior disorders (22.7%), autism spectrum disorder (ASD; 21.8%), and motor disorders (19.9%). No coexisting conditions were present in 17.1%; 1 in 36.8%, 2 in 26.8%, and ≥3 in 19.3%. Stimulants were initially prescribed for 322 (64.8%) and A2A for 175 (35.2%) children. Children prescribed stimulants were more likely to have no coexisting conditions than those prescribed A2A (22.3% vs. 7.4%; p<0.001). Coexisting ASD and sleep disorder were associated with increased likelihood of starting A2As versus stimulants (p<0.0005; p=0.002). The association between medication treatment and improvement varied by number of coexisting conditions for 0, 1, 2, or ≥3, respectively (84.7%, 73.8%, 72.9%, 64.6%; p=0.031). Children with ≥3 coexisting conditions were less likely to respond to stimulants than children with no coexisting conditions (67.4% vs. 79.9%; p=0.037). Conclusions: Among preschool-age children with ADHD, those with ≥3 coexisting conditions were less likely to respond to stimulants than those with no coexisting conditions. This was not found for A2A, but further research is needed as very few children with no coexisting conditions were treated with A2A.

  View details for DOI 10.1089/cap.2022.0009

  View details for PubMedID 35787014

• The SIT-PT Trial Protocol: A Dose-Matched Randomized Clinical Trial Comparing 2 Physical Therapist Interventions for Infants and Toddlers With Cerebral Palsy PHYSICAL THERAPY Dusing, S. C., Harbourne, R. T., Hsu, L., Koziol, N. A., Kretch, K., Sargent, B., Jensen-Willett, S., McCoy, S., Vanderbilt, D. L. 2022; 102 (7)

  Abstract

  Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy.Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal.This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population.

  View details for DOI 10.1093/ptj/pzac039

  View details for Web of Science ID 000826637800003

  View details for PubMedID 35421222

  View details for PubMedCentralID PMC9291380

• Outcomes and Hand Use of Reaching Attempts: Comparison of Infants at Risk for Developmental Disability and Infants With Typical Development. Frontiers in psychology Remec, N., Zhou, J., Shida-Tokeshi, J., Pickering, T. A., Vanderbilt, D. L., Smith, B. A. 2022; 13: 712252

  Abstract

  Infants at risk for developmental disabilities often show signs of motor delay. Reaching is a skill that can help us identify atypical motor trajectories in early infancy. Researchers have studied performance after onset of reaching, but none have followed infants at risk from pre-reaching to skilled reaching.We assessed differences in reaching outcomes and hand use as reaching skill emerged in infants at risk for developmental disabilities and with typical development.We followed infants at risk for developmental disabilities (n = 11) and infants with typical development (n = 21) longitudinally as they developed reaching skill. Infants reached for a toy at midline while sitting in the caregiver's lap. Video data were coded for reach outcome (miss, touch, partial grasp, and whole-hand grasp) and hand use (right, left, and bilateral).Infants at risk had a larger proportion of missed reaches across visits compared to infants with typical development. Infants at risk also showed less variability in hand use when grasping over the study period.Our results provide information to support early differences in reaching performance to inform identification of typical and atypical developmental trajectories. Future studies should assess how the missed reaches are different and consider other quantitative measures of movement variability in infants at risk.

  View details for DOI 10.3389/fpsyg.2022.712252

  View details for PubMedID 35726268

  View details for PubMedCentralID PMC9206530

• Rates of connection to early intervention from the neonatal intensive care unit in a high risk infant follow-up program JOURNAL OF PERINATOLOGY Mirzaian, C. B., Ghadiali, T., Vestal, N., Song, A., Vanderbilt, D., Lakshmanan, A. 2022; 42 (10): 1412-1414

  View details for DOI 10.1038/s41372-022-01408-3

  View details for Web of Science ID 000798030700002

  View details for PubMedID 35589971

• Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample ACADEMIC PEDIATRICS Lakshmanan, A., Sunshine, I., Escobar, C. M., Kipke, M., Vanderbilt, D., Friedlich, P. S., Mirzaian, C. B. 2022; 22 (2): 253-262

  Abstract

  To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample.Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis.Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds.The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.

  View details for DOI 10.1016/j.acap.2021.10.006

  View details for Web of Science ID 000819728800015

  View details for PubMedID 34757023

  View details for PubMedCentralID PMC8901461

• Parental Leave for Residents and Pediatric Training Programs. Pediatrics Takagishi, J., Garagozlo, K. 2022; 149 (3)

  Abstract

  Residency and fellowship are unique occupational time periods for many early career physicians, generally consisting of long duty hours. Many early career physicians have or are in the process of building their families during this time period. The literature suggests many medical and psychosocial benefits of protected parental leave for both parents and children, which necessitates parental leaves of absence. The Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act. The length of leave has considerable variability among residency programs. This policy statement aims to navigate and outline the challenges of parental leave policies in training programs and to put forth recommendations to protect trainees and their families. The definition of families should also be expanded to include all types of families.

  View details for DOI 10.1542/peds.2021-055988

  View details for PubMedID 35224640

• Child, Clinician and Assessment Characteristics Associated with Consistency of Autism Diagnosis by Developmental-Behavioral Pediatricians: a DBPNet Study Barbaresi, W. J., Roizen, N., Stein, R., Fussell, J., Cacia, J., Friedman, S., Hansen, R., Hofer, J., Vanderbilt, D., Sideridis, G. LIPPINCOTT WILLIAMS & WILKINS. 2022: E119

  View details for Web of Science ID 000797424900035

• Risk Factors for Parenting Stress in Parents of Children Treated with Laser Surgery for Twin-Twin Transfusion Syndrome 2 Years Postpartum AMERICAN JOURNAL OF PERINATOLOGY Schifsky, K., Deavenport-Saman, A., Mamey, M., Sheth, N., Mirzaian, C. B., Schrager, S. M., Chmait, R. H., Vanderbilt, D. L. 2021; 38 (09): 944-951

  Abstract

  Twin-twin transfusion syndrome (TTTS) is a rare but serious condition that can occur in monochorionic and diamniotic twin pregnancies. Research indicates almost half of postpartum mothers with TTTS may have clinically significant levels of stress. However, no studies have measured the levels of parenting stress at 2 years postpartum, and little research has been conducted on sources of stress.A prospective cohort study was conducted. Data were collected from parents whose children were treated with laser ablation in utero and were 2 years old at the time of screening. The Parenting Stress Index - Short Form (PSI-SF) and its three subscales were used to collect data. Descriptive, bivariate, and multivariate analyses were conducted to determine significant predictors associated with each outcome.A total of 99 children from 56 families were enrolled. Unmarried status (B = -22.8; p = 0.039) and lower maternal educational level (B = -7.8; p = 0.01) were both significantly associated with higher PSI-SF total score.Subgroups of parents whose pregnancy required laser surgery for TTTS may continue to have clinically significant levels of stress at 2 years postpartum. It is important the health care team is aware of this and the sociodemographic risk factors to provide appropriate support for families.

  View details for DOI 10.1055/s-0040-1701194

  View details for Web of Science ID 000672945400011

  View details for PubMedID 31986541

• Neurodevelopmental outcome of monochorionic twins with selective intrauterine growth restriction (SIUGR) type II: laser versus expectant management. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Quintero, R., Kontopoulos, E., Williams, M. E., Sloop, J., Vanderbilt, D., Chmait, R. H. 2021; 34 (10): 1513-1521

  Abstract

  To compare the neurodevelopmental outcome of monochorionic-diamniotic twins (MCDA) with type II selective intrauterine growth restriction (SIUGR-II) managed in utero either expectantly or with laser.Postnatal neurodevelopmental assessment was conducted on the children of patients that had been antenatally diagnosed with SIUGR-II between 16 and 26 weeks gestational age (GA) and that had been randomly assigned to expectant management (EM) versus laser therapy (LT). The assessment was conducted by trained specialists using the Battelle Developmental Inventory (BDI-2). BDI-2 total and domain (adaptive, personal-social, communication, motor, and cognitive) composite scores for the appropriately grown (AGA) and growth-restricted (IUGR) twins were compared by treatment arm.Twenty patients diagnosed with SIUGR had undergone block randomization between two centers to either expectant management (EM) (6) or laser therapy (LT) (14). The mean (SD) GA at diagnosis was no different between the EM and LT groups [21.5 (2.0) versus 21.1 (2.8) weeks, p = .7414, respectively]. However, GA at delivery was significantly lower in the EM versus LT groups [28.3 (1.8) versus 33.4 (3.8) weeks, p = .0039]. At 6 months, all 20 AGA babies were alive, whereas only 3/6 (50%) of the IUGR babies in the EM group and 4/14 (29%) in the LT group were alive (p = .6126). One family in the EM group and two families in the LT group declined BDI-2 assessment. The mean (SD) age at BDI-2 assessment was no different between the EM and LT groups [75.6 (14.4) versus 70.7 (18.2) months, p = .5618, respectively]. For the AGA children, there were no significant differences in total BDI-2 scores for the EM versus LT [97.4 (10.4) versus 98.0 (19.6), p = .8741], nor in any of the domain composite scores. For the IUGR children, no statistically significant differences were detected in total BDI-2 scores between the EM and LT [72.0 (31.1) versus 92.8 (22.1), p = .643], nor in any of the domain composite scores. The comparison of standardized scores between the AGA and IUGR pairs was significantly different, but within the normal range.Neurodevelopmental outcomes for SIUGR-II MCDA twins were similarly favorable, whether managed expectantly or with laser treated. However, the significantly different GA at delivery (28.3 versus 33.4 weeks, p = .0039, expectant versus laser, respectively) may suggest improved outcomes in laser-treated patients in a larger cohort.

  View details for DOI 10.1080/14767058.2019.1638902

  View details for PubMedID 31309857

• Care of Adolescent Parents and Their Children. Pediatrics Powers, M. E., Takagishi, J. 2021; 147 (5)

  Abstract

  Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

  View details for DOI 10.1542/peds.2021-050919

  View details for PubMedID 33903162

• Preschool Attention-Deficit/Hyperactivity Disorder and Telephone Medication Management at Developmental-Behavioral Pediatric Network Sites. Journal of developmental and behavioral pediatrics : JDBP Harstad, E., Shults, J., Barbaresi, W., Bax, A., Cacia, J., Deavenport-Saman, A., Friedman, S., LaRosa, A., Loe, I., Mittal, S., Vanderbilt, D., Blum, N. 2021

  Abstract

  OBJECTIVE: To understand developmental-behavioral pediatricians' (DBPs') use of clinic versus telephone encounters for preschool attention-deficit/hyperactivity disorder (ADHD) medication management. Understanding use of telephone encounters for pharmacologic management of ADHD in preschoolers may inform care for children with ADHD.METHODS: DBP investigators within Developmental Behavioral Pediatrics Research Network abstracted data from medical records of 503 children aged younger than 72 months treated for ADHD with medication by a DBP clinician between January 1, 2013, and July 1, 2017, across 7 sites. We abstracted data about medication treatment episodes (defined as start and end/change of a specific type, dose, and frequency of ADHD medication) and encounter type (clinic vs telephone). We present descriptive statistics related to encounter types and chi2 analyses to compare frequencies across reasons for the end of treatment episode and across sites.RESULTS: The study included 503 participants with a total of 1734 treatment episodes. The initial medication was started via a clinic encounter 85.9% of the time and via telephone encounters 14.1% of the time. When evaluating reasons for end of treatment episode, decreases in dose/frequency of medication were less common for clinic versus telephone encounters (27% vs 73%; p < 0.001) and adding an additional medication was more common at clinic versus telephone encounters (64% vs 36% p < 0.001). Sites varied significantly in frequency of telephone encounters, ranging from 16.9% to 68.9% (mean 45.7%).CONCLUSION: Telephone encounters were used for pharmacologic management of ADHD in preschoolers to varying degrees across 7 DBP sites. These findings suggest that telephone management serves an important role in ADHD care.

  View details for DOI 10.1097/DBP.0000000000000919

  View details for PubMedID 33929397

• Navigating School-Based Special Education Services: A Self-Paced Virtual Learning Module. MedEdPORTAL : the journal of teaching and learning resources Ihyembe, D., Stager, K., Deavenport-Saman, A., Yang, J., Imagawa, K. K., Vanderbilt, D. L. 2021; 17: 11108

  Abstract

  Introduction: Children with disabilities are particularly vulnerable to school failure, as they are more likely than their peers to experience school dropout and academic struggles. Early identification of learning difficulties and access to special education services are critical to the success of children with disabilities. However, few pediatricians feel competent in screening for risks of school failure and/or assisting families with navigating the special education system. Due to restricted duty hours and limited scheduled didactic time during residency, flexible training options are needed to fill this educational gap and address this systems-based practice competency.Methods: We developed a 30-minute self-paced virtual learning module aimed at educating pediatric residents on strategies for navigating the special education system. The module used a knowledge, attitudes, and self-efficacy framework, as well as case examples and pictorial relationships to illustrate concepts. Wilcoxon signed rank tests were conducted to assess changes in total knowledge, attitude, and self-efficacy scores.Results: After completion of the module, residents' self-efficacy total scores significantly increased (r = .88, p = .001), suggesting that they were more confident in their ability to identify, recognize, and advocate for special education services.Discussion: This virtual learning module successfully increased resident self-efficacy in screening for school failure and navigating the special education system. This highly feasible, self-paced training module can be modified to fit demanding resident schedules and serves as a potential tool to teach trainees and other pediatric providers about the special education system.

  View details for DOI 10.15766/mep_2374-8265.11108

  View details for PubMedID 33655076

• Electroencephalography measures of relative power and coherence as reaching skill emerges in infants born preterm SCIENTIFIC REPORTS Nishiyori, R., Xiao, R., Vanderbilt, D., Smith, B. A. 2021; 11 (1): 3609

  Abstract

  Electroencephalography (EEG) measures of relative power and coherence are associated with motor experience in infants with typical development, but these relationships have not been assessed in infants born preterm. The goal of our study was to investigate the changing patterns of relative power and coherence in the alpha band during resting state EEG in infants born preterm as they developed the skill of reaching. We collected monthly longitudinal data from fourteen infants born preterm between the adjusted ages of 56 and 295 days for a total of 37 sessions of EEG data. Alpha band power at motor cortices and cross-regional connectivity do not present consistent changing trends at the group level in infants born preterm. Individual level analysis reveals that infants born preterm are a heterogeneous group with subtypes of neural function development, some presenting similar changing trends as observed in the typically developing group while others present atypical patterns. This may be linked to the variability in developmental outcomes in infants born preterm. This study was a critical first step to support EEG as a potential tool for identifying and quantifying the developmental trajectories of neuromotor control in infants born preterm.

  View details for DOI 10.1038/s41598-021-82329-7

  View details for Web of Science ID 000626725700013

  View details for PubMedID 33574372

  View details for PubMedCentralID PMC7878512

• Side Effects of Methylphenidate and Guanfacine in Preschoolers with ADHD: A DBPNet Study Loe, I., Barbaresi, W. J., Bax, A., Cacia, J., Deavenport-Saman, A., Friedman, S., LaRosa, A., Mittal, S., Shults, J., Tulio, S., Vanderbilt, D., Harstad, E., Blum, N. LIPPINCOTT WILLIAMS & WILKINS. 2021: S11-S12

  View details for Web of Science ID 000670615500043

• Methylphenidate More Effective Than Guanfacine in Preschoolers with ADHD: A DBPNet Study Harstad, E., Shults, J., Barbaresi, W. J., Bax, A., Cacia, J., Deavenport-Saman, A., Friedman, S., LaRosa, A., Loe, I., Mittal, S., Tulio, S., Vanderbilt, D., Blum, N. LIPPINCOTT WILLIAMS & WILKINS. 2021: S5

  View details for Web of Science ID 000670615500026

• Coexisting Conditions Related to Medication Use and Dose to Achieve Effectiveness in Preschoolers with ADHD: A DBPNet Study Deavenport-Saman, A., Vanderbilt, D. L., Harstad, E., Shults, J., Barbaresi, W. J., Bax, A., Cacia, J., Friedman, S. L., LaRosa, A., Loe, I., Mittal, S., Tulio, S., Blum, N. J. LIPPINCOTT WILLIAMS & WILKINS. 2021: S6

  View details for Web of Science ID 000670615500028

• Effect of home environment on academic achievement in child protective service-involved children: Results from the second national survey of child and adolescent well-being study CHILD ABUSE & NEGLECT Johnson, J., Perrigo, J. L., Deavenport-Saman, A., Wee, C., Imagawa, K., Schonfeld, D. J., Vanderbilt, D. 2021; 111: 104806

  Abstract

  Children involved with Child Protective Services (CPS) have been shown to have lower academic achievement. It is unclear whether certain qualities of the home environment can optimize academic achievement in this vulnerable population.This study sought to determine whether home environments with higher levels of emotional support and cognitive stimulation predict later academic achievement and whether this relationship is moderated by placement type (i.e. biological/adoptive parent care, kinship care, or non-kinship foster care).This study included 1,206 children from the second National Survey of Child and Adolescent Well-Being (NSCAW-II) who were involved with CPS between 2-7 years of age.Multivariate analyses were completed to examine the effect of the Home Observation for Measurement of the Environment (HOME) score on later Woodcock-Johnson III Tests of Achievement (WJ-ACH) scores. Moderation analyses were conducted to determine the effect of placement type on this relationship.Although these relationships between HOME scores and WJ-ACH scores were significant in bivariate analyses, they were not statistically significant in multivariate analyses, primarily due to the variable of household income. Although children placed primarily in non-kinship foster care demonstrated higher WJ-ACH scores for Passage Comprehension and Letter-Word Identification subscales, placement type did not appear to moderate the relationship between HOME scores and academic achievement.Child- and caregiver-level factors, as well as financial resources available in the environment, may account for the relationship between home environment and academic achievement.

  View details for DOI 10.1016/j.chiabu.2020.104806

  View details for Web of Science ID 000609882100020

  View details for PubMedID 33190848

  View details for PubMedCentralID PMC9358982

• Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study BMC PREGNANCY AND CHILDBIRTH Gateau, K., Song, A., Vanderbilt, D. L., Gong, C., Friedlich, P., Kipke, M., Lakshmanan, A. 2021; 21 (1): 48

  Abstract

  Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother's mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations.In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models.One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant's Vineland Adaptive Behavior Scales, second edition of - 9.08 (- 15.6, - 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of - 8.1 (- 12, - 3.9)(p < 0.01) and - 7.7 (- 12, - 3) (p = 0.01) respectively.More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted.

  View details for DOI 10.1186/s12884-020-03536-0

  View details for Web of Science ID 000609226400001

  View details for PubMedID 33435907

  View details for PubMedCentralID PMC7802207

• The association of care transitions measure-15 score and outcomes after discharge from the NICU BMC PEDIATRICS Yeh, A. M., Song, A. Y., Vanderbilt, D. L., Gong, C., Friedlich, P. S., Williams, R., Lakshmanan, A. 2021; 21 (1): 7

  Abstract

  Our objectives were (1) to describe Care Transitions Measure (CTM) scores among caregivers of preterm infants after discharge from the neonatal intensive care unit (NICU) and (2) to describe the association of CTM scores with readmissions, enrollment in public assistance programs, and caregiver quality of life scores.The study design was a cross-sectional study. We estimated adjusted associations between CTM scores (validated measure of transition) with outcomes using unconditional logistic and linear regression models and completed an E-value analysis on readmissions to quantify the minimum amount of unmeasured confounding.One hundred sixty-nine parents answered the questionnaire (85% response rate). The majority of our sample was Hispanic (72.5%), non-English speaking (67.1%) and reported an annual income of <$20,000 (58%). Nearly 28% of the infants discharged from the NICU were readmitted within a year from discharge. After adjusting for confounders, we identified that a positive 10-point change of CTM score was associated with an odds ratio (95% CI) of 0.74 (0.58, 0.98) for readmission (p = 0.01), 1.02 (1, 1.05) for enrollment in early intervention, 1.03 (1, 1.05) for enrollment in food assistance programs, and a unit change (95% CI) 0.41 (0.27, 0.56) in the Multicultural Quality of Life Index score (p < 0.0001). The associated E-value for readmissions was 1.6 (CI 1.1) suggesting moderate confounding.The CTM may be a useful screening tool to predict certain outcomes for infants and their families after NICU discharge. However, further work must be done to identify unobserved confounding factors such as parenting confidence, problem-solving and patient activation.

  View details for DOI 10.1186/s12887-020-02463-5

  View details for Web of Science ID 000606925000007

  View details for PubMedID 33397291

  View details for PubMedCentralID PMC7780380

• Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome. Prenatal diagnosis Rajagopalan, V., Ashouri, K., Llanes, A., Vanderbilt, D. L., Lepore, N., Bluml, S., Lai, H. A., Wisnowski, J., Chon, A. H., Chmait, R. H. 2021; 41 (2): 190-199

  Abstract

  Fetal magnetic resonance imaging (MRI) and spectroscopy (MRS) provide a unique opportunity to non-invasively measure markers of neurodevelopment in survivors of twin-twin transfusion syndrome (TTTS).To characterize fetal brain maturation after laser surgery for TTTS by measuring brain volumes and cerebral metabolite concentrations using fetal MRI + MRS.Prospective study of dual surviving fetuses treated with laser surgery for TTTS. At 4-5 postoperative weeks, fetal MRI was used together with novel image analysis to automatically extract major brain tissue volumes. Fetal MRS was used to measure major metabolite concentrations in the fetal brain.Twenty-one twin pairs were studied. The average (±SD) gestational age at MRI was 25.89 (±2.37) weeks. Total brain volume (TBV) was lower in the donors, although cerebral volumes were not different between twin pairs. Recipients showed lower proportions of cortical and cerebellar volumes, normalized to TBV and cerebral volumes. MRS data showed that biochemical differences between twin brains were related to discrepancy in their brain volumes.Although donors have a smaller TBV compared to recipients, proportionality of brain tissue volumes are preserved in donors. MRS maturational markers of fetal brain development show that recovery in donors persists 4 weeks after surgery.

  View details for DOI 10.1002/pd.5866

  View details for PubMedID 33191511

  View details for PubMedCentralID PMC8101071

• α2-Adrenergic Agonists or Stimulants for Preschool-Age Children With Attention-Deficit/Hyperactivity Disorder. JAMA Harstad, E. n., Shults, J. n., Barbaresi, W. n., Bax, A. n., Cacia, J. n., Deavenport-Saman, A. n., Friedman, S. n., LaRosa, A. n., Loe, I. M., Mittal, S. n., Tulio, S. n., Vanderbilt, D. n., Blum, N. J. 2021

  Abstract

  Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in approximately 2.4% of preschool-age children. Stimulants are recommended as first-line medication treatment. However, up to 25% of preschool-age children with ADHD are treated with α2-adrenergic agonist medications, despite minimal evidence about their efficacy or adverse effects in this age range.To determine the frequency of reported improvement in ADHD symptoms and adverse effects associated with α2-adrenergic agonists and stimulant medication for initial ADHD medication treatment in preschool-age children.Retrospective electronic health record review. Data were obtained from health records of children seen at 7 outpatient developmental-behavioral pediatric practices in the Developmental Behavioral Pediatrics Research Network in the US. Data were abstracted for 497 consecutive children who were younger than 72 months when treatment with an α2-adrenergic agonist or stimulant medication was initiated by a developmental-behavioral pediatrician for ADHD and were treated between January 1, 2013, and July 1, 2017. Follow-up was complete on February 27, 2019.α2-Adrenergic agonist vs stimulant medication as initial ADHD medication treatment.Reported improvement in ADHD symptoms and adverse effects.Data were abstracted from electronic health records of 497 preschool-age children with ADHD receiving α2-adrenergic agonists or stimulants. Median child age was 62 months at ADHD medication initiation, and 409 children (82%) were males. For initial ADHD medication treatment, α2-adrenergic agonists were prescribed to 175 children (35%; median length of α2-adrenergic agonist use, 136 days) and stimulants were prescribed to 322 children (65%; median length of stimulant use, 133 days). Improvement was reported in 66% (95% CI, 57.5%-73.9%) of children who initiated α2-adrenergic agonists and 78% (95% CI, 72.4%-83.4%) of children who initiated stimulants. Only daytime sleepiness was more common for those receiving α2-adrenergic agonists vs stimulants (38% vs 3%); several adverse effects were reported more commonly for those receiving stimulants vs α2-adrenergic agonists, including moodiness/irritability (50% vs 29%), appetite suppression (38% vs 7%), and difficulty sleeping (21% vs 11%).In this retrospective review of health records of preschool-age children with ADHD treated in developmental-behavioral pediatric practices, improvement was noted in the majority of children who received α2-adrenergic agonists or stimulants, with differing adverse effect profiles between medication classes. Further research, including from randomized clinical trials, is needed to assess comparative effectiveness of α2-adrenergic agonists vs stimulants.

  View details for DOI 10.1001/jama.2021.6118

  View details for PubMedID 33946100

• Child Temperament Outcomes After Laser Surgery for Twin-Twin Transfusion Syndrome. Journal of developmental and behavioral pediatrics : JDBP Chmait, H. R., Chon, A. H., Korst, L. M., Putnam, S. P., Llanes, A., Vanderbilt, D. L. 2021; 42 (1): 41-45

  Abstract

  Twin-twin transfusion syndrome (TTTS) is a severe pregnancy complication of monochorionic (identical) twins that results in markedly discordant in utero environments for each twin. The aim of this study was to test for differences in temperament between former donor (hypovolemic, smaller) and recipient (hypervolemic, larger) twins with TTTS.Parents of dual survivors aged 3 to 7 years who underwent in utero laser surgery for TTTS were surveyed using the Children's Behavior Questionnaire-Very Short Form (CBQ-VSF). The CBQ-VSF assessed 3 traits: Surgency, Negative Affect, and Effortful Control. Differences in traits between donor and recipients were assessed using a paired t test.We studied 85 twin pairs treated in utero for TTTS. There were no statistically significant differences in Surgency, Negative Affect, or Effortful Control between recipients and donors, although score differences for each trait varied widely among sibling pairs.Despite varied in utero environments, no temperament differences between donor and recipient monozygotic twins were found for the population as a whole. This finding may be of some reassurance to parents whose pregnancies are complicated by TTTS.

  View details for DOI 10.1097/DBP.0000000000000851

  View details for PubMedID 32858578

• Collecting Infant Environmental and Experiential Data Using Smartphone Surveys. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association Rosales, M. R., Rohloff, P., Vanderbilt, D. L., Tripathi, T., Valentini, N. C., Dusing, S., Smith, B. A. 2021; 33 (1): 47-49

  Abstract

  We propose that the collection of infant experiential and environmental data using smartphone surveys has the potential to fill a gap in foundational and clinical knowledge. To achieve this, these data need to be collected in a systematic way that is translatable globally. We can then begin to understand differences in child development and physical therapy from a variety of cultures and traditions. An infant's development is shaped by experiences in everyday life, and everyday experiences vary around the world. Hence, it is important to quantify these experiences to better understand variability in developmental trajectories. Recent increase in smartphone access has made the capability of collecting infant experiential data more feasible around the world. We provide examples and suggestions for ways in which experiential and environmental data can be collected for future practice.

  View details for DOI 10.1097/PEP.0000000000000766

  View details for PubMedID 33337776

• Beyond the neonatal intensive care unit: the impact of preterm birth. Developmental medicine and child neurology Lakshmanan, A., Smith, B. A., Vanderbilt, D. L. 2020; 62 (10): 1117-1118

  View details for DOI 10.1111/dmcn.14620

  View details for PubMedID 32633827

• How Many Days are Necessary to Represent Typical Daily Leg Movement Behavior for Infants at Risk of Developmental Disabilities? Sensors (Basel, Switzerland) Deng, W., Nishiyori, R., Vanderbilt, D. L., Smith, B. A. 2020; 20 (18)

  Abstract

  Movement characteristics can differentiate between infants at risk and infants with typical development. However, it is unknown how many days are needed to accurately represent typical daily behavior for infants at risk of developmental disabilities when using wearable sensors. To consider the balance between participant burden and the amount of data collected and optimizing the efficiency of data collection, our study determined (1) how many days were necessary to represent typical movement behavior for infants at risk of developmental disabilities and (2) whether movement behavior was different on weekend days and weekdays.We used Opal wearable sensors to collect at least 5 days of 11 infants' leg movement data. The standard (average of 5 days) was compared with four methods (average of the first 1/2/3/4 days) using the Bland-Altman plots and the Spearman correlation coefficient. We also compared the data from the average of 2 weekend days to the average of the first 2 weekdays for 8 infants.The Spearman correlation coefficient comparing the average of the first 2 days of data and the standards were all above 0.7. The absolute differences between them were all below 10% of the standards. The Bland-Altman plots showed more than 90% of the data points comparing the average of 2 days and the standards fell into the limit of agreement for each variable. The absolute difference between weekend days and weekdays for the leg movement rate, duration, average acceleration, and peak acceleration was 15.2%, 1.7%, 6.8% and 6.3% of the corresponding standard, respectively.Our results suggest 2 days is the optimal amount of data to represent typical daily leg movement behavior of infants at risk of developmental disabilities while minimizing participant burden. Further, leg movement behavior did not differ distinctly across weekend days and weekdays. These results provide supportive evidence for an efficient amount of data collections when using wearable sensors to evaluate movement behavior in infants at risk of developmental disabilities.

  View details for DOI 10.3390/s20185344

  View details for PubMedID 32961954

  View details for PubMedCentralID PMC7570480

• Assessing the Quality of the Systems of Care for Children with Congenital Zika Virus Infection and Other Neurodevelopmental Disabilities in the United States Pacific Island Territories. Hawai'i journal of health & social welfare Zai, T., Yasuda, P. M., Rao, S., Iizumi, S., Vanderbilt, D. L., Deavenport-Saman, A. 2020; 79 (9): 279-284

  Abstract

  Congenital Zika virus (ZIKV) infection can cause lifelong medical and developmental conditions and management needs. There is limited information on the strengths and weaknesses of the systems of care for addressing ZIKV and other neurodevelopmental disabilities (NRD) in the United States (US) Affiliated Pacific Island Territories. Therefore, the purpose of the study was to assess the quality of the chronic illness systems of care for children with congenital ZIKV and other NRD in the US Pacific Island Territories. A cross-sectional study was conducted among health professionals from American Samoa, Guam, and Commonwealth of the Northern Mariana Islands. Participants completed an adapted version of the Assessment of Chronic Illness Care 3.5 (ACIC), which is based on the Chronic Care Model. The median Total Program Score was calculated, which ranged from limited support (0-2), basic support (3-5), reasonably good support (6-8), to fully developed support for care (9-11). Among the 17 health professionals who completed the survey, 47% were Guamanian/Chamorro, 24% were Samoan, 12% were Filipino, and 6% were Other Pacific Islanders. The median (25th percentile, 75th percentile [interquartile range]) Total Program Score was 5 (3, 6 [3]), indicating basic support for ZIKV and other NRD care for children. As more is learned about the full spectrum of clinical findings related to ZIKV, it is critical to continue to build an interdisciplinary maternal and child health workforce with the capacity and preparation to adequately address the special needs of children with ZIKV and other NRD.

  View details for PubMedID 32914095

• Maternal Depressive Symptoms and Developmental Delay at Age 2: A Diverse Population-Based Longitudinal Study MATERNAL AND CHILD HEALTH JOURNAL Chorbadjian, T., Deavenport-Saman, A., Higgins, C., Chao, S., Yang, J. H., Koolwijk, I., Vanderbilt, D. L. 2020; 24 (10): 1267-1277

  Abstract

  Children raised by depressed mothers perform lower on measures of cognitive, emotional, and behavioral skills, compared to children of non-depressed mothers. It is unclear how maternal depressive symptoms (MDS), which persist and accrue over time, impact child development. The purpose of this study was to determine whether cumulative MDS from pre-pregnancy to postpartum influences child development in children by age 2.5.Using a longitudinal population-based study design, 2679 racially and ethnically diverse mothers completed the 2014 Los Angeles Mommy and Baby (LAMB) and 2016 Follow-Up surveys. A total MDS score was created based on responses to standardized questions, including the Patient Health Questionnaire-2 (PHQ-2). Data was collected for before pregnancy, during pregnancy, and 4 months postpartum in the 2014 survey, and at 2.5 years postpartum in the 2016 survey. Child development was measured using the CDC's Learn the Signs. Act Early Milestones Checklist. Bivariate and multivariate logistic regressions were conducted.The prevalence of any cumulative MDS was 45.2%. Language, cognitive/adaptive, motor, and social-emotional delays for surveyed toddlers were 7.7%, 4.0%, 1.2%, and 14.2%. After adjusting for covariates, mothers reporting depressive symptoms at all four time points were significantly more likely to report a social-emotional delay in their child (aOR = 4.39, 95% CI - 1.72 to 11.18).Mothers with cumulative depressive symptoms are at-risk of reporting social-emotional delays by age 2.5. Understanding these effects may help direct resources to target interventions that support mothers with depressive symptoms early-on and promote positive developmental outcomes among their children.

  View details for DOI 10.1007/s10995-020-02990-8

  View details for Web of Science ID 000558609400001

  View details for PubMedID 32780269

• Use of Rating Scales and Complexity of Presentation for Preschoolers Treated with Medication for ADHD: A Developmental-Behavioral Pediatrics Research Network (DBPNet) Study Mittal, S., LaRosa, A., Loe, I., Tulio, S., Vanderbilt, D., Harstad, E. LIPPINCOTT WILLIAMS & WILKINS. 2020: S24–S25

  View details for Web of Science ID 000526852800059

• Response to Commentary by Saeid Safiri et al. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Schrager, S., Chmait, R. H., Vanderbilt, D. L. 2020; 33 (1): 171

  View details for DOI 10.1080/14767058.2018.1484900

  View details for PubMedID 29860913

• Risk Factors for Depressed Mood and Anhedonia in Mothers of Infants with Twin-Twin Transfusion Syndrome. Journal of Reproductive Medicine McMahon, E., Korst, L. M., Stohl, H. E., Chmait, R. H., Vanderbilt, D. L. 2020; 65 (1): 21-30
• Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants CLINICAL PEDIATRICS Lakshmanan, A., Song, A. Y., Flores-Fenlon, N., Parti, U., Vanderbilt, D. L., Friedlich, P. S., Williams, R., Kipke, M. 2020; 59 (1): 53-61

  Abstract

  The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.

  View details for DOI 10.1177/0009922819884583

  View details for Web of Science ID 000495275200001

  View details for PubMedID 31672064

  View details for PubMedCentralID PMC8345225

• School Readiness. Pediatrics Williams, P. G., Lerner, M. A. 2019; 144 (2)

  Abstract

  School readiness includes the readiness of the individual child, the school's readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to meet the needs of all children at all levels of readiness. Children's readiness for kindergarten should become an outcome measure for a coordinated system of community-based programs and supports for the healthy development of young children. Our rapidly expanding insights into early brain and child development have revealed that modifiable factors in a child's early experience can greatly affect that child's health and learning trajectories. Many children in the United States enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification and attention to child and family needs. A strong correlation between social-emotional development and school and life success, combined with alarming rates of preschool expulsion, point toward the urgency of leveraging opportunities to support social-emotional development and address behavioral concerns early. Pediatric primary care providers have access to the youngest children and their families. Pediatricians can promote and use community supports, such as home visiting programs, quality early care and education programs, family support programs and resources, early intervention services, children's museums, and libraries, which are important for addressing school readiness and are too often underused by populations who can benefit most from them. When these are not available, pediatricians can support the development of such resources. The American Academy of Pediatrics affords pediatricians many opportunities to improve the physical, social-emotional, and educational health of young children, in conjunction with other advocacy groups. This technical report provides an updated version of the previous iteration from the American Academy of Pediatrics published in 2008.

  View details for DOI 10.1542/peds.2019-1766

  View details for PubMedID 31331984

• Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study BMC PEDIATRICS Lakshmanan, A., Kubicek, K., Williams, R., Robles, M., Vanderbilt, D. L., Mirzaian, C. B., Friedlich, P. S., Kipke, M. 2019; 19: 223

  Abstract

  We have limited information on families' experiences during transition and after discharge from the neonatal intensive care unit.Open-ended semi-structured interviews were conducted with English or Spanish- speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis.Twenty-one participants completed the study. The infant's median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity.Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge.

  View details for DOI 10.1186/s12887-019-1604-6

  View details for Web of Science ID 000474563000001

  View details for PubMedID 31277630

  View details for PubMedCentralID PMC6610911

• Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge CLINICAL PEDIATRICS Flores-Fenlon, N., Song, A. Y., Yeh, A., Gateau, K., Vanderbilt, D. L., Kipke, M., Friedlich, P., Lakshmanan, A. 2019; 58 (8): 903-911

  Abstract

  The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.

  View details for DOI 10.1177/0009922819848080

  View details for Web of Science ID 000485295100007

  View details for PubMedID 31088122

  View details for PubMedCentralID PMC8362840

• Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Chmait, R. H., Chon, A. H., Schrager, S. M., Llanes, A., Hamilton, A. H., Vanderbilt, D. L. 2019; 32 (1): 80-84

  Abstract

  The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery.Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI.Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001).Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.

  View details for DOI 10.1080/14767058.2017.1371694

  View details for PubMedID 28835143

• In utero Fetal Intubation for a Large Neck Mass: A Minimally Invasive EXIT Option Chmait, R. H., Chon, A. H., Anselmo, D., Vanderbilt, D. L., Townsend, J., Julian-Wang, B., Don, D. KARGER. 2019: 275-280

  Abstract

  Fetuses with obstructive neck and orofacial lesions have been delivered via an ex utero intrapartum treatment (EXIT) procedure to facilitate securement of the airway while on placental circulation. Pregnancy-related cardiovascular changes and technical issues unique to an EXIT procedure increase fetal and maternal risks relative to a standard cesarean section. In order to circumvent such issues, fetal endoscopic intubation has been proposed. We report a case of a fetus with a large neck mass (mixed solid and multiloculated cystic lesion measuring 9.2 × 5.3 × 8.5 cm, neck hyperextension, protruding tongue, and serial gagging movements) that was successfully intubated in utero and delivered at 36 weeks and 0 days via standard cesarean section, thereby avoiding an EXIT procedure. The risks, benefits, and technical issues of in utero tracheal intubation are reviewed.

  View details for DOI 10.1159/000487394

  View details for Web of Science ID 000464377100009

  View details for PubMedID 29642057

• Selecting Appropriate Toys for Young Children in the Digital Era. Pediatrics Healey, A., Mendelsohn, A. 2019; 143 (1)

  Abstract

  Play is essential to optimal child development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. It also offers an ideal and significant opportunity for parents and other caregivers to engage fully with children using toys as an instrument of play and interaction. The evolution of societal perceptions of toys from children's playthings to critical facilitators of early brain and child development has challenged caregivers in deciding which toys are most appropriate for their children. This clinical report strives to provide pediatric health care providers with evidence-based information that can be used to support caregivers as they choose toys for their children. The report highlights the broad definition of a toy; consideration of potential benefits and possible harmful effects of toy choices on child development; and the promotion of positive caregiving and development when toys are used to engage caregivers in play-based interactions with their children that are rich in language, pretending, problem-solving, and creativity. The report aims to address the evolving replacement of more traditional toys with digital media-based virtual "toys" and the lack of evidence for similar benefits in child development. Furthermore, this report briefly addresses the role of toys in advertising and/or incentive programs and aims to bring awareness regarding safety and health hazards associated with toy availability and accessibility in public settings, including some health care settings.

  View details for DOI 10.1542/peds.2018-3348

  View details for PubMedID 30509931

• Relationships between variance in electroencephalography relative power and developmental status in infants with typical development and at risk for developmental disability: An observational study. Gates open research Hooyman, A., Kayekjian, D., Xiao, R., Jiang, C., Vanderbilt, D. L., Smith, B. A. 2018; 2: 47

  Abstract

  Background: Electroencephalography (EEG) is a non-invasive tool that has the potential to identify and quantify atypical brain development. We introduce a new measure here, variance of relative power of resting-state EEG. We sought to assess whether variance of relative power of resting-state EEG could predict i) classification of infants as typical development (TD) or at risk (AR) for developmental disability, and ii) Bayley developmental scores at the same visit or future visits. Methods: A total of 22 infants with TD participated, aged between 38 and 203 days. In addition, 11 infants broadly at risk participated (6 high-risk pre-term, 4 low-risk pre-term, 1 high-risk full-term), aged between 40 and 225 days of age (adjusted for prematurity). We used EEG to measure resting-state brain function across months. We calculated variance of relative power as the standard deviation of the relative power across each of the 32 EEG electrodes. The Bayley Scales of Infant Development (3 rd edition) was used to measure developmental level. Infants were measured 1-6 times each, with 1 month between measurements. Results: Our main findings were: i) variance of relative power of resting state EEG can predict classification of infants as TD or AR, and ii) variance of relative power of resting state EEG can predict Bayley developmental scores at the same visit (Bayley raw fine motor, Bayley raw cognitive, Bayley total raw score, Bayley motor composite score) and at a future visit (Bayley raw fine motor). Conclusions: This was a preliminary, exploratory, small study. Our results support variance of relative power of resting state EEG as an area of interest for future study as a biomarker of neurodevelopmental status and as a potential outcome measure for early intervention.

  View details for DOI 10.12688/gatesopenres.12868.2

  View details for PubMedID 30569037

  View details for PubMedCentralID PMC6266744

• The Interprofessional/Family-Centered-Care Observation Rubric (I-FOR): Results of a Multicenter Study of a New Measure of Educational Outcomes MATERNAL AND CHILD HEALTH JOURNAL Brosco, J. P., Pulgaron, E., Vanderbilt, D. L., Macias, M., Mathew, M., Blum, N. J. 2018; 22 (10): 1384-1392

  Abstract

  Introduction The ability to provide family-centered care (FCC) and the ability to work in interprofessional care teams (IPC) are essential educational outcomes in graduate training programs. Lack of standardized measures leave programs to rely on idiosyncratic methods to monitor outcomes. We developed a faculty observation tool as part of an effort to create a national quality improvement database. We present evidence for the feasibility and validity of the faculty observation tool. Methods Trainees and faculty at four independent training programs participated. Nineteen maternal and child health disciplines were represented. Faculty supervisors rated trainees using the new measure (I-FOR), and trainees completed related subscales of a previously developed self-report measure, the core competency measure (CCM). Faculty provided qualitative feedback regarding the I-FOR in a separate questionnaire. Results Faculty (n = 78) completed the I-FOR on 86 trainees (86/92 = 93%) and reported satisfaction with completing the measures. The I-FOR demonstrated good internal consistency (Cronbach's alpha > 0.930) and test-retest reliability (IPC r = 0.862, FCC r = 0.823, p < 0.001). Greater than 95% of participants reported that the I-FOR accurately addressed the relevant skills for each practice domain. The I-FOR showed no correlation with the CCM. Significant improvements over time in the I-FOR ratings were demonstrated in three out of four programs. Discussion The I-FOR demonstrated good internal consistency and test-retest reliability. Faculty responses provide evidence for the feasibility and validity of the instrument. Self-report and faculty-observation measures both increased with training but were not correlated with each other.

  View details for DOI 10.1007/s10995-018-2591-1

  View details for Web of Science ID 000445198600003

  View details for PubMedID 30014376

• Relationships between full-day arm movement characteristics and developmental status in infants with typical development as they learn to reach: An observational study. Gates open research Shida-Tokeshi, J., Lane, C. J., Trujillo-Priego, I. A., Deng, W., Vanderbilt, D. L., Loeb, G. E., Smith, B. A. 2018; 2: 17

  Abstract

  Background: Advances in wearable sensor technology now allow us to quantify the number, type and kinematic characteristics of bouts of infant arm movement made across a full day in the natural environment. Our aim here was to determine whether the amount and kinematic characteristics of arm movements made across the day in the natural environment were related to developmental status in infants with typical development as they learned to reach for objects using their arms. Methods: We used wearable sensors to measure arm movement across days and months as infants developed arm reaching skills. In total, 22 infants with typical development participated, aged between 38 and 203 days. Of the participants, 2 infants were measured once and the other 20 infants were measured once per month for 3 to 6 visits. The Bayley Scales of Infant Development was used to measure developmental level. Results: Our main findings were: 1) infant arm movement characteristics as measured by full-day wearable sensor data were related to Bayley motor, cognitive and language scores, indicating a relationship between daily movement characteristics and developmental status; 2) infants who moved more had larger increases in language and cognitive scores across visits; and 3) larger changes in movement characteristics across visits were related to higher motor scores. Conclusions: This was a preliminary, exploratory, small study of the potential importance of infant arm movement characteristics as measured by full-day wearable sensor data. Our results support full-day arm movement activity as an area of interest for future study as a biomarker of neurodevelopmental status and as a target for early intervention.

  View details for DOI 10.12688/gatesopenres.12813.2

  View details for PubMedID 29708221

  View details for PubMedCentralID PMC5915838

• Differences in Spontaneous Leg Movement Patterns Between Infants With Typical Development and Infants at Risk for Developmental Delay: Cross-sectional Observation Prior to Sitting Onset. Journal of motor learning and development Deng, W., Vanderbilt, D. L., Smith, B. A. 2018; 6 (1): 101-113

  Abstract

  To investigate differences in the patterns of supine spontaneous leg movements produced before sitting onset between infants with typical development (TD) and infants at risk for developmental delay (AR).Cross-sectional, observational study. Thirty-five infants were included, 18 infants with TD (130.4 ±38.0 days) and 17 infants AR (124.1± 65.7 days). Infants were placed in the supine position and video taped for 4 to 5 minutes while in an alert, content state. After the recording, videos were coded frame by frame to identify the type of each leg movement produced: single flexion, single extension, alternate flexion, alternate extension, parallel flexion, parallel extension, leg wave, leg circle, leg thump, foot rub, foot flexion, or foot rotation.Unilateral movements (single flexion and single extension) were the most common leg movements in TD group. Infants AR produced a significantly lower proportion of unilateral and foot rub movements than infants with TD.These results provide a foundation of the types of leg movement pattern differences to build on in future research. Knowledge about differences in spontaneous movement patterns between infants AR and infants with TD has relevance both for early identification of neuromotor impairment and clinical practice.

  View details for DOI 10.1123/jmld.2016-0056

  View details for PubMedID 30886873

  View details for PubMedCentralID PMC6419961

• The relationship between preoperative fetal head circumference and 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome. Prenatal diagnosis Chon, A. H., Mamey, M. R., Schrager, S. M., Vanderbilt, D. L., Chmait, R. H. 2018; 38 (3): 173-178

  Abstract

  To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin-twin transfusion syndrome (TTTS).Donor and recipient twin HCs were measured preoperatively (16-26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child-level risk factors for lower Battelle Developmental Inventory Second Edition (BDI-2) scores. A repeated-measures ANOVA was used to examine HC growth among recipients and donors between preoperative and 2 years.Ninety-nine children were evaluated. The average BDI-2 score for the cohort was 101.4 (SD = 12.2). After controlling for covariates, larger preoperative HC percentiles were significantly associated with an increase in total BDI-2 scores (β = 0.29; P < 0.001), where a 12.5% increase in preoperative HC percentile was associated with 1-point increase in total BDI-2 score. The mean recipient and donor twin HC percentiles preoperatively and at age 2 years were 51st percentile vs 20th percentile (P = .050) and 60th percentile vs 49th percentile (P = .676), respectively.Smaller preoperative HC percentiles identified children at risk of lower, but still within normal range, total BDI-2 scores. The discordance in HC percentiles between the donor and recipient twin decreased after laser surgery.

  View details for DOI 10.1002/pd.5204

  View details for PubMedID 29314091

  View details for PubMedCentralID PMC5867238

• Language Barriers Impact Access to Services for Children with Autism Spectrum Disorders JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS St Amant, H. G., Schrager, S. M., Pena-Ricardo, C., Williams, M. E., Vanderbilt, D. L. 2018; 48 (2): 333-340

  Abstract

  Racial and ethnic disparities in accessing health care have been described in children with autism spectrum disorder (ASD). In a retrospective chart review of 152 children with ASD, children of parents whose primary language was English were significantly more likely to have both social skills and communication goals within their individualized education plan (IEP) compared to children of parents whose primary language was not English. Additionally, children of primary English speakers received significantly more hours of direct services from their state disability program. After controlling for demographic covariates, findings suggest that language barriers may negatively affect parents' abilities to access health care services for their child with ASD. Acculturation factors must therefore be considered when analyzing disparities in autism.

  View details for DOI 10.1007/s10803-017-3330-y

  View details for Web of Science ID 000424669000001

  View details for PubMedID 28988384

• Validity of Level of Supervision Scales for Assessing Pediatric Fellows on the Common Pediatric Subspecialty Entrustable Professional Activities. Academic medicine : journal of the Association of American Medical Colleges Mink, R. B., Schwartz, A., Herman, B. E., Turner, D. A., Curran, M. L., Myers, A., Hsu, D. C., Kesselheim, J. C., Carraccio, C. L. 2018; 93 (2): 283-291

  Abstract

  Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN).SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015.Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson's iota = 0.73).The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.

  View details for DOI 10.1097/ACM.0000000000001820

  View details for PubMedID 28700462

• Electroencephalography power and coherence changes with age and motor skill development across the first half year of life. PloS one Xiao, R., Shida-Tokeshi, J., Vanderbilt, D. L., Smith, B. A. 2018; 13 (1): e0190276

  Abstract

  Existing research in infants has correlated electroencephalography (EEG) measures of power and coherence to cognitive development and to locomotor experience, but only in infants older than 5 months of age. Our goal was to explore the relationship between EEG measures of power and coherence and motor skill development in younger infants who are developing reaching skill. Twenty-one infants with typical development between 38 and 203 days of age participated. Longitudinal EEG recording sessions were recorded in monthly increments, with 3-5 sessions acquired for 19 participants and 1 session for 2 participants, resulting in 71 sessions in total. EEG variables of interest were relative power in the 6-9 Hz range and coherence between selected electrode pairs. We describe the development of the peak in relative power in the 6-9 Hz frequency band of EEG; it is not present around 1 month of age and starts to appear across the following months. Coherence generally increased in the bilateral frontal-parietal networks, while the interhemispheric connectivity in motor cortices generally decreased. The results of this relatively small pilot study provide a foundational description of neural function changes observed as motor skills are changing across the first half year of life. This is a first step in understanding experience-dependent plasticity of the infant brain and has the potential to aid in the early detection of atypical brain development.

  View details for DOI 10.1371/journal.pone.0190276

  View details for PubMedID 29329316

  View details for PubMedCentralID PMC5766131

• Creating the Subspecialty Pediatrics Investigator Network JOURNAL OF PEDIATRICS Mink, R., Schwartz, A., Carraccio, C., High, P., Dammann, C., McGann, K. A., Kesselheim, J., Herman, B., Steering Comm Subspecialty Pediat 2018; 192: 3-+

  View details for DOI 10.1016/j.jpeds.2017.09.079

  View details for Web of Science ID 000423353900001

  View details for PubMedID 29246355

• Breastfeeding Improves 2 Year Neurodevelopmental Outcomes in Infants with Twin-Twin Transfusion Syndrome Breastfeeding Review Mirzaian, C., Vanderbilt, D. L., et al 2018; 26 (2): 9–35
• Sample Entropy Identifies Differences in Spontaneous Leg Movement Behavior between Infants with Typical Development and Infants at Risk of Developmental Delay. Technologies Smith, B. A., Vanderbilt, D. L., Applequist, B., Kyvelidou, A. 2017; 5 (3)

  Abstract

  We are interested in using wearable sensor data to analyze detailed characteristics of movement, such as repeatability and variability of movement patterns, over days and months to accurately capture real-world infant behavior. The purpose of this study was to explore Sample Entropy (SampEn) from wearable sensor data as a measure of variability of spontaneous infant leg movement and as a potential marker of the development of neuromotor control. We hypothesized that infants at risk (AR) of developmental delay would present significantly lower SampEn values than infants with typical development (TD). Participants were 11 infants with TD and 20 infants AR. We calculated SampEn from 1-4 periods of data of 7200 samples in length when the infants were actively playing across the day. The infants AR demonstrated smaller SampEn values (median 0.21) than the infants with TD (median 1.20). Lower values of SampEn indicate more similarity in patterns across time, and may indicate more repetitive, less exploratory behavior in infants AR compared to infants with TD. In future studies, we would like to expand to analyze longer periods of wearable sensor data and/or determine how to optimally sample representative periods across days and months.

  View details for DOI 10.3390/technologies5030055

  View details for PubMedID 29114479

  View details for PubMedCentralID PMC5671804

• Early Childhood Home Visiting. Pediatrics Duffee, J. H., Mendelsohn, A. L., Kuo, A. A., Legano, L. A., Earls, M. F. 2017; 140 (3)

  Abstract

  High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.

  View details for DOI 10.1542/peds.2017-2150

  View details for PubMedID 28847981

• Development of a Wearable Sensor Algorithm to Detect the Quantity and Kinematic Characteristics of Infant Arm Movement Bouts Produced across a Full Day in the Natural Environment. Technologies Trujillo-Priego, I. A., Lane, C. J., Vanderbilt, D. L., Deng, W., Loeb, G. E., Shida, J., Smith, B. A. 2017; 5 (3)

  Abstract

  We developed a wearable sensor algorithm to determine the number of arm movement bouts an infant produces across a full day in the natural environment. Full-day infant arm movement was recorded from 33 infants (22 infants with typical development and 11 infants at risk of atypical development) across multiple days and months by placing wearable sensors on each wrist. Twenty second sections of synchronized video data were used to compare the algorithm against visual observation as the gold standard for counting the number of arm movement bouts. Overall, the algorithm counted 173 bouts and the observer identified 180, resulting in a sensitivity of 90%. For each bout produced across the day, we then calculated the following kinematic characteristics: duration, average and peak acceleration, average and peak angular velocity, and type of movement (one arm only, both arms for some portion of the bout, or both arms for the entire bout). As the first step toward developing norms, we present average values of full-day arm movement kinematic characteristics across the first months of infancy for infants with typical development. Identifying and quantifying infant arm movement characteristics produced across a full day has potential application in early identification of developmental delays and the provision of early intervention therapies to support optimal infant development.

  View details for DOI 10.3390/technologies5030039

  View details for PubMedID 28824853

  View details for PubMedCentralID PMC5558826

• Quality Early Education and Child Care From Birth to Kindergarten. Pediatrics Donoghue, E. A. 2017; 140 (2)

  Abstract

  High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels.

  View details for DOI 10.1542/peds.2017-1488

  View details for PubMedID 28771418

• Parent-Reported Strengths in Children with Autism Spectrum Disorders at the Time of an Interdisciplinary Diagnostic Evaluation JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Sabapathy, T., Madduri, N., Deavenport-Saman, A., Zamora, I., Schrager, S. M., Vanderbilt, D. L. 2017; 38 (3): 181-186

  Abstract

  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.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.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.Pediatricians have a unique opportunity to discuss parental positive perceptions of children with ASD and to learn about their strengths.

  View details for DOI 10.1097/DBP.0000000000000423

  View details for Web of Science ID 000399585500003

  View details for PubMedID 28368969

• "Footprints in the Bathroom": The Role of Spirituality in Patient Diagnosis. Journal of developmental and behavioral pediatrics : JDBP Meneses, V., Vanderbilt, D., Barnes, L., Augustyn, M. 2017; 38 Suppl 1: S79-S81

  Abstract

  Lucy is a 12-year-old Latina whose mother brought her to the pediatric clinic for help with her anxiety symptoms, "hearing voices," and episodes of "spacing out." Lucy did not cry at birth secondary to vocal cord paralysis and still has the tracheostomy performed at a few days of life. In addition to her neonatal intensive care unit stay, she has been hospitalized for pneumonia. Her mother says she is "sickly" and has a weak immune system due to her asthma symptoms. Lucy also experiences somatic complaints related to gastroesophageal reflux and constipation.Lucy is described as being "in another world" and must be called several times before she responds. Lucy states she is nervous "all the time" and often experiences a fast heartbeat, chest pain, and headache. Her attention and internalizing problems began at age 4 years and have worsened since she entered adolescence. When she is alone in the dark, she sees an unknown person and becomes frightened. She hears the voice of her paternal uncle telling her something will harm her mother and runs crying to "check" on her. Lucy also says she hears voices of paternal family members fighting. She has dreamed that her paternal uncle stabbed her in an alley. Lucy reports experiencing sadness and feelings of wanting to die. She has not tried to harm herself and has no plan to do this. She states that she does not know when she is awake or asleep and "hate people talking in my head." She does not report drug use.Lucy's family is bilingual, English and Spanish. Her mother works part-time as a nutritionist, and her father is a machinist. Her father receives counseling for anger management, and there have been previous unsub- stantiated child abuse reports involving Lucy and her younger brother. The maternal uncle has been involved in a gang and attempts to phone Lucy's mother, who does not wish to have contact with him. Lucy's mother expresses strong Christian religious and spiritual beliefs, including demons and spirits that may enter her home and can be cast off with prayer. Recently, the family purchased a "cuadro" (picture) at a yard sale, and Lucy's mother said this resulted in footprints in the bathroom that are disappearing with prayer, guidance from the church minister, and discarding of the "cuadro."The primary pediatrician ordered a home school program, given Lucy's frequent illnesses. She is progressing well with a special education teacher. Her recent psychological evaluation at school showed a below average nonverbal intelligence quotient, with strengths in the areas of perceptual, logical, and abstract relationships. Lucy's mother in the past has been hesitant to follow through with psychiatric evaluation because "it is up to God."In the clinic, she is pale and slender with an ethereal look. She is awake and alert with appropriate affect and mentation. Her tracheostomy is intact without any respiratory distress noted. There are no signs of drug use or active hallucinations. You are left wondering whether these voices need psychiatric management.

  View details for DOI 10.1097/DBP.0000000000000393

  View details for PubMedID 28141730

• Clinician disparities in anxiety and trauma screening among children with ADHD: A pilot study CHILDRENS HEALTH CARE Spitzer, J., Schrager, S. M., Imagawa, K., Vanderbilt, D. L. 2017; 46 (4): 344-355

  View details for DOI 10.1080/02739615.2016.1193809

  View details for Web of Science ID 000415647600003

• Addressing Early Childhood Emotional and Behavioral Problems. Pediatrics Gleason, M. M., Goldson, E., Yogman, M. W. 2016; 138 (6)

  Abstract

  More than 10% of young children experience clinically significant mental health problems, with rates of impairment and persistence comparable to those seen in older children. For many of these clinical disorders, effective treatments supported by rigorous data are available. On the other hand, rigorous support for psychopharmacologic interventions is limited to 2 large randomized controlled trials. Access to psychotherapeutic interventions is limited. The pediatrician has a critical role as the leader of the medical home to promote well-being that includes emotional, behavioral, and relationship health. To be effective in this role, pediatricians promote the use of safe and effective treatments and recognize the limitations of psychopharmacologic interventions. This technical report reviews the data supporting treatments for young children with emotional, behavioral, and relationship problems and supports the policy statement of the same name.

  View details for DOI 10.1542/peds.2016-3025

  View details for PubMedID 27940734

• Addressing Early Childhood Emotional and Behavioral Problems. Pediatrics 2016; 138 (6)

  Abstract

  Emotional, behavioral, and relationship problems can develop in very young children, especially those living in high-risk families or communities. These early problems interfere with the normative activities of young children and their families and predict long-lasting problems across multiple domains. A growing evidence base demonstrates the efficacy of specific family-focused therapies in reducing the symptoms of emotional, behavioral, and relationship symptoms, with effects lasting years after the therapy has ended. Pediatricians are usually the primary health care providers for children with emotional or behavioral difficulties, and awareness of emerging research about evidence-based treatments will enhance this care. In most communities, access to these interventions is insufficient. Pediatricians can improve the care of young children with emotional, behavioral, and relationship problems by calling for the following: increased access to care; increased research identifying alternative approaches, including primary care delivery of treatments; adequate payment for pediatric providers who serve these young children; and improved education for pediatric providers about the principles of evidence-based interventions.

  View details for DOI 10.1542/peds.2016-3023

  View details for PubMedID 27940733

• Aggression in Autism Spectrum Disorder: Supporting the Entire Family. Journal of developmental and behavioral pediatrics : JDBP Sabapathy, T., Vanderbilt, D. L., Zamora, I., Augustyn, M. 2016; 37 (8): 685-6

  Abstract

  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?

  View details for DOI 10.1097/DBP.0000000000000347

  View details for PubMedID 27676698

• The Pediatrician's Role in Optimizing School Readiness. Pediatrics 2016; 138 (3)

  Abstract

  School readiness includes not only the early academic skills of children but also their physical health, language skills, social and emotional development, motivation to learn, creativity, and general knowledge. Families and communities play a critical role in ensuring children's growth in all of these areas and thus their readiness for school. Schools must be prepared to teach all children when they reach the age of school entry, regardless of their degree of readiness. Research on early brain development emphasizes the effects of early experiences, relationships, and emotions on creating and reinforcing the neural connections that are the basis for learning. Pediatricians, by the nature of their relationships with families and children, may significantly influence school readiness. Pediatricians have a primary role in ensuring children's physical health through the provision of preventive care, treatment of illness, screening for sensory deficits, and monitoring nutrition and growth. They can promote and monitor the social-emotional development of children by providing anticipatory guidance on development and behavior, by encouraging positive parenting practices, by modeling reciprocal and respectful communication with adults and children, by identifying and addressing psychosocial risk factors, and by providing community-based resources and referrals when warranted. Cognitive and language skills are fostered through timely identification of developmental problems and appropriate referrals for services, including early intervention and special education services; guidance regarding safe and stimulating early education and child care programs; and promotion of early literacy by encouraging language-rich activities such as reading together, telling stories, and playing games. Pediatricians are also well positioned to advocate not only for children's access to health care but also for high-quality early childhood education and evidence-based family supports such as home visits, which help provide a foundation for optimal learning.

  View details for DOI 10.1542/peds.2016-2293

  View details for PubMedID 27573085

• The effects of therapeutic hypothermia on cerebral metabolism in neonates with hypoxic-ischemic encephalopathy: An in vivo <SUP>1</SUP>H-MR spectroscopy study JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM Wisnowski, J. L., Wu, T., Reitman, A. J., McLean, C., Friedlich, P., Vanderbilt, D., Ho, E., Nelson, M. D., Panigrahy, A., Bluml, S. 2016; 36 (6): 1075-1086

  Abstract

  Therapeutic hypothermia has emerged as the first empirically supported therapy for neuroprotection in neonates with hypoxic-ischemic encephalopathy (HIE). We used magnetic resonance spectroscopy ((1)H-MRS) to characterize the effects of hypothermia on energy metabolites, neurotransmitters, and antioxidants. Thirty-one neonates with HIE were studied during hypothermia and after rewarming. Metabolite concentrations (mmol/kg) were determined from the thalamus, basal ganglia, cortical grey matter, and cerebral white matter. In the thalamus, phosphocreatine concentrations were increased by 20% during hypothermia when compared to after rewarming (3.49 ± 0.88 vs. 2.90 ± 0.65, p < 0.001) while free creatine concentrations were reduced to a similar degree (3.00 ± 0.50 vs. 3.74 ± 0.85, p < 0.001). Glutamate (5.33 ± 0.82 vs. 6.32 ± 1.12, p < 0.001), aspartate (3.39 ± 0.66 vs. 3.87 ± 1.19, p < 0.05), and GABA (0.92 ± 0.36 vs. 1.19 ± 0.41, p < 0.05) were also reduced, while taurine (1.39 ± 0.52 vs. 0.79 ± 0.61, p < 0.001) and glutathione (2.23 ± 0.41 vs. 2.09 ± 0.33, p < 0.05) were increased. Similar patterns were observed in other brain regions. These findings support that hypothermia improves energy homeostasis by decreasing the availability of excitatory neurotransmitters, and thereby, cellular energy demand.

  View details for DOI 10.1177/0271678X15607881

  View details for Web of Science ID 000376782700009

  View details for PubMedID 26661180

  View details for PubMedCentralID PMC4908621

• Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes. Prenatal diagnosis Chmait, R. H., Chon, A. H., Schrager, S. M., Llanes, A., Hamilton, A., Vanderbilt, D. L. 2016; 36 (1): 63-7

  Abstract

  The cerebroplacental ratio (CPR) is a semi-quantitative marker for fetal brain-sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin-twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years.One-hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI-2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI-2.Ninety-nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post-laser CPR <1.0 was a risk factor for lower BDI-2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = -0.23, p = 0.01]; this relationship remained significant after controlling for pre-surgical CPR and Quintero stage (adjusted β = -0.25, p = 0.01).In this population, an abnormal CPR was associated with poorer 2-year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd.

  View details for DOI 10.1002/pd.4713

  View details for PubMedID 26515250

• Donor catch-up growth after laser surgery for twin-twin transfusion syndrome EARLY HUMAN DEVELOPMENT Chmait, R. H., Chon, A. H., Schrager, S. M., Kontopoulos, E. V., Quintero, R. A., Vanderbilt, D. L. 2015; 91 (12): 751-754

  Abstract

  To assess fetal growth after laser surgery for TTTS at the time of prenatal diagnosis, birth, and at 2years of age.Growth data were collected from surviving children treated between 2007 and 2010 as part of a study to assess neurodevelopment at 24months (±6weeks) corrected age. Fetal weights were obtained via ultrasound using Hadlock's formula at the time of preoperative assessment for laser surgery. Birth weights were recorded by the staff at the delivering institutions. Weights at 2years corrected age were recorded at the time of neurodevelopmental testing. Weights were converted into percentiles according to standard growth curves. Growth restriction was defined as <10th percentile for given age. Multilevel latent growth curve models in Mplus (twins nested in families) examined weight change over time as a function of donor status, and repeated measures ANOVA was utilized to assess in donor-recipient weight discordance over time for twin pairs.99 of 206 children (56 of 130 families) were studied. There were no differences between enrolled and non-enrolled patients in donor/recipient status and survival rates, fetal demise, intrauterine growth restriction, Quintero stage, and gestational age of surgery or delivery. 48.5% were donors. The median fetal, birth, and 2-year weights for all twins were 288g, 1.9kg, and 11.8kg, respectively, and the overall prevalence of growth restriction was 28%, 22%, and 3%, respectively. Growth restriction rates at prenatal diagnosis were 56% in donors vs. 2% in recipients (OR=64.3, p<0.001); at birth, 35% vs. 10% (OR=5.0, p<0.01); and at 2years, 6% vs. 0%. Donors showed significant gains in weight percentile (B=13.1, p<0.001) and a significant decrease in growth restriction rates over time (B=-1.6, p<0.001). Weight discordance between donor and recipient pairs also significantly decreased over time (linear F(1,42)=54.34, p<0.001).After laser surgery for TTTS, donor twins exhibit significant catch-up growth by two years of age.

  View details for DOI 10.1016/j.earlhumdev.2015.08.006

  View details for Web of Science ID 000366440000016

  View details for PubMedID 26364515

  View details for PubMedCentralID PMC8369892

• Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. Pediatrics 2015; 136 (4): e1131-40

  Abstract

  Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves.

  View details for DOI 10.1542/peds.2015-2655

  View details for PubMedID 26416941

• Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. Pediatrics Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S. 2015; 136 (4): e1142-66

  Abstract

  Children and adolescents involved with child welfare, especially those who are removed from their family of origin and placed in out-of-home care, often present with complex and serious physical, mental health, developmental, and psychosocial problems rooted in childhood adversity and trauma. As such, they are designated as children with special health care needs. There are many barriers to providing high-quality comprehensive health care services to children and adolescents whose lives are characterized by transience and uncertainty. Pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services in the context of a medical home, and health care coordination and advocacy on their behalf. This technical report supports the policy statement of the same title.

  View details for DOI 10.1542/peds.2015-2656

  View details for PubMedID 26416934

• Blood pressure evaluation in children treated with laser surgery for twin-twin transfusion syndrome at 2-year follow-up Pruetz, J. D., Schrager, S. M., Wang, T. V., Llanes, A., Chmait, R. H., Vanderbilt, D. L. MOSBY-ELSEVIER. 2015: 417.e1-7

  Abstract

  Twin survivors of twin-twin transfusion syndrome (TTTS) may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure (BP) among children treated with selective laser photocoagulation of communicating vessels.Data were prospectively collected from surviving children treated for TTTS with laser surgery from 2008 through 2010. Systolic BP (SBP) and diastolic BP (DBP) were obtained from 91 child survivors at age 24 months (±6 weeks) and evaluated based on age, sex, and height percentile. BP percentiles were calculated for each patient and categorized as normal (<95%) or abnormal (>95%). Clinical variables were evaluated using multilevel regression models to evaluate risk factors for elevated BP.BP was categorized as normal in 38% and abnormal in 62% of twin survivors based on percentile for sex, age, and height; a comparable distribution was found for DBP elevation. There were no differences between donor and recipient twins for absolute SBP and DBP or BP classification. In a multivariate analysis, significant risk factors for higher SBP included prematurity (β -0.54; 95% confidence interval [CI], -0.99 to -0.09; P = .02), higher weight percentile (β 0.24; 95% CI, 0.05-0.42; P = .01), and presence of cardiac disease (β 0.50; 95% CI, 0.10-0.89; P = .01). Prematurity was also a significant risk for abnormal DBP (odds ratio, 0.89; 95% CI, 0.80-1.00; P = .05).Child survivors of TTTS had elevated SBP and DBP measurements at 2 years of age, with no differences seen between former donor and recipient twins. Prematurity may be a risk factor for elevated BP measurements in this population. Future studies are warranted to ascertain whether these cardiovascular findings persist over time.

  View details for DOI 10.1016/j.ajog.2015.05.031

  View details for Web of Science ID 000360551700044

  View details for PubMedID 26003061

  View details for PubMedCentralID PMC4556589

• Social Behaviors and Active Videogame Play in Children with Autism Spectrum Disorder. Games for health journal Chung, P. J., Vanderbilt, D. L., Soares, N. S. 2015; 4 (3): 225-34

  Abstract

  Children with autism spectrum disorder (ASD) often display problematic and excessive videogame play. Using active videogames (AVGs) may have physical benefits, but its effects on socialization are unknown.We conducted an A-B-A' experiment comparing sedentary videogames and AVGs for three dyads of a child with ASD and his sibling. An augmented reality (AR) game was used to introduce AVGs. Sessions were coded for communication, positive affect, and aggression.One dyad had increases in positive affect with AVGs. Otherwise, social behaviors were unchanged or worse. The AR game demonstrated consistent elevations in social behaviors.Use of AVGs has inconsistent effects on social behavior for children with ASD. Further research is needed to understand mediators of response to AVGs. AR games should be evaluated for potential benefits on socialization and positive affect.

  View details for DOI 10.1089/g4h.2014.0125

  View details for PubMedID 26182068

• Active Videogaming for Individuals with Severe Movement Disorders: Results from a Community Study. Games for health journal Chung, P. J., Vanderbilt, D. L., Schrager, S. M., Nguyen, E., Fowler, E. 2015; 4 (3): 190-4

  Abstract

  Active videogaming (AVG) has potential to provide positive health outcomes for individuals with cerebral palsy (CP), but their use for individuals with severe motor impairments is limited. Our objective was to evaluate the accessibility and enjoyment of videogames using the Kinect™ (Microsoft, Redmond, WA) with the Flexible Action and Articulated Skeleton Toolkit (FAAST) system (University of Southern California Institute for Creative Technologies, Los Angeles, CA) for individuals with severely limiting CP.A videogaming system was installed in a community center serving adults with CP, and a staff member was instructed in its use. Participants completed a baseline survey assessing demographics, mobility, and prior videogame experience; they then used the FAAST system with Kinect and completed a 5-point Likert survey to assess their experience. Descriptive statistics assessed overall enjoyment of the system, and Mann-Whitney U tests were conducted to determine whether responses differed by demographic factors, mobility, or prior videogame experience.Twenty-two subjects were recruited. The enjoyment scale demonstrated high internal consistency (Cronbach's alpha=0.88). The mean total enjoyment score was 4.24 out of 5. Median scores did not significantly differ by ethnicity, gender, CP severity, or previous videogame exposure.The FAAST with Kinect is a low-cost system that engages individuals with severe movement disorders across a wide range of physical ability and videogame experience. Further research should be conducted on in-home use, therapeutic applications, and potential benefits for socialization.

  View details for DOI 10.1089/g4h.2014.0091

  View details for PubMedID 26182063

• Promoting optimal development: screening for behavioral and emotional problems. Pediatrics Weitzman, C., Wegner, L. 2015; 135 (2): 384-95

  Abstract

  By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.

  View details for DOI 10.1542/peds.2014-3716

  View details for PubMedID 25624375

• Neonatal cerebral lesions predict two-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome (TTTS) Chmait, R., Schrager, S., Llanes, A., Hamilton, A., Vanderbilt, D. MOSBY-ELSEVIER. 2015: S342

  View details for DOI 10.1016/j.ajog.2014.10.905

  View details for Web of Science ID 000361140900693

• Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome (TTTS) is associated with two-year neurodevelopmental outcomes Chmait, R., Schrager, S., Llanes, A., Hamilton, A., Vanderbilt, D. MOSBY-ELSEVIER. 2015: S197

  View details for DOI 10.1016/j.ajog.2014.10.422

  View details for Web of Science ID 000361140900372

• Predictors of 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome Vanderbilt, D. L., Schrager, S. M., Llanes, A., Hamilton, A., Seri, I., Chmait, R. H. MOSBY-ELSEVIER. 2014: 388.e1-7

  Abstract

  The purpose of this study was to determine risk factors for poor cognitive performance among children who are treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome.This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed with the Battelle Developmental Inventory 2nd Edition (BDI-2). Multilevel regression models evaluated risk factors for poor cognitive performance at shared (pregnancy) and individual (child) levels. In addition to development, blindness, deafness, and cerebral palsy were assessed based on physical examination. A priori power analysis determined that a sample of ≥100 children was required for adequate statistical power (0.80).One hundred children (57 families) were evaluated. Total BDI-2 score was within normal range (mean, 101.3 ± [SD]12.2); 1 child had a BDI-2 score of <70. Individual child-level risk factors for lower BDI-2 included male sex (β = -0.37; P < .01), lower head circumference (β = 0.28; P < .01), and higher diastolic blood pressure (β = -0.29; P < .01). At the pregnancy level, lower maternal education (β = 0.60; P < .001), higher Quintero stage (β = -0.36; P < .01), and lower gestational age at birth (β = 0.30; P < .01) were associated with worse cognitive outcomes. Donor/recipient status, gestational age at surgery, fetal growth restriction, and co-twin fetal death were not risk factors. The rate of neurodevelopmental impairment (blindness, deafness, cerebral palsy, and/or a BDI-2 score <70) was 4%.Overall cognitive performance quotients were in the normal range, with risk factors for poor outcomes seen at the pregnancy and child levels. Clinical and socioeconomic characteristics can identify at-risk children who need additional interventions.

  View details for DOI 10.1016/j.ajog.2014.03.050

  View details for Web of Science ID 000342572200021

  View details for PubMedID 24681290

  View details for PubMedCentralID PMC4175130

• Literacy promotion: an essential component of primary care pediatric practice. Pediatrics High, P. C., Klass, P. 2014; 134 (2): 404-9

  Abstract

  Reading regularly with young children stimulates optimal patterns of brain development and strengthens parent-child relationships at a critical time in child development, which, in turn, builds language, literacy, and social-emotional skills that last a lifetime. Pediatric providers have a unique opportunity to encourage parents to engage in this important and enjoyable activity with their children beginning in infancy. Research has revealed that parents listen and children learn as a result of literacy promotion by pediatricians, which provides a practical and evidence-based opportunity to support early brain development in primary care practice. The American Academy of Pediatrics (AAP) recommends that pediatric providers promote early literacy development for children beginning in infancy and continuing at least until the age of kindergarten entry by (1) advising all parents that reading aloud with young children can enhance parent-child relationships and prepare young minds to learn language and early literacy skills; (2) counseling all parents about developmentally appropriate shared-reading activities that are enjoyable for children and their parents and offer language-rich exposure to books, pictures, and the written word; (3) providing developmentally appropriate books given at health supervision visits for all high-risk, low-income young children; (4) using a robust spectrum of options to support and promote these efforts; and (5) partnering with other child advocates to influence national messaging and policies that support and promote these key early shared-reading experiences. The AAP supports federal and state funding for children's books to be provided at pediatric health supervision visits to children at high risk living at or near the poverty threshold and the integration of literacy promotion, an essential component of pediatric primary care, into pediatric resident education. This policy statement is supported by the AAP technical report "School Readiness" and supports the AAP policy statement "Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health."

  View details for DOI 10.1542/peds.2014-1384

  View details for PubMedID 24962987

• Screening parents of high-risk infants for emotional distress: rationale and recommendations. Journal of perinatology : official journal of the California Perinatal Association Hynan, M. T., Mounts, K. O., Vanderbilt, D. L. 2013; 33 (10): 748-53

  Abstract

  Having a baby hospitalized in a neonatal intensive care unit (NICU) is a potentially traumatic event for parents. This article summarizes research documenting heightened symptoms of depression and post-traumatic stress in these parents and reviews studies of the relationship of parental distress with impaired infant and child development. We describe an array of validated screening devices for depression and post-traumatic stress, along with research on risk factors for elevated scores. In making recommendations for screening both mothers and fathers for emotional distress in the NICU, we (a) present commentary on the pros and cons of screening, (b) propose a timetable for screening and (c) describe both supportive interventions for parents in the NICU and a variety of referral possibilities for parents most at risk.

  View details for DOI 10.1038/jp.2013.72

  View details for PubMedID 23807720

• A multivariate surface-based analysis of the putamen in premature newborns: regional differences within the ventral striatum. PloS one Shi, J., Wang, Y., Ceschin, R., An, X., Lao, Y., Vanderbilt, D., Nelson, M. D., Thompson, P. M., Panigrahy, A., Leporé, N. 2013; 8 (7): e66736

  Abstract

  Many children born preterm exhibit frontal executive dysfunction, behavioral problems including attentional deficit/hyperactivity disorder and attention related learning disabilities. Anomalies in regional specificity of cortico-striato-thalamo-cortical circuits may underlie deficits in these disorders. Nonspecific volumetric deficits of striatal structures have been documented in these subjects, but little is known about surface deformation in these structures. For the first time, here we found regional surface morphological differences in the preterm neonatal ventral striatum. We performed regional group comparisons of the surface anatomy of the striatum (putamen and globus pallidus) between 17 preterm and 19 term-born neonates at term-equivalent age. We reconstructed striatal surfaces from manually segmented brain magnetic resonance images and analyzed them using our in-house conformal mapping program. All surfaces were registered to a template with a new surface fluid registration method. Vertex-based statistical comparisons between the two groups were performed via four methods: univariate and multivariate tensor-based morphometry, the commonly used medial axis distance, and a combination of the last two statistics. We found statistically significant differences in regional morphology between the two groups that are consistent across statistics, but more extensive for multivariate measures. Differences were localized to the ventral aspect of the striatum. In particular, we found abnormalities in the preterm anterior/inferior putamen, which is interconnected with the medial orbital/prefrontal cortex and the midline thalamic nuclei including the medial dorsal nucleus and pulvinar. These findings support the hypothesis that the ventral striatum is vulnerable, within the cortico-stiato-thalamo-cortical neural circuitry, which may underlie the risk for long-term development of frontal executive dysfunction, attention deficit hyperactivity disorder and attention-related learning disabilities in preterm neonates.

  View details for DOI 10.1371/journal.pone.0066736

  View details for PubMedID 23843961

  View details for PubMedCentralID PMC3700976

• Chimerism in monochorionic dizygotic twins: case study and review. American journal of medical genetics. Part A Chen, K., Chmait, R. H., Vanderbilt, D., Wu, S., Randolph, L. 2013; 161A (7): 1817-24

  Abstract

  Chimerism occurs when an organism contains cells derived from more than one distinct zygote. We focus on monochorionic dizygotic twin blood chimerism, and particularly twin-twin transfusion syndrome in such pregnancies. For years, researchers have understood chimerism to be a common phenomenon in cattle. Although, this review will not delve deeply into animal chimerism, an understanding of chimerism in the animal world can provide clues regarding health implications for human chimeras. This report serves two purposes: an update and assessment of the twins we reported previously in 2010 [Assaf et al., 2010] and a review on dizygotic monochorionic chimeric twins. First, our updated assessment of the twins shows no identifiable regression of Müllerian sex derivatives in the female, and normal neurodevelopment was documented in both. Our research has suggested several key points; one that blood chimerism persists from fetal life to at least age two years. Second, chimerism in humans is not as rare as previously thought, although it has been studied only recently. Third, assisted reproductive technologies appear to increase the risk of monochorionic dizygotic twin pregnancies.

  View details for DOI 10.1002/ajmg.a.35957

  View details for PubMedID 23703979

• Two-year neurodevelopmental outcomes in children treated with laser surgery for twin-twin transfusion syndrome (TTTS) Vanderbilt, D., Schrager, S., Llanes, A., Hamilton, A., Seri, I., Chmait, R. MOSBY-ELSEVIER. 2013: S86

  View details for DOI 10.1016/j.ajog.2012.10.342

  View details for Web of Science ID 000313393500179

• Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome. American journal of obstetrics and gynecology Vanderbilt, D. L., Schrager, S. M., Llanes, A., Chmait, R. H. 2012; 207 (4): 320.e1-6

  Abstract

  To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery.A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in "high-risk survivors," defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts.For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 "high-risk survivors" (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery <32 weeks' (odds ratio, 4.95; P < .001) and <28 weeks' (odds ratio, 6.25; P < .001) gestation were associated with increased likelihood of any cerebral lesion.This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.

  View details for DOI 10.1016/j.ajog.2012.06.031

  View details for PubMedID 23021698

  View details for PubMedCentralID PMC3462319

• Neurodevelopmental outcomes after laser therapy for twin-twin transfusion syndrome: a systematic review and meta-analysis. Obstetrics and gynecology Rossi, A. C., Vanderbilt, D., Chmait, R. H. 2011; 118 (5): 1145-1150

  Abstract

  To perform a systematic review of the literature regarding the occurrence of neurologic morbidity, neurologic impairment, or neurologic morbidity and impairment of patients treated with laser therapy for twin-twin transfusion syndrome.The PubMed, MEDLINE, EMBASE databases and reference lists were searched up to December 2010 for studies describing outcomes in laser-treated twin-twin transfusion syndrome pregnancies. METHODS FOR STUDY SELECTION: Inclusion criteria were twin-twin transfusion syndrome diagnosed with standard criteria and treated by laser therapy and neurologic morbidity and neurologic impairment collected at birth or 28 days after birth. Exclusion criteria were omission of at least one criterion; data in graphs or percentage; and non-English publications, letters, personal communications.Data recorded were rates and length of successful follow-up, age at diagnosis and type of neurologic morbidity, affected donors and recipients, prevalence of neurologic morbidity, and neurologic impairment for twin sets. From 15 articles, the incidence of neurologic morbidity at birth was 55 out of 895 (6.1%), without differences between donors and recipients (19/249, 7.6% compared with 16/273, 5.8%; odds ratio [OR] 1.36; 95% confidence interval [CI] 0.68-2.70). At follow-up, the incidence of neurologic impairment was 140 out of 1,255 (11.1%), with cerebral palsy the most frequent (60/151, 39.7%). Neurologic impairment was identified equally between donors and recipients (48/330, 14.5% compared with 54/364, 14.8%; OR 1.02; 95% CI 0.66-1.57), and between one survivor and two survivors for twin sets (24/139, 17.3% compared with 88/489, 18.0%; OR 0.67; 95% CI 0.18-2.49).A small number (11.1%) of cases of twin-twin transfusion syndrome treated with laser therapy are affected with neurologic impairment that manifests during infancy. A strict follow-up of apparently healthy neonates is warranted.

  View details for DOI 10.1097/AOG.0b013e318231827f

  View details for PubMedID 22015883

• Mental health concerns of the premature infant through the lifespan. Pediatric clinics of North America Vanderbilt, D., Gleason, M. M. 2011; 58 (4): 815-32, ix

  Abstract

  Because of increased survival rates, neurodevelopmental issues, chronic medical problems, and sometimes complex family issues involved with prematurity, mental health clinicians commonly assess preterm clients and manage their behavioral and mental health problems. Understanding prematurity survival and neurodevelopmental outcomes is important for contextualizing the mental health problems seen in this high-risk population. This article provides a brief overview of prematurity outcomes in the domains of prematurity relevant to practicing child psychiatrists. Prematurity is also examined as it relates to parental mental health challenges, infant mental health outcomes, high frequency attention problems, and psychiatric disorders. The complex interactions between prematurity and family well-being are also highlighted. Finally, evidence-based treatment modalities involved in prevention and management are explored.

  View details for DOI 10.1016/j.pcl.2011.06.012

  View details for PubMedID 21855709

• "Footprints in the bathroom": the role of spirituality in patient diagnosis. Journal of developmental and behavioral pediatrics : JDBP Meneses, V., Vanderbilt, D., Barnes, L., Augustyn, M. 2011; 32 (2): 169-71

  View details for DOI 10.1097/DBP.0b013e31820998b1

  View details for PubMedID 21217403

• Mental health concerns of the premature infant through the lifespan. Child and adolescent psychiatric clinics of North America Vanderbilt, D., Gleason, M. M. 2010; 19 (2): 211-28, vii-viii

  Abstract

  Because of increased survival rates, neurodevelopmental issues, chronic medical problems, and sometimes complex family issues involved with prematurity, mental health clinicians commonly assess preterm clients and manage their behavioral and mental health problems. Understanding prematurity survival and neurodevelopmental outcomes is important for contextualizing the mental health problems seen in this high-risk population. This article provides a brief overview of prematurity outcomes in the domains of prematurity relevant to practicing child psychiatrists. Prematurity is also examined as it relates to parental mental health challenges, infant mental health outcomes, high frequency attention problems, and psychiatric disorders. The complex interactions between prematurity and family well-being are also highlighted. Finally, evidence-based treatment modalities involved in prevention and management are explored.

  View details for DOI 10.1016/j.chc.2010.02.003

  View details for PubMedID 20478497

• Clinical genetic testing for patients with autism spectrum disorders. Pediatrics Shen, Y., Dies, K. A., Holm, I. A., Bridgemohan, C., Sobeih, M. M., Caronna, E. B., Miller, K. J., Frazier, J. A., Silverstein, I., Picker, J., Weissman, L., Raffalli, P., Jeste, S., Demmer, L. A., Peters, H. K., Brewster, S. J., Kowalczyk, S. J., Rosen-Sheidley, B., McGowan, C., Duda, A. W., Lincoln, S. A., Lowe, K. R., Schonwald, A., Robbins, M., Hisama, F., Wolff, R., Becker, R., Nasir, R., Urion, D. K., Milunsky, J. M., Rappaport, L., Gusella, J. F., Walsh, C. A., Wu, B. L., Miller, D. T. 2010; 125 (4): e727-35

  Abstract

  Multiple lines of evidence indicate a strong genetic contribution to autism spectrum disorders (ASDs). Current guidelines for clinical genetic testing recommend a G-banded karyotype to detect chromosomal abnormalities and fragile X DNA testing, but guidelines for chromosomal microarray analysis have not been established.A cohort of 933 patients received clinical genetic testing for a diagnosis of ASD between January 2006 and December 2008. Clinical genetic testing included G-banded karyotype, fragile X testing, and chromosomal microarray (CMA) to test for submicroscopic genomic deletions and duplications. Diagnostic yield of clinically significant genetic changes was compared.Karyotype yielded abnormal results in 19 of 852 patients (2.23% [95% confidence interval (CI): 1.73%-2.73%]), fragile X testing was abnormal in 4 of 861 (0.46% [95% CI: 0.36%-0.56%]), and CMA identified deletions or duplications in 154 of 848 patients (18.2% [95% CI: 14.76%-21.64%]). CMA results for 59 of 848 patients (7.0% [95% CI: 5.5%-8.5%]) were considered abnormal, which includes variants associated with known genomic disorders or variants of possible significance. CMA results were normal in 10 of 852 patients (1.2%) with abnormal karyotype due to balanced rearrangements or unidentified marker chromosome. CMA with whole-genome coverage and CMA with targeted genomic regions detected clinically relevant copy-number changes in 7.3% (51 of 697) and 5.3% (8 of 151) of patients, respectively, both higher than karyotype. With the exception of recurrent deletion and duplication of chromosome 16p11.2 and 15q13.2q13.3, most copy-number changes were unique or identified in only a small subset of patients.CMA had the highest detection rate among clinically available genetic tests for patients with ASD. Interpretation of microarray data is complicated by the presence of both novel and recurrent copy-number variants of unknown significance. Despite these limitations, CMA should be considered as part of the initial diagnostic evaluation of patients with ASD.

  View details for DOI 10.1542/peds.2009-1684

  View details for PubMedID 20231187

  View details for PubMedCentralID PMC4247857

• Acute Posttraumatic Stress Symptoms Among Urban Mothers With Newborns in the Neonatal Intensive Care Unit: A Preliminary Study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Vanderbilt, D., Bushley, T., Young, R., Frank, D. A. 2009; 30 (1): 50-56

  Abstract

  Traumatic stress symptoms from multiple causes are endemic among impoverished women who are also at high risk for delivering infants requiring neonatal intensive care unit (NICU) care, but whether this event itself constitutes a distinct traumatic stress trigger is unknown. Previous research does suggest having an infant in the NICU generates traumatic stress among white middle-class mothers, stress that can impact their infant's behavior and development. This study evaluated the prevalence of acute posttraumatic stress symptoms among low-income mothers of infants admitted to the NICU compared with similar mothers with infants in the well baby nursery (WBN).A total of 59 NICU and 60 WBN mothers were recruited from the Boston Medical Center. Within the first week after birth, all participants were assessed for postpartum acute posttraumatic stress and depression symptoms and asked about lifetime traumatic events before the birth of their baby. The acute posttraumatic stress symptoms were analyzed as a continuous variable and whether they reached the categorical severity criteria for acute stress disorder.NICU mothers show increased symptoms of acute posttraumatic stress and depression. Twenty-three percent of NICU and 3% of WBN reached severity criteria for acute stress disorder. When controlling for relevant covariates, having a newborn in the NICU had a significant association with the number of mothers' acute posttraumatic stress symptoms not fully explained by their symptoms of depression or prior lifetime history of traumatic events.Addressing acute posttraumatic stress symptoms may enhance interventions to help urban families of NICU infants.

  View details for DOI 10.1097/DBP.0b013e318196b0de

  View details for Web of Science ID 000263570500008

  View details for PubMedID 19194322

• Asthma severity and PTSD symptoms among inner city children: a pilot study. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD) Vanderbilt, D., Young, R., MacDonald, H. Z., Grant-Knight, W., Saxe, G., Zuckerman, B. 2008; 9 (2): 191-207

  Abstract

  Although the association between posttraumatic stress symptoms and asthma severity among children has been hypothesized, it has yet to be explored rigorously. This study sought to describe the posttraumatic stress symptoms of children with asthma and explore the relationship between asthma severity and posttraumatic stress symptoms in an inner city sample with high rates of traumatic exposures. Children aged 7 to 17 years, with a clinician-defined asthma diagnosis, were recruited from an inner city outpatient asthma clinic. Caregivers completed measures assessing the child's asthma and posttraumatic stress symptoms and health care utilization. Children also completed measures of asthma, posttraumatic stress symptoms, and asthma-related quality of life. In all, 24 children-caregiver dyads were enrolled. The sample was 79% male and 83% African American, and the mean age was 11 years. Overall the sample had severe asthma, with 33% having been hospitalized over the past year. In addition, 25% of the sample met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for the diagnosis of posttraumatic stress disorder, and 74% of the sample experienced a traumatic event. Posttraumatic stress disorder symptoms were found to be significantly related to asthma severity, quality of life, and health care utilization. Assessing for and treating posttraumatic stress symptoms among children with severe asthma may help to improve their asthma course and quality of life. Further research should explore this relationship and related treatment implications.

  View details for DOI 10.1080/15299730802046136

  View details for PubMedID 19042774