Heidi M. Feldman

All Publications

• Challenging Case: Family Navigation for Autism Spectrum Disorder. Journal of developmental and behavioral pediatrics : JDBP Lin, I. Y., Stahmer, A. C., Feinberg, E., Feldman, H. M., Deras, M., Augustyn, M. 2024

  Abstract

  Leo is a 28-month-old boy from a monolingual Spanish-speaking family who was referred to a developmental-behavioral pediatrics (DBP) clinic for concerns regarding autism. His parents migrated to the United States 8 years ago and currently live and work on a farm. He was born in a US hospital after an uncomplicated pregnancy and has been generally healthy. His parents first became concerned about his development when he was 16 months old. He stopped saying mama/dada in Spanish and started lining up random objects. He had frequent temper tantrums and was difficult to console during unexpected changes in his routine. He screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) at his 18-month well-child visit, and his pediatrician referred him to the local early intervention program. Calls from the early intervention program to his parents were unanswered. At his 24-month well-child visit, he again screened positive on the M-CHAT-R/F, and his pediatrician placed a referral for a DBP consultation. During the DBP visit at 28 months of age, developmental testing indicated his receptive and expressive language skills to be in the extremely low range, with significant scatter in his cognitive and adaptive skills. Behavioral observations were consistent with parental history and showed differences in social communication and interaction, the presence of repetitive behaviors, and extreme distress with transitions. He was diagnosed with autism spectrum disorder. Recommendations, including referral to early intervention, applied behavior analysis therapy, speech and language therapy, audiology evaluation, and genetic testing, were discussed with his parents through an interpreter. An autism packet, written in Spanish, with detailed information about autism and community resources was given to the family. By the time of a follow-up DBP visit 6 months later, Leo had not started on any early intervention or therapeutic services. Where do you go from here?

  View details for DOI 10.1097/DBP.0000000000001322

  View details for PubMedID 39446066

• Listening to Mom in the Neonatal Intensive Care Unit: A randomized trial of increased maternal speech exposure on white matter connectivity in infants born preterm. medRxiv : the preprint server for health sciences Travis, K. E., Scala, M., Marchman, V. A., Wu, H., Dodson, C., Bruckert, L., Lazarus, M., Poblaciones, R. V., Yeom, K., Feldman, H. M. 2024

  Abstract

  Background: Early speech experiences have been proposed to contribute to the development of brain structures involved in processing spoken language. However, previous research has been limited to correlational studies. Here, we conducted an RCT with preterm neonates to determine whether increased exposure to maternal speech during NICU hospitalization is causally linked to structural white matter maturation.Methods: We enrolled 46 preterm neonates (24-31 weeks gestational age). Participants were randomly assigned to receive increased (T: n=21) or routine (C: n=25) exposure to mother's speech. The T-group heard 10-minute audio recordings of their mothers reading a children's story two times/hour between 10pm-6am, increasing speech exposure by 2.67 hours/day. At near-term-equivalent age, we obtained two high-angular resolution diffusion MRI (scan 1 bvalue=700, scan 2 bvalue=1500) and quantitative T1 relaxometry scans. We assessed mean diffusivity (MD), pre-registered primary outcome ( NCT02847689 ), of the left and right arcuate fasciculus, tracts implicated in language processing. Secondary outcomes included fractional anisotropy (FA) and R1 (1/T1).Findings: T- and C-groups were equivalent on medical and demographic variables. Compared to the C- group, the T-group demonstrated significantly lower MD in the left (scan 1: mean difference Delta = 0.11, 95% CI:0.03 - 0.19; scan 2: Delta = 0.13, 95% CI:0.04 - 0.21) but not right arcuate (scan 1: Delta = 0.06, 95% CI: -0.23 - 0.15; scan 2: Delta = 0.05, 95% CI:-0.05 - 0.13). The T-group also demonstrated significantly higher FA (scan 1: Delta = - 0.02, 95% CI:-0.04 - -0.00; scan 2: Delta = -0.03, 95% CI:-0.06 - -0.00) and R1 ( Delta = -0.02, 95% CI:-0.04 - -0.01) in the left but not right arcuate.Interpretation: Preterm neonates who experienced increased exposure to maternal speech during hospitalization demonstrated more mature microstructure of the left arcuate. Findings provide evidence for a causal link between speech experiences and brain development. Increasing speech exposure in the NICU may benefit preterm children.Research in Context Panel: Evidence before this study: Observational studies document the importance of early speech experience for language learning and brain development in term and preterm children. Children born preterm are at-risk for adverse language outcomes that have been attributed to alterations in brain development from limited exposure to speech in the neonatal intensive care unit (NICU). However, evidence that early speech experiences causally effect the development of brain structures relevant for language is lacking.Added value of this study: The Listening to Mom in NICU study is the first randomized controlled trial specifically designed to test the causal effects of maternal speech exposure on white matter brain development in neonates born preterm. This study demonstrates that speech experiences during neonatal development directly contribute to the maturation of the left arcuate fasciculus, a white matter tract implicated in language.Implications of all the available evidence: Study findings advance understandings for how early speech experiences contribute to neonatal brain development. This study also demonstrates that increasing exposure to speech via audio recordings among infants born preterm could serve as an inexpensive and scalable intervention to support recovery from alterations in brain development related to the NICU experience.

  View details for DOI 10.1101/2024.09.20.24314094

  View details for PubMedID 39399034

• Disability health in medical education: development, implementation, and evaluation of a pilot curriculum at Stanford School of Medicine. Frontiers in medicine Sapp, R. W., Lee, E., Bereknyei Merrell, S., Schillinger, E., Lau, J. N., Feldman, H. M., Poffenberger, C. M. 2024; 11: 1355473

  Abstract

  People with disabilities face significant healthcare disparities due to barriers to accessing care, negative attitudes of providers, and lack of education on disabilities for healthcare professionals. Physicians report discomfort when interacting with patients with disabilities, adding to the disparity, warranting research on medical school education.Two educational interventions were structured: (1) a brief 2-h intervention in the mandatory curriculum and (2) a 9-week elective course which included interactions with individuals with disabilities through workshops and partner programs. We predicted that both of these interventions would result in improvements in attitude and empathy toward individuals with disabilities and reduce student anxiety.During the 2018-2019 academic year, 54 students completed the surveys for the 2-h intervention and 8 students completed the 2-h intervention and elective course. Pre-, post-, and delayed post-intervention surveys (3 months after post survey) measured students' attitudes, using validated surveys on attitudes, empathy and anxiety toward individuals with disabilities.Both educational interventions resulted in improved attitudes toward individuals with disabilities. However, students reported only feeling prepared to care for patients with disabilities after the elective course. The elective course, but not the 2-h course, significantly decreased student anxiety levels, likely due to more individual time working with individuals with disabilities. Delayed analysis after 3 months showed that both interventions had a lasting impact on attitudes and behavior change when caring for individuals with disabilities.Medical education is effective at improving medical students' attitudes and behaviors toward individuals with disabilities. A 2-h session can lead to a modest improvement in attitudes. However, more dedicated time and exposure to persons with disabilities results in a greater improvement in students' attitudes, anxiety and preparedness.

  View details for DOI 10.3389/fmed.2024.1355473

  View details for PubMedID 39296898

  View details for PubMedCentralID PMC11408233

• Role of perinatal inflammation in neurodevelopmental impairment of small-for-gestational age and extremely preterm infants. Pediatric research Darmstadt, G. L., Feldman, H. M. 2024

  View details for DOI 10.1038/s41390-024-03454-3

  View details for PubMedID 39143202

  View details for PubMedCentralID 3399936

• Inpatient Skin-to-Skin Care Predicts 12-month Neurodevelopmental Outcomes in Very Preterm Infants. The Journal of pediatrics Lazarus, M. F., Marchman, V. A., Brignoni-Perez, E., Dubner, S., Feldman, H. M., Scala, M., Travis, K. E. 2024: 114190

  Abstract

  OBJECTIVE: To examine the relationship between inpatient skin-to-skin care rates and neurodevelopmental scores measured at 12 months in very preterm infants.STUDY DESIGN: From a retrospective review of medical records of 181 very preterm infants (<32 weeks gestational age [GA]at birth), we derived skin-to-skin care rate, ie, total minutes of skin-to-skin care each infant received over the number of days of hospital stay. We used scores on the Capute Scales from routine follow-up assessments at 12 months to measure neurodevelopmental outcomes.RESULTS: Families averaged approximately 17 minutes/day of skin-to-skin care (2 days/week, 70 minutes/session), although there was substantial variability. Variation in skin-to-skin rate was positively associated with outcomes at 12 months corrected age (r = 0.25, p < .001). Skin-to-skin rate significantly predicted 6.2% unique variance in 12-month neurodevelopmental outcomes, after adjusting for GA, socioeconomic status (SES), health acuity, and visitation frequency. A 20-minute increase in skin-to-skin care per day was associated with a 10-point increase (0.67 SDs) in neurodevelopmental outcomes at 12 months. GA, and infant health acuity did not moderate these relations.CONCLUSION: Very preterm infants who experienced more skin-to-skin care during hospitalization demonstrated higher scores on 12-month neurodevelopmental assessments. Results provide evidence that skin-to-skin care confers extended benefits to very preterm infants through the first year of life. Skin-to-skin care offers promise as part of family-centered interventions designed to promote positive developmental outcomes in at-risk infants.

  View details for DOI 10.1016/j.jpeds.2024.114190

  View details for PubMedID 39004169

• Early language processing efficiency and pre-literacy outcomes in children born full term and preterm. Journal of experimental child psychology Marchman, V. A., Ashland, M. D., Loi, E. C., Munévar, M., Shannon, K. A., Fernald, A., Feldman, H. M. 2024; 246: 105980

  Abstract

  Language processing efficiency-that is, the skill at processing language in real time-assessed in toddlerhood is associated with later language outcomes in children born full term (FT) and preterm (PT) during school age. No studies to date have assessed patterns of relations between early language processing efficiency and pre-literacy skills, such as print knowledge and phonological awareness, and whether relations are similar in FT and PT children. In this study, participants (N = 94, 49 FT and 45PT) were assessed in the looking-while-listening (LWL) task at 18 months of age (corrected for degree of prematurity), deriving measures of processing speed and accuracy. At 4½ years of age, children were assessed on standardized tests of print knowledge, phonological awareness, and expressive language. Processing speed and accuracy predicted both pre-literacy outcomes (r2 change = 7.8%-19.5%, p < .01); birth group did not moderate these effects. Relations were significantly reduced when controlling for expressive language. Thus, early language processing efficiency supports later expressive language abilities, which in turn supports developing pre-literacy skills. Processing speed and phonological awareness were also directly related, indicating an independent role for processing speed in literacy development. Mediation effects were not moderated by birth group, suggesting a similar developmental pathway in FT and PT children.

  View details for DOI 10.1016/j.jecp.2024.105980

  View details for PubMedID 38865929

• Associations of behavioral problems with white matter circuits connecting to the frontal lobes in school-aged children born at term and preterm. Neuroimage. Reports Hosoki, M., Eidsness, M. A., Bruckert, L., Travis, K. E., Feldman, H. M. 2024; 4 (2)

  Abstract

  This study investigated whether internalizing and externalizing behavioral problems in children were associated with fractional anisotropy of white matter tracts connecting other brain regions to the frontal lobes. We contrasted patterns of association between children born at term (FT) and very preterm (PT: gestational age at birth =< 32 weeks).Parents completed the Child Behavior Checklist/6-18 questionnaire to quantify behavioral problems when their children were age 8 years (N = 36 FT and 37 PT). Diffusion magnetic resonance scans were collected at the same age and analyzed using probabilistic tractography. Multiple linear regressions investigated the strength of association between age-adjusted T-scores of internalizing and externalizing problems and mean fractional anisotropy (mean-FA) of right and left uncinate, arcuate, anterior thalamic radiations, and dorsal cingulate bundle, controlling for birth group and sex.Models predicting internalizing T-scores found significant group-by-tract interactions for left and right arcuate and right uncinate. Internalizing scores were negatively associated with mean-FA of left and right arcuate only in FT children (p left AF = 0.01, p right AF = 0.01). Models predicting externalizing T-scores found significant group-by-tract interactions for the left arcuate and right uncinate. Externalizing scores were negatively associated with mean-FA of right uncinate in FT (p right UF = 0.01) and positively associated in PT children (p right UF preterm = 0.01). Other models were not significant.In children with a full range of scores on behavioral problems from normal to significantly elevated, internalizing and externalizing behavioral problems were negatively associated with mean-FA of white matter tracts connecting to frontal lobes in FT children; externalizing behavioral problems were positively associated with mean-FA of the right uncinate in PT children. The different associations by birth group suggest that the neurobiology of behavioral problems differs in the two birth groups.

  View details for DOI 10.1016/j.ynirp.2024.100201

  View details for PubMedID 39301247

  View details for PubMedCentralID PMC11412113

• Leveraging a Large Language Model to Assess Quality-of-Care: Monitoring ADHD Medication Side Effects. medRxiv : the preprint server for health sciences Bannett, Y., Gunturkun, F., Pillai, M., Herrmann, J. E., Luo, I., Huffman, L. C., Feldman, H. M. 2024

  Abstract

  To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD).Retrospective population-based cohort study of electronic health records. Cohort included children aged 6-11 years with ADHD diagnosis and ≥2 ADHD medication encounters (stimulants or non-stimulants prescribed) between 2015-2022 in a community-based primary healthcare network (n=1247). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n=15,593 notes). Model performance was assessed using holdout and deployment test sets, compared to manual chart review.The LLaMA model achieved excellent performance in classifying notes that contain side effects inquiry (sensitivity= 87.2%, specificity=86.3/90.3%, area under curve (AUC)=0.93/0.92 on holdout/deployment test sets). Analyses revealed no model bias in relation to patient age, sex, or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; patient characteristics were similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower in telephone encounters than in-clinic/telehealth encounters (51.9% vs. 73.0%, p<0.01). Side effects inquiry was documented in 61% of encounters following stimulant prescriptions and 48% of encounters following non-stimulant prescriptions (p<0.01).Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality-of-care and uncovered opportunities to improve psychopharmacological medication management in primary care.

  View details for DOI 10.1101/2024.04.23.24306225

  View details for PubMedID 38712037

  View details for PubMedCentralID PMC11071552

• Commentary: Taking stock and moving forward - the need to consider the influence of loss to follow-up in autism screening research. Journal of child psychology and psychiatry, and allied disciplines Aishworiya, R., Ma, V. K., Feldman, H. M. 2024

  Abstract

  This commentary highlights the limitations of many existing population-based studies examining the utility of the Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) in screening for autism. We expound on three major factors: (a) the limited number of screen-negative children who undergo diagnostic evaluations, (b) the substantial number of children who screen positive and were subsequently lost to follow-up (i.e. without further diagnostic evaluations), and (c) the sizeable number of children who did not complete the full two-stage screening process as intended. Each of these factors can lead to erroneous estimates of the psychometric properties, specifically, the sensitivity, specificity, and negative predictive value. Hence, we emphasize the need for future studies to increase the number of children who screen negative and receive a diagnostic evaluation and ensure that these children are selected at random without a higher likelihood for the presence of autism. It is also imperative that concrete steps are taken to minimize the number of screen-positive children who are lost to follow-up both within and after the screening process. Both of these will play a major role in ensuring more robust results from empirical research that can guide the clinical implementation of the M-CHAT-R/F.

  View details for DOI 10.1111/jcpp.13977

  View details for PubMedID 38485245

• Leveraging Large Language Models to Assess Documentation of Medication Side Effects in Clinical Visits for Children with Attention-Deficit/Hyperactivity Disorder Bannett, Y., Gunturkun, F., Pllai, M., Herrmann, J. E., Huffman, L. C., Feldman, H. M. SAGE PUBLICATIONS LTD. 2024: 624-626

  View details for Web of Science ID 001307337600619

• Leveraging Large Language Models to Assess Medication Side Effects Documentation in Children with Attention-Deficit/Hyperactivity Disorder Bannett, Y., Gunturkun, F., Pillai, M., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2024: E119

  View details for Web of Science ID 001165262900046

• Primary Care Physician Identification of Developmental Delays in the COVID-19 Era: A Quantitative Review of Electronic Health Record Data Frelinger, C., Bannett, Y., Gunturkun, F., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2024: E103-E104

  View details for Web of Science ID 001165262900010

• Social Factors Predicting Pre-Linguistic Skills in Infants born Preterm. Pesantez, S., Lazarus, M., Marchman, V. A., Feldman, H. M. SAGE PUBLICATIONS LTD. 2024: 443-444

  View details for Web of Science ID 001307337600459

• NEONATAL INFLAMMATION AND NEAR-TERM WHITE MATTER MICROSTRUCTURE IN INFANTS BORN PRETERM Anderson, K., Lazarus, M., Bruckert, L., Poblaciones, R., Scala, M., Marchman, V. A., Feldman, H. M., Travis, K. E. SAGE PUBLICATIONS LTD. 2024: 526-527

  View details for Web of Science ID 001307337600534

• Rapid Online Assessment of Reading (ROAR): Evaluation of an Online Tool for Screening Reading Skills in a Developmental-Behavioral Pediatrics Clinic. Journal of developmental and behavioral pediatrics : JDBP Barrington, E., Sarkisian, S. M., Feldman, H. M., Yeatman, J. D. 2023; 44 (9): e604-e610

  Abstract

  Reading difficulties are highly prevalent and frequently co-occur with other neurodevelopmental/behavioral conditions. It is difficult to assess reading routinely in pediatric clinical practice because of time and resource constraints. Rapid Online Assessment of Reading (ROAR) is an objective, gamified assessment that children take in a web browser without adult supervision. This study's purpose was to evaluate ROAR as a screening tool for reading difficulties in a clinical setting.A convenience sample of 6- to 14-year-old children, attending an in-person or telehealth visit in a developmental-behavioral pediatrics (DBP) clinic participated. Children took ROAR and completed the Woodcock-Johnson IV Letter-Word Identification (LWID) and Word Attack (WA). Basic Reading Skills (BRS), a standardized aggregate score of LWID and WA, was used as the gold-standard assessment. The strength of association between standard scores on ROAR and BRS was calculated. BRS scores < 90 (bottom quartile) were classified as poor readers. Receiver operating characteristic (ROC) curve analysis was used to assess the quality of ROAR as a screening test.A sample of 41 children, 78% boys, mean age 9.5 years (SD 2.0 years), completed the study. The correlation of ROAR standard score with BRS was r = 0.66, p < 0.001. ROC curve analysis with ROAR scores accurately classified poor readers with an area under the curve (AUC) of 0.90.ROAR is a useful objective screening tool to identify children at high risk for reading difficulties. Assessment of the tool during a busy clinic was challenging, and a larger replication is warranted.

  View details for DOI 10.1097/DBP.0000000000001226

  View details for PubMedID 38016008

  View details for PubMedCentralID PMC10686102

• Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants. Pediatric research Dubner, S. E., Rickerich, L., Bruckert, L., Poblaciones, R. V., Sproul, D., Scala, M., Feldman, H. M., Travis, K. E. 2023

  Abstract

  Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life.Retrospective cohort study.Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle.Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract.Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age.This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone. Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways. Hydrocortisone did not have a significant effect on early brain white matter circuits.

  View details for DOI 10.1038/s41390-023-02903-9

  View details for PubMedID 38030826

  View details for PubMedCentralID 3265791

• Associations of behavioral problems with white matter circuits connecting to the frontal lobes in school-aged children born at term and preterm. medRxiv : the preprint server for health sciences Hosoki, M., Eidsness, M. A., Bruckert, L., Travis, K. E., Feldmana, H. M. 2023

  Abstract

  Introduction: This study investigated whether behavioral problems in children were associated with fractional anisotropy (FA) of white matter tracts connecting from other brain regions to right and left frontal lobes. We considered internalizing and externalizing behavioral problems separately and contrasted patterns of associations in children born at term and very preterm.Methods: Parents completed the Child Behavior Checklist/6-18 questionnaire to quantify behavioral problems when their children were age 8 years (N=36 FT and 37 PT). Diffusion magnetic resonance scans were collected at the same age and analyzed using probabilistic tractography. We used multiple linear regression to investigate the strength of association between age-adjusted T-scores of internalizing and externalizing problems and mean fractional anisotropy (mean-FA) of right and left uncinate, arcuate, and anterior thalamic radiations, controlling for birth group and sex.Results: Regression models predicting internalizing T-scores from mean-FA found significant group-by-tract interactions for the left and right arcuate and right uncinate. Internalizing scores were negatively associated with mean-FA of left and right arcuate only in children born at term ( p left AF =0.01, p right AF =0.01). Regression models predicting externalizing T-scores from mean-FA found significant group-by-tract interactions for the left arcuate and right uncinate. Externalizing scores were negatively associated with mean-FA of right uncinate in children born at term ( p right UF =0.01) and positively associated in children born preterm ( p right UF preterm =0.01). Other models were not significant.Conclusions: In this sample of children with scores for behavioral problems across the full range, internalizing and externalizing behavioral problems were negatively associated with mean-FA of white matter tracts connecting to frontal lobes in children born at term; externalizing behavioral problems were positively associated with mean-FA of the right uncinate in children born preterm. The different associations by birth group suggest that the neurobiology of behavioral problems differs in the two birth groups.Highlights: ⍰ Internalizing problems were negatively associated with arcuate FA in term children.Externalizing problems negatively associated with right uncinate FA in term children.Externalizing problems were positively associated with right uncinate FA in preterm.

  View details for DOI 10.1101/2023.11.08.23298268

  View details for PubMedID 37986772

• Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC medical education Mink, R. B., Carraccio, C. L., Herman, B. E., Weiss, P., Turner, D. A., Stafford, D. E., McGann, K. A., Kesselheim, J., Hsu, D. C., High, P. C., Fussell, J. J., Curran, M. L., Chess, P. R., Sauer, C., Pitts, S., Myers, A. L., Mahan, J. D., Dammann, C. E., Aye, T., Schwartz, A. 2023; 23 (1): 720

  Abstract

  Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment.We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME).In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale.One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05).We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.

  View details for DOI 10.1186/s12909-023-04689-0

  View details for PubMedID 37789289

  View details for PubMedCentralID PMC10548580

• Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening. Pediatrics Aishworiya, R., Ma, V. K., Stewart, S., Hagerman, R., Feldman, H. M. 2023

  Abstract

  The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is used worldwide to screen for autism spectrum disorder (ASD).To calculate psychometric properties of the M-CHAT-R/F for subsequent diagnosis of ASD.Systematic searches of Medline, Embase, SCOPUS, and Trip Pro databases from January 2014 to November 2021.Studies were included if they (1) used the M-CHAT-R/F (2) applied standard scoring protocol, (3) used a diagnostic assessment for ASD, and (4) reported at least 1 psychometric property of the M-CHAT-R/F.Two independent reviewers completed screening, full-text review, data extraction, and quality assessment, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A random-effects model was used to derive pooled estimates and assess for between-study heterogeneity.Of 667 studies identified, 15 with 18 distinct samples from 10 countries (49 841 children) were used in the meta-analysis. Pooled positive predictive value (PPV), was 57.7% (95% confidence interval [CI] 48.6-66.8, τ2 = 0.031). PPV was higher among high-risk (75.6% [95% CI 66.0-85.2]) than low-risk samples (51.2% [95% CI 43.0-59.5]). Pooled negative predictive value was 72.5% (95% CI 62.5-82.4 τ2 = 0.031), sensitivity was 82.6% (95% CI 76.2-88.9) and specificity 45.7% (95% CI 25.0-66.4).Negative predictive value, sensitivity, and specificity were calculated based on small sample sizes because of limited or no evaluation of screen-negative children.These results support use of the M-CHAT-R/F as a screening tool for ASD. Caregiver counseling regarding likelihood of an ASD diagnosis after positive screen should acknowledge the moderate PPV.

  View details for DOI 10.1542/peds.2022-059393

  View details for PubMedID 37203373

• Anxiety and Depression Treatment in Primary Care Pediatrics. Pediatrics Lester, T. R., Herrmann, J. E., Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. 2023

  Abstract

  Primary care pediatricians (PCP) are often called on to manage child and adolescent anxiety and depression. The objective of this study was to describe PCP care practices around prescription of selective serotonin reuptake inhibitors (SSRI) for patients with anxiety and/or depression by using medical record review.We identified 1685 patients who had at least 1 visit with a diagnosis of anxiety and/or depression in a large primary care network and were prescribed an SSRI by a network PCP. We randomly selected 110 for chart review. We reviewed the visit when the SSRI was first prescribed (medication visit), immediately previous visit, and immediately subsequent visit. We abstracted rationale for prescribing medication, subspecialist involvement, referral for psychotherapy, and medication monitoring practices.At the medication visit, in 82% (n = 90) of cases, PCPs documented reasons for starting an SSRI, most commonly clinical change (57%, n = 63). Thirty percent (n = 33) of patients had documented involvement of developmental-behavioral pediatrics or psychiatry subspecialists at 1 of the 3 visits reviewed. Thirty-three percent (n = 37) were referred to unspecified psychotherapy; 4% (n = 4) were referred specifically for cognitive behavioral therapy. Of 69 patients with a subsequent visit, 48% (n = 33) had documentation of monitoring for side effects.When prescribing SSRIs for children with anxiety and/or depression, PCPs in this network documented appropriate indications for starting medication and prescribed without subspecialist involvement. Continuing medical education for PCPs who care for children with these conditions should include information about evidence-based psychotherapy and strategies for monitoring potential side effects.

  View details for DOI 10.1542/peds.2022-058846

  View details for PubMedID 37066669

• Inpatient Kangaroo Care Predicts Early Cognitive Development at 6 and 12 Months in Infants Born Very Preterm. medRxiv : the preprint server for health sciences Lazarus, M. F., Marchman, V. A., Brignoni-Perez, E., Dubner, S., Feldman, H. M., Scala, M., Travis, K. E. 2023

  Abstract

  Background: Limited research links hospital-based experiences of Kangaroo Care (KC), or skin-to-skin holding to longer-term neurodevelopmental outcomes in preterm children. The present study examined relations between inpatient KC and cognitive abilities measured at 6- and 12-months of age in a sample of very preterm (VPT) infants.Methods: Retrospective study reviewing medical records of 132 (54% male) VPT infants (<32 weeks gestational age (GA)). We calculated KC frequency (instances/day), KC rate (minutes/day), and KC duration (minutes/instance). Scores on the Cognitive-Adaptive Test were available as part of routine follow-up care at 6 ( n =77) and 12 ( n = 37) months.Results: Families engaged in KC about 2 days/week, 20 minutes/day, and 70 minutes/session, on average, although there was substantial variability. Variation in KC was positively associated with cognitive outcomes at both 6 (frequency: r=0.32; rate: r=0.29) and 12 (frequency: r=0.53; rate: r=0.59; duration: r=0.38) months. KC significantly predicted 7 to 27% unique variance in 6- and 12-month cognitive outcomes, after controlling for GA, socioeconomic status, health acuity, visitation frequency, and prior cognitive scores. Small increases in KC frequency (e.g., 1 day/week), rate (e.g., 20 minutes/day) or duration (e.g., 20 minutes/instance) were associated with 0.5 to 1.0 SD increases in cognitive outcomes at 12 months. SES, GA, and infant health acuity did not moderate these relations.Conclusion: VPT infants with more KC during hospitalization demonstrated higher scores on 6- and 12- month assessments of cognitive development. Results provide strong evidence that KC may confer neuroprotection on VPT infants through the first year of life.Article Summary: Variation in family-delivered Kangaroo Care in the NICU predicted infants' higher cognitive performance at 6 and 12 months, beyond visitation, clinical, and demographic factors.What is Known on This Subject: Kangaroo Care is a developmental care practice associated with positive short-term outcomes for preterm infants. Kangaroo Care is thought to mitigate adverse neurodevelopmental outcomes associated with preterm birth, but direct evidence of effects beyond hospital discharge is limited.What This Study adds: In this retrospective cohort study, frequency, amount, and duration of family-delivered Kangaroo Care in the NICU predicted cognitive abilities at 6 and 12 months. Kangaroo care may be a long-term neuroprotective clinical strategy for infants born preterm.

  View details for DOI 10.1101/2023.04.06.23288260

  View details for PubMedID 37066271

• Detection of Speech-Language Delay in the Primary Care Setting: An Electronic Health Record Investigation. Journal of developmental and behavioral pediatrics : JDBP Frelinger, C., Gardner, R. M., Huffman, L. C., Whitgob, E. E., Feldman, H. M., Bannett, Y. 2023; 44 (3): e196-e203

  Abstract

  The purpose of this study is to determine the rate and age at first identification of speech-language delay in relation to child sociodemographic variables among a pediatric primary care network.We analyzed a deidentified data set of electronic health records of children aged 1- to 5-years-old seen between 2015 and 2019 at 10 practices of a community-based pediatric primary health care network. Primary outcomes were numbers (proportions) of patients with relevant ICD-10 visit-diagnosis codes and patient age (months) at first documentation of speech-language delay. Regression models estimated associations between outcomes and patient characteristics, adjusting for practice affiliation.Of 14,559 included patients, 2063 (14.1%) had speech-language delay: 68.4% males, 74.4% with private insurance, and 96.1% with English as a primary household language. Most patients (60%) were first identified at the 18- or 24-month well-child visit. The mean age at first documentation was 25.4 months (SD = 9.3), which did not differ between practices reporting the use of standardized developmental screener and those using surveillance questionnaires. Regression models showed that males were more than twice as likely than females to be identified with speech-language delay (adjusted odds ratio [aOR] = 2.05, 95% CI: [1.86-2.25]); publicly insured were more likely than privately insured patients to be identified with speech-language delay (aOR = 1.48, 95% CI: [1.30-1.68]). Females were older than males at first identification (+1.2 months, 95% CI: [0.3-2.1]); privately insured were older than military insured patients (private +3.3 months, 95% CI: [2.2-4.4]).Pediatricians in this network identified speech-language delays at similar rates to national prevalence. Further investigation is needed to understand differences in speech-language delay detection across patient subgroups in practices that use developmental screening and/or surveillance.

  View details for DOI 10.1097/DBP.0000000000001167

  View details for PubMedID 36978234

• Primary Care Pediatricians Prescribing Selective Serotonin Reuptake Inhibitors for Children with Anxiety and Depression Lester, T., Herrmann, J., Bannett, Y., Gardner, R., Feldman, H., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2023: E149

  View details for Web of Science ID 001002197500009

• EFFECTS OF POSTNATAL GLUCOCORTICOIDS ON BRAIN STRUCTURE IN PRETERM INFANTS, A SCOPING REVIEW. Neuroscience and biobehavioral reviews Robles, I., Eidsness, M. A., Travis, K. E., Feldman, H. M., Dubner, S. E. 2023: 105034

  Abstract

  Glucocorticoids (GC) are used in neonatal intensive care units to prevent or reduce the severity of chronic lung disease in preterm infants and have been implicated in impaired neurodevelopment. Our objective was to identify what is known about the effects of postnatal GC treatment in human preterm infants on structural brain development and to identify gaps in the literature. Following Arksey and O'Malley's scoping review methodological framework, we searched scientific literature databases for original research on human preterm infants, postnatal GCs, and brain structure. 11 studies assessed the effects of GCs on structural brain outcomes. 56 studies reported brain injury, but not structure. Dexamethasone was consistently associated with decreased total and regional brain volumes, including cerebellar volumes. Hydrocortisone was often, but not always associated with absence of brain volume differences. No studies examined the impact of inhaled GC on brain structure. Additional research on the effects of neonatal GCs after preterm birth on a variety of structural brain measures is required for understanding contributions to neurodevelopment and informing practice guidelines.

  View details for DOI 10.1016/j.neubiorev.2023.105034

  View details for PubMedID 36608916

• Associations between early efficiency in language processing and language and cognitive outcomes in children born full term and preterm: similarities and differences. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence Marchman, V. A., Ashland, M. D., Loi, E. C., Munevar, M., Shannon, K. A., Fernald, A., Feldman, H. M. 2022: 1-20

  Abstract

  Associations between children's early language processing efficiency and later verbal and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across different domains of function. Examining whether the strengths of associations are similar in typically developing and at-risk populations provides an additional lens into the varying routes to learning that children may take across development. In this follow-up study, children born full-term (FT, n = 49) and preterm (PT, n = 45, ≤32 weeks gestational age, birth weight <1800 g) were assessed in the Looking While Listening (LWL) task at 18 months (corrected for degree of prematurity in PT group). This eye-tracking task assesses efficiency of real-time spoken language comprehension as accuracy and speed (RT) of processing. At 4 ½ years, children were assessed on standardized tests of receptive vocabulary, expressive language, and non-verbal IQ. Language processing efficiency was associated with both language outcomes (r2-change: 7.0-19.7%, p < 0.01), after covariates. Birth group did not moderate these effects, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between speed and non-verbal IQ (r2-change: 4.5%, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of verbal and non-verbal domains in the PT compared to the FT group.

  View details for DOI 10.1080/09297049.2022.2138304

  View details for PubMedID 36324057

• White matter properties underlying reading abilities differ in 8-year-old children born full term and preterm: A multi-modal approach NEUROIMAGE Brignoni-Perez, E., Dubner, S. E., Ben-Shachar, M., Berman, S., Mezer, A. A., Feldman, H. M., Travis, K. E. 2022; 256

  View details for DOI 10.1016/j.neuroimage.2022.119246

  View details for Web of Science ID 000830858700002

• Continuity of Care in Primary Care for Young Children with Chronic Conditions. Academic pediatrics Bannett, Y., Gardner, R. M., Huffman, L. C., Feldman, H. M., Sanders, L. M. 2022

  Abstract

  OBJECTIVES: (1) To assess continuity of care (CoC) within primary-care practices for children with asthma and autism spectrum disorder (ASD) compared to children without chronic conditions, and (2) to determine patient and clinical-care factors associated with CoC.METHODS: Retrospective cohort study of electronic health records from office visits of children <9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary healthcare network in California. Three cohorts were constructed: (1)Asthma: ≥2 visits with asthma visit-diagnoses; (2)ASD: same method; (3)Controls: no chronic conditions. CoC, using Usual Provider of Care measure (range >0-1), was calculated for (1) all visits (overall) and (2) well-care visits. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits.RESULTS: Of 30,678 children, 1875 (6.1%) were classified as Asthma, 294 (1.0%) as ASD, and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean=0.58, SD 0.21) and ASD (M=0.57, SD 0.20) than Controls (M=0.66, SD 0.21); differences in well-care CoC were minimal. In regression models, lower overall CoC was found for Asthma (aOR 0.90, 95% CI 0.85-0.94). Lower overall and well-care CoC were associated with public insurance (aOR 0.77, CI 0.74-0.81; aOR 0.64, CI 0.59-0.69).CONCLUSION: After accounting for patient and clinical-care factors, children with asthma, but not with ASD, in this primary-care network had significantly lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC, emphasizing the need to address disparities in CoC.

  View details for DOI 10.1016/j.acap.2022.07.012

  View details for PubMedID 35858663

• Cochlear Implants for Deaf Children With Early Developmental Impairment. Pediatrics Oghalai, J. S., Bortfeld, H., Feldman, H. M., Chimalakonda, N., Emery, C., Choi, J. S., Zhou, S. 2022

  Abstract

  Infants with profound hearing loss are typically considered for cochlear implantation. Many insurance providers deny implantation to children with developmental impairments because they have limited potential to acquire verbal communication. We took advantage of differing insurance coverage restrictions to compare outcomes after cochlear implantation or continued hearing aid use.Young children with deafness were identified prospectively from 2 different states, Texas and California, and followed longitudinally for an average of 2 years. Children in cohort 1 (n = 138) had normal cognition and adaptive behavior and underwent cochlear implantation. Children in cohorts 2 (n = 37) and 3 (n = 29) had low cognition and low adaptive behavior. Those in cohort 2 underwent cochlear implantation, whereas those in cohort 3 were treated with hearing aids.Cohorts did not substantially differ in demographic characteristics. Using cohort 2 as the reference, children in cohort 1 showed more rapid gains in cognitive, adaptive function, language, and auditory skills (estimated coefficients, 0.166 to 0.403; P ≤ .001), whereas children in cohort 3 showed slower gains (-0.119 to -0.243; P ≤ .04). Children in cohort 3 also had greater increases in stress within the parent-child system (1.328; P = .02), whereas cohorts 1 and 2 were not different.Cochlear implantation benefits children with deafness and developmental delays. This finding has health policy implications not only for private insurers but also for large, statewide, publicly administered programs. Cognitive and adaptive skills should not be used as a "litmus test" for pediatric cochlear implantation.

  View details for DOI 10.1542/peds.2021-055459

  View details for PubMedID 35607935

• Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic. Journal of developmental and behavioral pediatrics : JDBP Bannett, Y., Dahlen, A., Huffman, L. C., Feldman, H. M. 2022

  Abstract

  OBJECTIVE: The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care.METHOD: We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared.RESULTS: ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years.CONCLUSION: Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

  View details for DOI 10.1097/DBP.0000000000001087

  View details for PubMedID 35503665

• White matter properties underlying reading abilities differ in 8-year-old children born full term and preterm: A multi-modal approach. NeuroImage Brignoni-Perez, E., Dubner, S. E., Ben-Shachar, M., Berman, S., Mezer, A. A., Feldman, H. M., Travis, K. E. 2022: 119240

  Abstract

  Many diffusion magnetic resonance imaging (dMRI) studies document associations between reading skills and fractional anisotropy (FA) within brain white matter, suggesting that efficient transfer of information across the brain contributes to individual differences in reading. Use of complementary imaging methods can determine if these associations relate to myelin content of white matter tracts. Compared to children born at term (FT), children born preterm (PT) are at risk for reading deficits. We used two MRI methods to calculate associations of reading and white matter properties in FT and PT children. Participants (N=79: 36 FT and 43 PT) were administered the Gray's Oral Reading Test at age 8. We segmented three dorsal (left arcuate and bilateral superior longitudinal fasciculus) and four ventral (bilateral inferior longitudinal fasciculus and bilateral uncinate) tracts and quantified (1) FA from dMRI and (2) R1 from quantitative T1 relaxometry. We examined correlations between reading scores and these metrics along the trajectories of the tracts. Reading positively correlated with FA in segments of left arcuate and bilateral superior longitudinal fasciculi in FT children; no FA associations were found in PT children. Reading positively correlated with R1 in segments of the left superior longitudinal, right uncinate, and left inferior longitudinal fasciculi in PT children; no R1 associations were found in FT children. Birth group significantly moderated the associations of reading and white matter metrics. Myelin content of white matter may contribute to individual differences in PT but not FT children.

  View details for DOI 10.1016/j.neuroimage.2022.119240

  View details for PubMedID 35490913

• Spatiotemporal changes in along-tract profilometry of cerebellar peduncles in cerebellar mutism syndrome. NeuroImage. Clinical Toescu, S. M., Bruckert, L., Jabarkheel, R., Yecies, D., Zhang, M., Clark, C. A., Mankad, K., Aquilina, K., Grant, G. A., Feldman, H. M., Travis, K. E., Yeom, K. W. 2022: 103000

  Abstract

  Cerebellar mutism syndrome, characterised by mutism, emotional lability and cerebellar motor signs, occurs in up to 39% of children following resection of medulloblastoma, the most common malignant posterior fossa tumour of childhood. Its pathophysiology remains unclear, but prior studies have implicated damage to the superior cerebellar peduncles. In this study, the objective was to conduct high-resolution spatial profilometry of the cerebellar peduncles and identify anatomic biomarkers of cerebellar mutism syndrome. In this retrospective study, twenty-eight children with medulloblastoma (mean age 8.8±3.8years) underwent diffusion MRI at four timepoints over one year. Forty-nine healthy children (9.0±4.2years), scanned at a single timepoint, served as age- and sex-matched controls. Automated Fibre Quantification was used to segment cerebellar peduncles and compute fractional anisotropy (FA) at 30 nodes along each tract. Thirteen patients developed cerebellar mutism syndrome. FA was significantly lower in the distal third of the left superior cerebellar peduncle pre-operatively in all patients compared to controls (FA in proximal third 0.228, middle and distal thirds 0.270, p=0.01, Cohen's d=0.927). Pre-operative differences in FA did not predict cerebellar mutism syndrome. However, post-operative reductions in FA were highly specific to the distal left superior cerebellar peduncle, and were most pronounced in children with cerebellar mutism syndrome compared to those without at the 1-4month follow up (0.325 vs 0.512, p=0.042, d=1.36) and at the 1-year follow up (0.342, vs 0.484, p=0.038, d=1.12). High spatial resolution cerebellar profilometry indicated a site-specific alteration of the distal segment of the superior cerebellar peduncle seen in cerebellar mutism syndrome which may have important surgical implications in the treatment of these devastating tumours of childhood.

  View details for DOI 10.1016/j.nicl.2022.103000

  View details for PubMedID 35370121

• Behavioral Treatment Recommendation for Preschoolers with ADHD Symptoms: How Are Primary Care Pediatricians Doing? Bannett, Y., Gardner, R. M., Posada, J. D., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: E123-E124

  View details for Web of Science ID 000797424900043

• Neonatal Inflammation, Corpus Callosum Microstructure, and Language Skills in 2-Year-Old Children Born Preterm Dubner, S. E., Sproul, D., Rickerich, L., Robles, I., Feldman, H., Travis, K. LIPPINCOTT WILLIAMS & WILKINS. 2022: E140-E141

  View details for Web of Science ID 000797424900075

• Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care. Maternal and child health journal Buysse, C. A., Bentley, B., Baer, L. G., Feldman, H. M. 1800

  Abstract

  INTRODUCTION: Adverse Childhood Experiences (ACEs) are traumatic events that occur before 18years. ACEs, associated with increased health-risk behaviors and chronic health disorders, disproportionately impact people from marginalized communities. Evidence shows that toxic stress from ACEs and adverse social determinants of health can be prevented and treated with trauma-informed care (TIC). The purpose of this educational program was to train a maternal and child health workforce to bring evidence-based trauma-informed care to all impacted people.METHODS: Participants were professionals recruited from Federally Qualified Health Centers, community behavioral health organizations, educational institutions, and agencies serving low-income children and families. 100 unique participants representing 3 counties and 54 agencies joined sessions. Twelve virtual educational sessions were convened over 6months using the Project ECHO model via Zoom technology. Sessions consisted of didactic lectures and case-based discussions.RESULTS: After completion of the series, participants reported high satisfaction and increased knowledge and confidence in using TIC best practice skills. After participation, a significant number of participants voluntarily completed an additional online training about the specific TIC best practices that had been taught in the ECHO. Participants rated the opportunity for interprofessional collaboration and peer support for vicarious trauma as program strengths.DISCUSSION: This project demonstrated feasibility and effectiveness in delivery of a curriculum on trauma-informed care to cross-sector, multi-agency maternal and child health workforce professionals using the Project ECHO model. Robust interprofessional collaboration and participants' request for more sessions demonstrate the potential for this model to effect change at a local systems level.

  View details for DOI 10.1007/s10995-021-03328-8

  View details for PubMedID 35013885

• EFFECTS OF POSTNATAL GLUCOCORTICOIDS ON BRAIN STRUCTURE IN PRETERM INFANTS, A SCOPING REVIEW Robles, I., Eidsness, M. A., Feldman, H. M., Dubner, S. E. BMJ PUBLISHING GROUP. 2022: 217

  View details for DOI 10.1136/jim-2022-WRMC.208

  View details for Web of Science ID 000737295900229

• Academic Half-Day Education Experience in Post-graduate Medical Training: A Scoping Review of Characteristics and Learner Outcomes. Frontiers in medicine Choe, M. S., Huffman, L. C., Feldman, H. M., Hubner, L. M. 2022; 9: 835045

  Abstract

  Background: The academic half-day (AHD) has grown in popularity for medical education because it intends to provide learners with uninterrupted, immersive learning time that may promote participant attendance, engagement, and knowledge. Little is known about the extent of use, forms, or effectiveness of AHD in Post-graduate medical education. This scoping review summarizes existing literature and describes the learning outcomes, according to the Kirkpatrick model of learning evaluation, of AHD experiences on Post-graduate medical trainees.Methods: Authors used Arksey and O'Malley's methodological framework, searching electronic scientific literature databases from the years of 1977-2019 with relevant key terms and identifying 735 papers. Two independent raters completed title/abstract screening and then extracted pertinent data from papers meeting specified criteria.Results: Authors identified 38 relevant papers published in English, originating from programs in US (n = 19) and Canada (n = 19), spanning 4 disciplines: Medicine (n = 17, 45%), Pediatrics (n = 10, 26%), Critical Care/Surgery (n = 9, 24%), Radiology (n = 2, 5%). A majority (n = 33, 87%) described specific educational experiences; most focused on residents only (n = 27). The educational experiences included various teaching strategies; few were didactics only (n = 4) and most were multi-modal including simulation, case-based learning, problem-based learning, and/or self-directed online study. AHD size ranged from 5 to 364 participants (median 39). AHD length was 1.5-6 h (median 3). Required resources were inconsistently described. When evaluations of the specific educational experience were reported (n = 35 studies), the majority of studies used weak research designs (e.g., one group, pre/post-test, n = 19); few studies used strong research designs (e.g., randomized controlled trial, n = 2). Positive effects of AHD ranged across Kirkpatrick levels 1-3 learner outcomes.Conclusions: The composition and content of AHD in Post-graduate medical education vary. Few studies of AHD use stringent research designs, and none include learner outcome measures at the highest Kirkpatrick level (i.e., level 4 results/patient outcomes). A consensus definition and further high-quality research on AHD in Post-graduate medical education is needed.

  View details for DOI 10.3389/fmed.2022.835045

  View details for PubMedID 35308489

• Associations of Behavioral Problems and White Matter Properties of the Cerebellar Peduncles in Boys and Girls Born Full Term and Preterm. Cerebellum (London, England) Hosoki, M., Bruckert, L., Borchers, L. R., Marchman, V. A., Travis, K. E., Feldman, H. M. 2022

  Abstract

  Accumulating evidence suggests that the role of cerebellum includes regulation of behaviors; cerebellar impairment may lead to behavioral problems. Behavioral problems differ by sex: internalizing problems are more common in girls, externalizing problems in boys. Behavioral problems are also elevated in children born preterm (PT) compared to children born full term (FT). The current study examined internalizing and externalizing problems in 8-year-old children in relation to sex, birth-group, fractional anisotropy (FA) of the three cerebellar peduncles (superior, middle, and inferior), and interactions among these predictor variables. Participants (N = 78) were 44 boys (28 PT) and 34 girls (15 PT). We assessed behavioral problems via standardized parent reports and FA of the cerebellar peduncles using deterministic tractography. Internalizing problems were higher in children born PT compared to children born FT (p = .032); the interaction of sex and birth-group was significant (p = .044). When considering the contribution of the mean-tract FA of cerebellar peduncles to behavioral problems, there was a significant interaction of sex and mean-tract FA of the inferior cerebellar peduncle (ICP) with internalizing problems; the slope was negative in girls (p = .020) but not in boys. In boys, internalizing problems were only associated with mean-tract FA ICP in those born preterm (p = .010). We found no other significant associations contributing to internalizing or externalizing problems. Thus, we found sexual dimorphism and birth-group differences in the association of white matter metrics of the ICP and internalizing problems in school-aged children. The findings inform theories of the origins of internalizing behavioral problems in middle childhood and may suggest approaches to treatment at school age.

  View details for DOI 10.1007/s12311-022-01375-7

  View details for PubMedID 35138604

• Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study. Frontiers in pediatrics Lester, T. R., Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. 2022; 10: 794722

  Abstract

  Objectives: To describe medication management of children diagnosed with anxiety and/or depression by primary care providers within a primary care network.Study Design/Methods: We performed a retrospective cross-sectional analysis of electronic health record (EHR) structured data from all children seen at least twice in a 4-year observation period within a network of primary care clinics in Northern California. For children who had visit diagnoses of anxiety, depression, anxiety+depression or symptoms characteristic of these conditions, we analyzed the rates and types of medications prescribed. A logistic regression model considered patient variables for the combined sample.Results: Of all patients 6-18 years old (N = 59,484), 4.4% (n = 2,635) had a diagnosis of anxiety only, 2.4% (n = 1,433) depression only, and 1.2% (n = 737) both anxiety and depression (anxiety + depression); 18% of children with anxiety and/or depression had comorbid ADHD. A total of 15.0% with anxiety only (n = 357), 20.5% with depression only (n = 285), and 47.4% with anxiety+depression (n=343) were prescribed a psychoactive non-stimulant medication. For anxiety and depression only, the top three medications prescribed were sertraline, fluoxetine, and citalopram. For anxiety + depression, the top three medications prescribed were citalopram, sertraline, and escitalopram. Frequently prescribed medications also included benzodiazepines. Logistic regression modeling showed that the depression only and anxety + depression categories had increased likelihood of medication prescription. Older age and mental health comorbidities were independently associated with increased likelihood of medication prescription.Conclusions: In this network, ~8% of children carried a diagnosis of anxiety and/or depression. Medication choices generally aligned with current recommendations with the exception of use of benzodiazepines.

  View details for DOI 10.3389/fped.2022.794722

  View details for PubMedID 35372169

• Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit. Journal of developmental and behavioral pediatrics : JDBP Brignoni-Perez, E., Scala, M., Feldman, H. M., Marchman, V. A., Travis, K. E. 2021

  Abstract

  OBJECTIVE: The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families.METHODS: Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day.RESULTS: Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant.CONCLUSION: Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.

  View details for DOI 10.1097/DBP.0000000000001029

  View details for PubMedID 34723932

• Rate of Pediatrician Recommendations for Behavioral Treatment for Preschoolers With Attention-Deficit/Hyperactivity Disorder Diagnosis or Related Symptoms. JAMA pediatrics Bannett, Y., Gardner, R. M., Posada, J., Huffman, L. C., Feldman, H. M. 2021

  View details for DOI 10.1001/jamapediatrics.2021.4093

  View details for PubMedID 34661611

• SPATIOTEMPORAL CHANGES IN ALONG-TRACT PROFILOMETRY OF CEREBELLAR PEDUNCLES IN CEREBELLAR MUTISM SYNDROME Toescu, S., Bruckert, L., Jabarkheel, R., Yecies, D., Grant, G., Mankad, K., Clark, C., Aquilina, K., Feldman, H., Travis, K., Yeom, K. OXFORD UNIV PRESS INC. 2021: 4-5

  View details for Web of Science ID 000713697200011

• Listening to Mom in the NICU: effects of increased maternal speech exposure on language outcomes and white matter development in infants born very preterm. Trials Brignoni-Perez, E., Morales, M. C., Marchman, V. A., Scala, M., Feldman, H. M., Yeom, K., Travis, K. E. 2021; 22 (1): 444

  Abstract

  BACKGROUND: Infants born very preterm (<32weeks gestational age (GA)) are at risk for developmental language delays. Poor language outcomes in children born preterm have been linked to neurobiological factors, including impaired development of the brain's structural connectivity (white matter), and environmental factors, including decreased exposure to maternal speech in the neonatal intensive care unit (NICU). Interventions that enhance preterm infants' exposure to maternal speech show promise as potential strategies for improving short-term health outcomes. Intervention studies have yet to establish whether increased exposure to maternal speech in the NICU offers benefits beyond the newborn period for brain and language outcomes.METHODS: This randomized controlled trial assesses the long-term effects of increased maternal speech exposure on structural connectivity at 12months of age (age adjusted for prematurity (AA)) and language outcomes between 12 and 18months of age AA. Study participants (N=42) will include infants born very preterm (24-31weeks 6/7days GA). Newborns are randomly assigned to the treatment (n=21) or standard medical care (n=21) group. Treatment consists of increased maternal speech exposure, accomplished by playing audio recordings of each baby's own mother reading a children's book via an iPod placed in their crib/incubator. Infants in the control group have the identical iPod setup but are not played recordings. The primary outcome will be measures of expressive and receptive language skills, obtained from a parent questionnaire collected at 12-18months AA. The secondary outcome will be measures of white matter development, including the mean diffusivity and fractional anisotropy derived from diffusion magnetic resonance imaging scans performed at around 36weeks postmenstrual age during the infants' routine brain imaging session before hospital discharge and 12months AA.DISCUSSION: The proposed study is expected to establish the potential impact of increased maternal speech exposure on long-term language outcomes and white matter development in infants born very preterm. If successful, the findings of this study may help to guide NICU clinical practice for promoting language and brain development. This clinical trial has the potential to advance theoretical understanding of how early language exposure directly changes brain structure for later language learning.TRIAL REGISTRATION: NIH Clinical Trials (ClinicalTrials.gov) NCT04193579 . Retrospectively registered on 10 December 2019.

  View details for DOI 10.1186/s13063-021-05385-4

  View details for PubMedID 34256820

• International Interprofessional Collaborative Office Rounds (iiCOR): Addressing Children's Developmental, Behavioral, and Emotional Health Using Distance Technology FRONTIERS IN PUBLIC HEALTH Kiing, J. H., Feldman, H. M., Ladish, C., Srinivasan, R., Donnelly, C. L., Chong, S., Weitzman, C. C. 2021; 9: 657780

  Abstract

  Developmental, behavioral, and emotional issues are highly prevalent among children across the globe. Among children living in low- and middle-income countries, these conditions are leading contributors to the global burden of disease. A lack of skilled professionals limits developmental and mental health care services to affected children globally. Collaborative Office Rounds are interprofessional groups that meet regularly to discuss actual cases from the participants' practices using a non-hierarchical, peer-mentoring approach. In 2017, International Interprofessional Collaborative Office Rounds was launched with several goals: to improve the knowledge and skills of practicing child health professionals in high and low resourced settings regarding developmental and mental health care, to support trainees and clinicians in caring for these children, and to promote best practice in diagnosis and management of these conditions. Five nodes, each comprised of 3-4 different sites with an interprofessional team, from 8 countries in North America, Africa, Asia, and South America met monthly via videoconferencing. This report describes and evaluates the first 2 years' experience. Baseline surveys from participants (N = 141) found that 13 disciplines were represented. Qualitative analysis of 51 discussed cases, revealed that all cases were highly complex. More than half of the cases (N = 26) discussed children with autism or traits of autism and almost all (N = 49) had three or more themes discussed. Frequently occurring themes included social determinants of health (N = 31), psychiatric co-morbidity (N = 31), aggression and self-injury (N = 25), differences with the healthcare provider (N = 17), cultural variation in accepting diagnosis or treatment (N = 19), and guidance on gender and sexuality issues (N = 8). Participants generally sought recommendations on next steps in clinical care or management. A survey of participants after year 1 (N = 47) revealed that 87% (N = 41) had expectations that were completely or mostly met by the program. Our experience of regular meetings of interprofessional groups from different countries using distance-learning technology allowed participants to share on overlapping challenges, meet continuing educational needs while learning about different approaches in high- and low-resourced settings. International Interprofessional Collaborative Office Rounds may prove a useful strategy for increasing the work force capacity for addressing developmental, behavioral, and emotional conditions worldwide. More systematic studies are needed.

  View details for DOI 10.3389/fpubh.2021.657780

  View details for Web of Science ID 000654268700001

  View details for PubMedID 34055722

  View details for PubMedCentralID PMC8149584

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000670615500076

• Diagnosis of Language Delay in the Primary Care Setting: An Electronic Health Record Investigation Frelinger, C., Gardner, R. M., Huffman, L., Whitgob, E., Feldman, H. M., Bannett, Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: S1-S2

  View details for Web of Science ID 000656627200016

• Continuity of Care by Primary Care Provider in Young Children with Autism Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S2

  View details for Web of Science ID 000656627200017

• Associations of Attention Problems, Behavior Problems, Social Competence, and Academic Skills in a School Aged Children Born Preterm and Term Hosoki, M., Travis, K. E., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2021: S18

  View details for Web of Science ID 000670615500061

• Diagnosis of Language Delay in the Primary Care Setting: An Electronic Health Record Investigation Frelinger, C., Gardner, R. M., Huffman, L., Whitgob, E., Feldman, H. M., Bannett, Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: S1-S2

  View details for Web of Science ID 000670615500016

• Continuity of Care by Primary Care Provider in Young Children with Autism Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S2

  View details for Web of Science ID 000670615500017

• Associations of Attention Problems, Behavior Problems, Social Competence, and Academic Skills in a School Aged Children Born Preterm and Term Hosoki, M., Travis, K. E., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2021: S18

  View details for Web of Science ID 000656627200061

• Disparities in Kangaroo Care in the Neonatal Intensive Care Unit as a function of Mother's Language Brignoni-Perez, E., Scala, M., Marchman, V. A., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S24-S25

  View details for Web of Science ID 000656627200082

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000656627200076

• Disparities in Kangaroo Care in the Neonatal Intensive Care Unit as a function of Mother's Language Brignoni-Perez, E., Scala, M., Marchman, V. A., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S24-S25

  View details for Web of Science ID 000670615500082

• Editorial: The Neural Signatures of Plasticity in Developmental and Early Acquired Speech, Language and Reading Disorders. Frontiers in human neuroscience Davila, G., Feldman, H. M., Lopez-Barroso, D. 2021; 15: 771567

  View details for DOI 10.3389/fnhum.2021.771567

  View details for PubMedID 34744672

• A Comparison of Quantitative R1 and Cortical Thickness in Identifying Age, Lifespan Dynamics, and Disease States of the Human Cortex. Cerebral cortex (New York, N.Y. : 1991) Erramuzpe, A., Schurr, R., Yeatman, J. D., Gotlib, I. H., Sacchet, M. D., Travis, K. E., Feldman, H. M., Mezer, A. A. 2020

  Abstract

  Brain development and aging are complex processes that unfold in multiple brain regions simultaneously. Recently, models of brain age prediction have aroused great interest, as these models can potentially help to understand neurological diseases and elucidate basic neurobiological mechanisms. We test whether quantitative magnetic resonance imaging can contribute to such age prediction models. Using R1, the longitudinal rate of relaxation, we explore lifespan dynamics in cortical gray matter. We compare R1 with cortical thickness, a well-established biomarker of brain development and aging. Using 160 healthy individuals (6-81 years old), we found that R1 and cortical thickness predicted age similarly, but the regions contributing to the prediction differed. Next, we characterized R1 development and aging dynamics. Compared with anterior regions, in posterior regions we found an earlier R1 peak but a steeper postpeak decline. We replicate these findings: firstly, we tested a subset (N=10) of the original dataset for whom we had additional scans at a lower resolution; and second, we verified the results on an independent dataset (N=34). Finally, we compared the age prediction models on a subset of 10 patients with multiple sclerosis. The patients are predicted older than their chronological age using R1 but not with cortical thickness.

  View details for DOI 10.1093/cercor/bhaa288

  View details for PubMedID 33095854

• Fellows Front and Center: Tele-Training and Telehealth ACADEMIC PEDIATRICS Huffman, L. C., Feldman, H. M., Hubner, L. M. 2020; 20 (6): 764–65

  View details for Web of Science ID 000567888700018

• Associations of Reading Efficiency with White Matter Properties of the Cerebellar Peduncles in Children. Cerebellum (London, England) Bruckert, L., Travis, K. E., Mezer, A. A., Ben-Shachar, M., Feldman, H. M. 2020

  Abstract

  Reading in children has been associated with microstructural properties of the cerebellar peduncles, the white matter pathways connecting the cerebellum to the cerebrum. In this study, we used two independent neuroimaging modalities to assess which features of the cerebellar peduncles would be associated with reading. Twenty-three 8-year-old children were evaluated on word reading efficiency and imaged using diffusion MRI (dMRI) and quantitative T1 relaxometry (qT1). We segmented the superior (SCP), middle, and inferior cerebellar peduncles and extracted two metrics: fractional anisotropy (FA) from dMRI and R1 from qT1. Tract-FA was significantly correlated with tract-R1 in left and right SCPs (left: rP(21)=.63, right: rP(21)=.76, p≤.001) suggesting that FA of these peduncles, at least in part, indexed myelin content. Tract-FA and tract R1 were not correlated in the other cerebellar peduncles. Reading efficiency negatively correlated with tract-FA of the left (rP(21)=-.43, p=.040) and right SCP (rP(21)=-.37, p=.079). Reading efficiency did not correlate with tract-R1 in the SCPs. The negative association of reading efficiency with tract-FA and the lack of association of reading efficiency with tract-R1 implicate properties other than myelin content as relevant to the information flow between the cerebellum and the cerebrum for individual differences in reading skills in children.

  View details for DOI 10.1007/s12311-020-01162-2

  View details for PubMedID 32642932

• Reading Abilities in Relation to Quantitative T1 MRI Metrics for Assessing Myelin Content in 8-Year Old Children Born Preterm Travis, K., Dubner, S., Feldman, H. LIPPINCOTT WILLIAMS & WILKINS. 2020: S16

  View details for Web of Science ID 000526852800038

• Neonatal white matter tract microstructure and 2-year language outcomes after preterm birth. NeuroImage. Clinical Dubner, S. E., Rose, J. n., Bruckert, L. n., Feldman, H. M., Travis, K. E. 2020; 28: 102446

  Abstract

  To determine whether variability in diffusion MRI (dMRI) white matter tract metrics, obtained in a cohort of preterm infants prior to neonatal hospital discharge, would be associated with language outcomes at age 2 years, after consideration of age at scan and number of major neonatal complications.30 children, gestational age 28.9 (2.4) weeks, underwent dMRI at mean post menstrual age 36.4 (1.4) weeks and language assessment with the Bayley Scales of Infant Development-III at mean age 22.2 (1.7) months chronological age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for 5 white matter tracts. Hierarchical linear regression assessed associations between tract FA, moderating variables, and language outcomes.FA of the left inferior longitudinal fasciculus accounted for 17% (p = 0.03) of the variance in composite language and FA of the posterior corpus callosum accounted for 19% (p = 0.02) of the variance in composite language, beyond that accounted for by post-menstrual age at scan and neonatal medical complications. The number of neonatal medical complications moderated the relationship between language and posterior corpus callosum FA but did not moderate the association in the other tract.Language at age 2 is associated with white matter metrics in early infancy in preterm children. The different pattern of associations by fiber group may relate to the stage of brain maturation and/or the nature and timing of medical complications related to preterm birth. Future studies should replicate these findings with a larger sample size to assure reliability of the findings.

  View details for DOI 10.1016/j.nicl.2020.102446

  View details for PubMedID 33035964

• Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience. Academic pediatrics Bannett, Y. n., Feldman, H. M., Gardner, R. M., Blaha, O. n., Huffman, L. C. 2020

  Abstract

  To assess (1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, (2) documented PCP adherence to ADHD clinical practice guidelines, and (3) patient factors influencing PCP variation in diagnosis and management.Retrospective cohort study of electronic health records from all office visits of children aged 2-5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary healthcare network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in (1) comorbidity documentation at or after ADHD diagnosis, (2) ADHD medication choice, and (3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics.Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (e.g., hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4-5-year-olds (40/195 (21%)); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (OR 1.94; 95% CI 1.40-2.66; OR 3.17; 95% CI 1.93-4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32-0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13-9.58).PCPs in this network frequently used symptom-level ADHD diagnoses in 2-5-year-olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low.

  View details for DOI 10.1016/j.acap.2020.04.009

  View details for PubMedID 32360494

• Colocated Developmental-Behavioral Pediatrics in Primary Care: Improved Outcome Across Settings. Journal of developmental and behavioral pediatrics : JDBP Martin-Herz, S. P., Buysse, C. A., DeBattista, A. n., Feldman, H. M. 2020

  Abstract

  We developed a colocation "Rapid Developmental Evaluation" (RDE) model for Developmental-Behavioral Pediatrics (DBP) to evaluate young children for developmental concerns raised during routine developmental surveillance and screening in a pediatric primary care Federally Qualified Health Center (FQHC). In this low-income patient population, we anticipated that colocation would improve patient access to DBP and decrease time from referral to first developmental evaluation and therapeutic services.Children were assessed at the FQHC by a DBP pediatrician, who made recommendations for therapeutic services and further diagnostic evaluations. A retrospective chart review over 27 months (N = 151) investigated dates of referral and visit, primary concern, diagnosis, and referral to tertiary DBP center and associated tertiary DBP center dates of service and diagnoses if appropriate. We surveyed primary care clinicians (PCCs) for satisfaction.The DBP pediatrician recommended that 51% of children be referred to the tertiary DBP center for further diagnostic evaluation or routine DBP follow-up. Average wait from referral to an RDE visit was 57 days compared with 137.3 days for the tertiary DBP center. Children referred from RDE to the tertiary DBP center completed visits at a higher rate (77%) than those referred from other sites (54%). RDE-recommended therapeutic services were initiated for 73% of children by the tertiary visit. Fidelity of diagnosis between RDE and the tertiary DBP center was high, as was PCC satisfaction.Colocation of a DBP pediatrician in an FQHC primary care pediatrics program decreased time to first developmental assessment and referral for early intervention services for an at-risk, low-income patient population.

  View details for DOI 10.1097/DBP.0000000000000789

  View details for PubMedID 32108124

• Development and Evaluation of a School Readiness Curriculum for Pediatrics Residents. MedEdPORTAL : the journal of teaching and learning resources Perrin, H. T., Feldman, H. M., Huffman, L. C. 2020; 16: 10976

  Abstract

  The American Academy of Pediatrics (AAP) recommends that pediatricians promote school readiness with children and families. To our knowledge, no published resident-focused curricula addressing school readiness are currently available. We sought to fill this gap by developing and evaluating a school readiness curriculum for pediatrics residents.We conducted a literature review and targeted needs assessment of pediatrics residents. We then developed a school readiness curriculum and piloted it over several months, adjusting it iteratively each month. The final curriculum was delivered to 34 primarily first-year pediatrics residents over 11 months and included three self-guided observations at local preschools using a templated observation guide, followed by a 1.5-hour in-person facilitated workshop with three components: a PowerPoint presentation, a discussion about preschool observations, and a case study with hands-on developmental questionnaire practice. The curriculum was evaluated with preintervention, immediate postintervention, and 2-months delayed postintervention surveys.Our curriculum successfully increased pediatrics residents' knowledge regarding the correct definition of school readiness and appropriate management plan for school readiness concerns, confidence discussing school readiness and addressing families' school readiness concerns, and behavior raising the topic of school readiness with families during well child checks.A school readiness curriculum had a beneficial effect of increasing pediatrics residents' knowledge, confidence, and behavior addressing school readiness in clinical encounters, meeting a priority of the AAP.

  View details for DOI 10.15766/mep_2374-8265.10976

  View details for PubMedID 33015356

  View details for PubMedCentralID PMC7526503

• PRIMARY CARE MANAGEMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN AGED 2-5 YEARS Bannett, Y., Feldman, H. M., Gardner, R. M., Blaha, O., Huffman, L. C. BMJ PUBLISHING GROUP. 2020: A164

  View details for DOI 10.1136/jim-2019-WMRC.380

  View details for Web of Science ID 000507513300380

• Predictors of early vocabulary growth in children born preterm and full term: A study of processing speed and medical complications CHILD NEUROPSYCHOLOGY Marchman, V. A., Ashland, M. D., Loi, E. C., Adams, K. A., Fernald, A., Feldman, H. M. 2019; 25 (7): 943–63

  View details for DOI 10.1080/09297049.2019.1569608

  View details for Web of Science ID 000474597400005

• Age-Dependent White Matter Characteristics of the Cerebellar Peduncles from Infancy Through Adolescence CEREBELLUM Bruckert, L., Shpanskaya, K., McKenna, E. S., Borchers, L. R., Yablonski, M., Blecher, T., Ben-Shachar, M., Travis, K. E., Feldman, H. M., Yeom, K. W. 2019; 18 (3): 372–87

  View details for DOI 10.1007/s12311-018-1003-9

  View details for Web of Science ID 000468112900008

• White Matter Plasticity in Reading-Related Pathways Differs in Children Born Preterm and at Term: A Longitudinal Analysis FRONTIERS IN HUMAN NEUROSCIENCE Bruckert, L., Borchers, L. R., Dodson, C. K., Marchman, V. A., Travis, K. E., Ben-Shachar, M., Feldman, H. M. 2019; 13

  View details for DOI 10.3389/fnhum.2019.00139

  View details for Web of Science ID 000467472300001

• White Matter Plasticity in Reading-Related Pathways Differs in Children Born Preterm and at Term: A Longitudinal Analysis. Frontiers in human neuroscience Bruckert, L., Borchers, L. R., Dodson, C. K., Marchman, V. A., Travis, K. E., Ben-Shachar, M., Feldman, H. M. 2019; 13: 139

  Abstract

  Children born preterm (PT) are at risk for white matter injuries based on complications of prematurity. They learn to read but on average perform below peers born full term (FT). Studies have yet to establish whether properties of white matter pathways at the onset of learning to read are associated with individual variation later in reading development in PT children. Here, we asked whether fractional anisotropy (FA) at age 6 years is associated with reading outcome at age 8 years in PT children in the same pathways as previously demonstrated in a sample of FT children. PT (n = 34, mean gestational age = 29.5 weeks) and FT children (n = 37) completed diffusion MRI and standardized measures of non-verbal IQ, language, and phonological awareness at age 6 years. Reading skills were assessed at age 8 years. Mean tract-FA was extracted from pathways that predicted reading outcome in children born FT: left arcuate fasciculus (Arc), bilateral superior longitudinal fasciculus (SLF), and left inferior cerebellar peduncle (ICP). We explored associations in additional pathways in the PT children: bilateral inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. Linear regression models examined whether the prediction of reading outcome at age 8 years based on mean tract-FA at age 6 years was moderated by birth group. Children born PT and FT did not differ significantly in tract-FA at age 6 years or in reading at age 8 years. Sex, socioeconomic status, and non-verbal IQ at age 6 years were associated with reading outcome and were included as covariates in all models. Birth group status significantly moderated associations between reading outcome and mean tract-FA only in the left Arc, right SLF, and left ICP, before and after consideration of pre-literacy skills. Microstructural properties of these cerebral and cerebellar pathways predicted later reading outcome in FT but not in PT children. Children born PT may rely on alternative pathways to achieve fluent reading. These findings have implications for plasticity of neural organization after early white matter injury.

  View details for DOI 10.3389/fnhum.2019.00139

  View details for PubMedID 31139064

  View details for PubMedCentralID PMC6519445

• Predicting text reading skills at age 8 years in children born preterm and at term EARLY HUMAN DEVELOPMENT Borchers, L. R., Bruckert, L., Travis, K. E., Dodson, C. K., Loe, I. M., Marchman, V. A., Feldman, H. M. 2019; 130: 80–86

  View details for DOI 10.1016/j.earlhumdev.2019.01.012

  View details for Web of Science ID 000462801000013

• Microstructural properties of white matter pathways in relation tosubsequent reading abilities in children: a longitudinal analysis BRAIN STRUCTURE & FUNCTION Borchers, L. R., Bruckert, L., Dodson, C. K., Travis, K. E., Marchman, V. A., Ben-Shachar, M., Feldman, H. M. 2019; 224 (2): 891–905

  View details for DOI 10.1007/s00429-018-1813-z

  View details for Web of Science ID 000461379400027

• Predictors of early vocabulary growth in children born preterm and full term: A study of processing speed and medical complications. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence Marchman, V. A., Ashland, M. D., Loi, E. C., Adams, K. A., Fernald, A., Feldman, H. M. 2019: 1–21

  Abstract

  Delays in expressive vocabulary may be harbingers of long-term language difficulties. In toddlers born full term (FT), individual differences in language processing speed are associated with variation in expressive vocabulary growth. Children born preterm (PT) are at increased risk for persistent language deficits. Here, we evaluate predictors of early vocabulary growth in PT toddlers in relation to two sources of variability: language processing speed and medical complications of prematurity. Vocabulary growth from 16 to 30months (adjusted for degree of prematurity) was modeled longitudinally using parent reports in English-speaking FT (n =63; ≥37weeks, ≥2495g) and PT (n =69; ≤32weeks, <1800g) children, matched on sex and socioeconomic status. Children were tested in the "looking-while-listening task" at 18months to derive a measure of language processing speed. Each PT child was assessed for number of medical complications (13 maximum), based on medical chart reviews. PT and FT children displayed similar vocabulary trajectories; however, birth group disparities began to emerge by 30months. PT children were slower in language processing speed than FT children. Critically, language processing speed predicted expressive vocabulary size at 30months; interactions with birth group were not significant (all p >.20). In PT children, faster language processing speed predicted stronger outcomes regardless of number of medical complications; slower processing speed and more medical complications predicted poorer outcomes. Faster processing speed reflected favorable neuropsychological processes associated with faster expressive vocabulary growth that overrode the impact of medical complications on language outcomes in PT children.

  View details for PubMedID 30714476

• Predicting text reading skills at age 8 years in children born preterm and at term. Early human development Borchers, L. R., Bruckert, L., Travis, K. E., Dodson, C. K., Loe, I. M., Marchman, V. A., Feldman, H. M. 2019; 130: 80–86

  Abstract

  BACKGROUND: Children born preterm are at risk for developing reading difficulties and for decrements in other cognitive skills compared to children born at term.AIMS: To assess how domains of function, often negatively impacted by preterm birth, predict reading development in children born preterm and at term.STUDY DESIGN: Longitudinal descriptive cohort study.SUBJECTS: Preterm (n = 48; gestational age 22-32 weeks, 30 males) and term (n = 41, 18 males) participants were assessed at age 6 years on a battery of verbal and non-verbal cognitive skills and reassessed at age 8 using the Gray Oral Reading Tests-5. Linear regressions assessed the contributions of phonological awareness, language, executive function, and non-verbal IQ at age 6 to reading outcome at age 8.RESULTS: Children born preterm had lower scores than children born at term on all measures (Cohen's d from 0.46 to 1.08, all p < .05). Phonological awareness and language abilities predicted reading in both groups (accounting for 19.9% and 25.0% of variance, respectively, p < .001). Birth group did not moderate the association. By contrast, the association between executive function and non-verbal intelligence and reading outcome was moderated by birth group (interaction accounted for 3.9-6.7% of variance, respectively, p < .05). Positive predictions to reading from executive function and non-verbal IQ were found only in children born preterm.CONCLUSIONS: Non-verbal cognitive skills improved the prediction of reading outcome only in the preterm group, suggesting that reading decrements represent a component of global deficits. These findings have implications for evaluation of children born preterm at school entry and treatment of reading difficulties.

  View details for PubMedID 30708270

• Executive Function in Relation to White Matter in Preterm and Full Term Children FRONTIERS IN PEDIATRICS Loe, I. M., Adams, J. N., Feldman, H. M. 2019; 6

  View details for DOI 10.3389/fped.2018.00418

  View details for Web of Science ID 000455718200001

• Age-Dependent White Matter Characteristics of the Cerebellar Peduncles from Infancy Through Adolescence. Cerebellum (London, England) Bruckert, L., Shpanskaya, K., McKenna, E. S., Borchers, L. R., Yablonski, M., Blecher, T., Ben-Shachar, M., Travis, K. E., Feldman, H. M., Yeom, K. W. 2019

  Abstract

  Cerebellum-cerebrum connections are essential for many motor and cognitive functions and cerebellar disorders are prevalent in childhood. The middle (MCP), inferior (ICP), and superior cerebellar peduncles (SCP) are the major white matter pathways that permit communication between the cerebellum and the cerebrum. Knowledge about the microstructural properties of these cerebellar peduncles across childhood is limited. Here, we report on a diffusion magnetic resonance imaging tractography study to describe age-dependent characteristics of the cerebellar peduncles in a cross-sectional sample of infants, children, and adolescents from newborn to 17years of age (N=113). Scans were collected as part of clinical care; participants were restricted to those whose scans showed no abnormal findings and whose history and exam had no risk factors for cerebellar abnormalities. A novel automated tractography protocol was applied. Results showed that mean tract-FA increased, while mean tract-MD decreased from infancy to adolescence in all peduncles. Rapid changes were observed in both diffusion measures in the first 24months of life, followed by gradual change at older ages. The shape of the tract profiles was similar across ages for all peduncles. These data are the first to characterize the variability of diffusion properties both across and within cerebellar white matter pathways that occur from birth through later adolescence. The data represent a rich normative data set against which white matter alterations seen in children with posterior fossa conditions can be compared. Ultimately, the data will facilitate the identification of sensitive biomarkers of cerebellar abnormalities.

  View details for PubMedID 30637673

• White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm. NeuroImage. Clinical Dubner, S. E., Dodson, C. K., Marchman, V. A., Ben-Shachar, M. n., Feldman, H. M., Travis, K. E. 2019; 23: 101832

  Abstract

  Cognitive outcomes in preterm (PT) children have been associated with microstructural properties of white matter. PT children who experienced neonatal inflammatory conditions have poorer cognitive outcomes than those who did not. The goal of this study was to contrast white matter microstructure and cognitive outcomes after preterm birth in relation to the presence or absence of severe inflammatory conditions in the neonatal period.PT children (n = 35), born at gestational age 22-32 weeks, were classified as either PT+ (n = 12) based on a neonatal history of inflammatory conditions, including bronchopulmonary dysplasia, necrotizing enterocolitis or culture positive sepsis, or PT- (n = 23) based on the absence of the three inflammatory conditions. Full term (FT) children (n = 43) served as controls. Participants underwent diffusion MRI and cognitive testing (intelligence, reading, and executive function) at age 6 years. The corpus callosum was segmented into 7 regions using deterministic tractography and based on the cortical projection zones of the callosal fibers. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for each segment. General linear models with planned contrasts assessed group differences in FA, MD and cognitive outcomes. Pearson correlations assessed associations of white matter metrics and cognitive outcome measures.FA was significantly lower and MD was significantly higher in PT+ compared to PT- or FT groups in multiple callosal segments, even after adjusting for gestational age. Executive function scores, but not intelligence or reading scores, were less favorable in PT+ than in PT- groups. Among the entire sample, occipital FA was significantly correlated with IQ (r = 0.25, p < 0.05), reading (r = 0.32, p < 0.01), and executive function (r = -0.28, p < 0.05) measures. Anterior frontal FA and superior parietal FA were significantly correlated with executive function (r = -0.25, r = 0.23, respectively, p < 0.05).We observed differences in the white matter microstructure of the corpus callosum and in the cognitive skills of 6-year-old PT children based on their history of neonatal inflammation. Neonatal inflammation is one medical factor that may contribute to variation in long-term neurobiological and neuropsychological outcomes in PT samples.

  View details for PubMedID 31075555

• Primary Care Physicians/Subspecialty Pediatricians HANDBOOK OF INTERDISCIPLINARY TREATMENTS FOR AUTISM SPECTRUM DISORDER Youssef, J. N., Won, D. C., Feldman, H. M., Rieske, R. D. 2019: 207–23

  View details for DOI 10.1007/978-3-030-13027-5_12

  View details for Web of Science ID 000510612800012

• Language nutrition for language health in children with disorders: a scoping review. Pediatric research Bang, J. Y., Adiao, A. S., Marchman, V. A., Feldman, H. M. 2019

  Abstract

  The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.

  View details for DOI 10.1038/s41390-019-0551-0

  View details for PubMedID 31454828

• The Importance of Language-Learning Environments to Child Language Outcomes. Pediatrics Feldman, H. M. 2019

  View details for DOI 10.1542/peds.2019-2157

  View details for PubMedID 31551397

• Variation in Primary Care Management of Attention-Deficit/Hyperactivity Disorder by Primary Care Providers Academic Pediatrics Bannett, Y., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  View details for DOI 10.1016/j.acap.2019.11.016

• PRETERM INFANTS' CARDIAC RESPONSE TO MATERNAL VOICE Gao, C., Feldman, H. M., Travis, K. E. BMJ PUBLISHING GROUP. 2019: 89

  View details for DOI 10.1136/jim-2018-000939.58

  View details for Web of Science ID 000457712500068

• More than myelin: Probing white matter differences in prematurity with quantitative T1 and diffusion MRI NEUROIMAGE-CLINICAL Travis, K. E., Castro, M. H., Berman, S., Dodson, C. K., Mezer, A. A., Ben-Shachar, M., Feldman, H. M. 2019; 22

  View details for DOI 10.1016/j.nicl.2019.101756

  View details for Web of Science ID 000470123000081

• Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Won, D. C., Feldman, H. M., Huffman, L. C. 2019; 40 (1): 20–31

  View details for DOI 10.1097/DBP.0000000000000624

  View details for Web of Science ID 000467812700003

• How Young Children Learn Language and Speech. Pediatrics in review Feldman, H. M. 2019; 40 (8): 398–411

  Abstract

  Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.

  View details for DOI 10.1542/pir.2017-0325

  View details for PubMedID 31371633

• Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers. Academic pediatrics Bannett, Y. n., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  Abstract

  To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation.Retrospective cohort study of electronic health records (EHR) from all office visits of patients aged 4-17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary healthcare network in California. Outcomes per clinician: (1) % patients seen for ADHD management; (2) % ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation.Of 40,323 patients in the cohort, 2,039 (5.1%) carried an ADHD diagnosis, of which 1,142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0 to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (i.e., sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high percent Full Time Equivalent (OR 1.17; 95% CI 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0 to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R=0.10).Objective EHR measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, % of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.

  View details for DOI 10.1016/j.acap.2019.11.016

  View details for PubMedID 31794864

• White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm NEUROIMAGE-CLINICAL Dubner, S. E., Dodson, C. K., Marchman, V. A., Ben-Shachar, M., Feldman, H. M., Travis, K. E. 2019; 23

  View details for DOI 10.1016/j.nicl.2019.101832

  View details for Web of Science ID 000485804400037

• Microstructural properties of white matter pathways in relation tosubsequent reading abilities in children: a longitudinal analysis. Brain structure & function Borchers, L. R., Bruckert, L., Dodson, C. K., Travis, K. E., Marchman, V. A., Ben-Shachar, M., Feldman, H. M. 2018

  Abstract

  Microstructural properties of white matter pathways are associated with concurrent reading abilities in children. In this longitudinal study, we asked whether properties of white matter pathways at the onset of learning to read would be associated with reading abilities at older ages. Children (N=37) with a wide range of reading abilities completed standardized measures of language and phonological awareness and diffusion MRI at age 6years. Mean tract-fractional anisotropy (FA) was extracted from reading-related pathways. At age 8, the same children were re-assessed using a standardized reading measure. Using linear regressions, we examined the contribution of tract-FA at age 6 to reading outcome at age 8, beyond known demographic and pre-literacy predictors of reading. Tract-FA of the left arcuate, left and right superior longitudinal fasciculus (SLF), and left inferior cerebellar peduncle (ICP) made unique contributions to reading outcome after consideration of sex and family history of reading delays. Tract-FA of the left and right SLF and left ICP made unique contributions to reading outcome after the addition of pre-literacy skills. Thus, cerebellar and bilateral cortical pathways represented a network associated with subsequent reading abilities. Early white matter properties may be associated with other neuropsychological functions that predict reading or may influence reading development, independent of reading-related abilities. Tract FA at early stages of learning to read may serve as a biomarker of later reading abilities.

  View details for PubMedID 30539288

• Sleep Problem Detection and Documentation in Children With ASD and ADHD by Developmental-Behavioral Pediatricians: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Won, D. C., Feldman, H. M., Huffman, L. C. 2018

  Abstract

  OBJECTIVE: To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.METHODS: Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).RESULTS: Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.CONCLUSION: Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.

  View details for PubMedID 30339559

• Caregiver Talk and Medical Risk as Predictors of Language Outcomes in Full Term and Preterm Toddlers CHILD DEVELOPMENT Adams, K. A., Marchman, V. A., Loi, E. C., Ashland, M. D., Fernald, A., Feldman, H. M. 2018; 89 (5): 1674–90

  View details for DOI 10.1111/cdev.12818

  View details for Web of Science ID 000443935700018

• White matter properties associated with pre-reading skills in 6-year-old children born preterm and at term DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Dodson, C. K., Travis, K. E., Borchers, L. R., Marchman, V. A., Ben-Shachar, M., Feldman, H. M. 2018; 60 (7): 695-+

  View details for DOI 10.1111/dmcn.13783

  View details for Web of Science ID 000434638500017

• White matter properties associated with pre-reading skills in 6-year-old children born preterm and at term. Developmental medicine and child neurology Dodson, C. K., Travis, K. E., Borchers, L. R., Marchman, V. A., Ben-Shachar, M., Feldman, H. M. 2018

  Abstract

  AIM: To assess associations between white matter properties and pre-reading skills (phonological awareness and receptive and expressive language) in children born preterm and at term at the onset of reading acquisition.METHOD: Six-year-old children born preterm (n=36; gestational age 22-32wks) and at term (n=43) underwent diffusion magnetic resonance imaging and behavioural assessments. Tracts were selected a priori based on findings from a study of 6-year-old children born at term: the left-hemisphere arcuate fasciculus and superior longitudinal fasciculus, and right-hemisphere uncinate fasciculus. Using linear regression, we assessed associations between fractional anisotropy of tracts and phonological awareness and receptive and expressive language scores. We investigated whether associations were moderated by prematurity.RESULTS: Fractional anisotropy of the left-hemisphere arcuate fasciculus contributed unique variance to phonological awareness across birth groups. The association between fractional anisotropy of the right-hemisphere uncinate fasciculus and receptive and expressive language was significantly moderated by prematurity.INTERPRETATION: A left-hemisphere tract was associated with phonological awareness in both birth groups. A right-hemisphere tract was associated with language only in the term group, suggesting that expressive and receptive language is mediated by different white matter pathways in 6-year-old children born preterm. These findings provide novel insights into similarities and differences of the neurobiology of pre-reading skills between children born preterm and at term at reading onset.WHAT THIS PAPER ADDS: White matter properties and pre-reading abilities were associated in children born preterm at the onset of reading. The neurobiology of phonological awareness was similar in children born preterm versus children born at term at 6 years. The neurobiology of language was different in children born preterm versus children born at term at 6 years.

  View details for PubMedID 29722009

• Nonword Repetition and Language Outcomes in Young Children Born Preterm JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Gresch, L. D., Marchman, V. A., Loi, E. C., Fernald, A., Feldman, H. M. 2018; 61 (5): 1203–15

  Abstract

  The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills.Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures.More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance.These findings suggest that phonological short-term memory is an important skill underlying language development in both children born PT and FT. These findings have relevance to clinical practice in assessing children born PT.

  View details for PubMedID 29800357

• Speed of Language Comprehension at 18 Months Old Predicts School-Relevant Outcomes at 54 Months Old in Children Born Preterm JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Marchman, V. A., Loi, E. C., Adams, K. A., Ashland, M., Fernald, A., Feldman, H. M. 2018; 39 (3): 246–53

  Abstract

  Identifying which preterm (PT) children are at increased risk of language and learning differences increases opportunities for participation in interventions that improve outcomes. Speed in spoken language comprehension at early stages of language development requires information processing skills that may form the foundation for later language and school-relevant skills. In children born full-term, speed of comprehending words in an eye-tracking task at 2 years old predicted language and nonverbal cognition at 8 years old. Here, we explore the extent to which speed of language comprehension at 1.5 years old predicts both verbal and nonverbal outcomes at 4.5 years old in children born PT.Participants were children born PT (n = 47; ≤32 weeks gestation). Children were tested in the "looking-while-listening" task at 18 months old, adjusted for prematurity, to generate a measure of speed of language comprehension. Parent report and direct assessments of language were also administered. Children were later retested on a test battery of school-relevant skills at 4.5 years old.Speed of language comprehension at 18 months old predicted significant unique variance (12%-31%) in receptive vocabulary, global language abilities, and nonverbal intelligence quotient (IQ) at 4.5 years, controlling for socioeconomic status, gestational age, and medical complications of PT birth. Speed of language comprehension remained uniquely predictive (5%-12%) when also controlling for children's language skills at 18 months old.Individual differences in speed of spoken language comprehension may serve as a marker for neuropsychological processes that are critical for the development of school-relevant linguistic skills and nonverbal IQ in children born PT.

  View details for PubMedID 29309294

  View details for PubMedCentralID PMC5866178

• Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach FRONTIERS IN PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2018; 6: 60

  Abstract

  Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician.Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17 years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work excuse note if needed. After the visit, SDM was assessed by both parents and DBP clinicians. SDM was scored as present if the respondent answered "strongly agree" to all SDM-related items. Logistic regression tested effects of visit, child, parent, clinician characteristics, and intervention group status on parent-reported SDM. Cohen's kappa assessed alignment between parent and clinician perceptions of SDM.Of 88 parents screened, 50 (61%) met eligibility criteria and agreed to participate (intervention n = 26; comparison n = 24). Eligible participants (parents and clinicians) for analysis completed the surveys with no missing data. Overall, SDM was present in 76% of parents and 34% of clinicians. With high rates of parent-reported SDM in both intervention and comparison groups, no main intervention effect was detected. Compared to the comparison group, there was greater alignment between parent and clinician perception of SDM in the intervention group.Parent and clinician enrollment and data collection with minimal loss suggest that this novel approach is easy to use and could be employed in future outpatient studies exploring SDM. In this clinical setting, both intervention and comparison group parents reported high levels of SDM participation and no main group effect was detected. Further study of this novel parent-directed SDM intervention approach is needed in a larger sample with greater variability in parent-reported SDM to determine its efficacy.

  View details for PubMedID 29616204

• Co-Location of Developmental-Behavioral Pediatrics in Primary Care: Improving Outcomes for Providers and Families Martin-Herz, S. P., Buysse, C. A., DeBattista, A. M., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2018: S11

  View details for Web of Science ID 000429375100036

• Executive Function in Relation to White Matter in Preterm and Full Term Children. Frontiers in pediatrics Loe, I. M., Adams, J. N., Feldman, H. M. 2018; 6: 418

  Abstract

  Background: Executive function (EF) refers to cognitive abilities used to guide goal-directed behavior. Diffusion Tensor Imaging (DTI) provides quantitative characterization of white matter tracts in the brain. Children with preterm birth often have EF impairments and white matter injury. Aim: To examine the degree of association between EF scores and white matter fractional anisotropy (FA) as measured by DTI in children born preterm and term Study design: Cross-sectional study Subjects: Participants, 9-16 years of age, born preterm (n = 25; mean gestational age 28.6 weeks; mean birth weight 1,191 grams), and full term (n = 20) Outcome measures: White matter FA analyzed with Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. Behavioral scores from EF tasks examining working memory, spatial memory capacity, and multiple skills from the Stockings of Cambridge. Results: The groups performed comparably on all tasks. In both groups, unfavorable working memory strategy scores were associated with lower FA. Other measures of EF were not associated with whole skeleton FA in either group in either direction. Conclusions: Strategy score on a spatial working memory task was associated with FA in preterm and full term children, suggesting common underlying neurobiology in both groups. Associations were found in frontal-parietal connections and other major tracts. Lack of associations between other EF tasks and FA may be due to variation in how children accomplish these EF tasks. Future research is required to fully understand the neurobiology of EF in children born preterm.

  View details for DOI 10.3389/fped.2018.00418

  View details for PubMedID 30697535

  View details for PubMedCentralID PMC6341022

• DEVELOPMENT AND BEHAVIOUR DIAGNOSES USED BY PAEDIATRIC PRIMARY CARE PROVIDERS: EXPLORING INTER-CLINICIAN VARIATION Bannett, Y., Feldman, H. M., Ansel, D., Huffman, L. C. BMJ PUBLISHING GROUP. 2018: 184

  View details for DOI 10.1136/jim-2017-000663.282

  View details for Web of Science ID 000432007400294

• Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome EARLY HUMAN DEVELOPMENT Loi, E. C., Vaca, K. C., Ashland, M. D., Marchman, V. A., Fernald, A., Feldman, H. M. 2017; 115: 110–17

  Abstract

  Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions.Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill.A longitudinal descriptive cohort study.39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES).The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months.Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary.The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty.

  View details for PubMedID 29111418

  View details for PubMedCentralID PMC5689464

• White matter properties differ in 6-year old Readers and Pre-readers BRAIN STRUCTURE & FUNCTION Travis, K. E., Adams, J. N., Kovachy, V. N., Ben-Shachar, M., Feldman, H. M. 2017; 222 (4): 1685-1703

  Abstract

  Reading, an essential life skill in modern society, is typically learned during childhood. Adults who can read show white matter differences compared to adults who never learned to read. Studies have not established whether children who can read show similar white matter differences compared to children who cannot read. We compared 6-year old children who could decode written English words and pseudowords (n = 31; Readers) and 6-year old children who could not decode pseudowords and had a standard score <100 on a task for reading single words (n = 11; Pre-readers). We employed diffusion MRI and tractography to extract fractional anisotropy (FA) along the trajectory of six bilateral intra-hemispheric tracts and two posterior subdivisions of the corpus callosum. Readers demonstrated significantly increased FA within the left anterior segment of the superior longitudinal fasciculus (aSLF-L) and the right uncinate fasciculus (UF-R) compared to Pre-readers. FA in the aSLF-L was significantly correlated with phonological awareness; FA in the UF-R was significantly correlated with language. Correlations in the UF-R but not the aSLF-L remained significant after controlling for reading ability, revealing that UF-R group differences were related to both children's language and reading abilities. Taken together, these findings demonstrate new evidence showing that individual differences in white matter structure relate to whether children have begun to read.

  View details for DOI 10.1007/s00429-016-1302-1

  View details for Web of Science ID 000400186400010

• Caregiver Talk and Medical Risk as Predictors of Language Outcomes in Full Term and Preterm Toddlers. Child development Adams, K. A., Marchman, V. A., Loi, E. C., Ashland, M. D., Fernald, A., Feldman, H. M. 2017

  Abstract

  This study examined associations between caregiver talk and language skills in full term (FT) and preterm (PT) children (n = 97). All-day recordings of caregiver-child interactions revealed striking similarities in amount of caregiver talk heard by FT and PT children. Children who heard more caregiver talk at 16 months demonstrated better knowledge- and processing-based language skills at 18 months. The unique contributions of caregiver talk were tempered by medical risk in PT children, especially for processing speed. However, there was no evidence that birth status or medical risk moderated the effects of caregiver talk. These findings highlight the role of caregiver talk in shaping language outcomes in FT and PT children and offer insights into links between neurodevelopmental risk and caregiver-child engagement.

  View details for DOI 10.1111/cdev.12818

  View details for PubMedID 28452393

• Beyond immigrant status: Book-sharing in low-income Mexican-American families JOURNAL OF EARLY CHILDHOOD RESEARCH Salinas, M., Perez-Granados, D. R., Feldman, H. M., Huffman, L. C. 2017; 15 (1): 17–33

  View details for DOI 10.1177/1476718X15577007

  View details for Web of Science ID 000411711300002

• Documentation of Sleep Problems in Children with ASD and ADHD by Developmental-Behavioral Pediatricians in DBPNet Won, D. C., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2017: S20–S21

  View details for Web of Science ID 000393951000071

• Executive Function Is Associated with Reading and Parent-Rated Child Function in 6 Year Old Preterm Children Loe, I. M., Kovachy, V. N., Travis, K. E., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2017: S2–S3

  View details for Web of Science ID 000393951000009

• Using Eye Movements to Assess Language Comprehension in Toddlers Born Preterm and Full Term JOURNAL OF PEDIATRICS Loi, E. C., Marchman, V. A., Fernald, A., Feldman, H. M. 2017; 180: 124-129

  Abstract

  To assess language skills in children born preterm and full term by the use of a standardized language test and eye-tracking methods.Children born ≤32 weeks' gestation (n = 44) were matched on sex and socioeconomic status to children born full term (n = 44) and studied longitudinally. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) were administered at 18 months (corrected for prematurity as applicable). The Looking-While-Listening Task (LWL) simultaneously presents 2 pictures and an auditory stimulus that directs the child's attention to one image. The pattern of eye movements reflects visual processing and the efficiency of language comprehension. Children born preterm were evaluated on LWL 3 times between 18 and 24 months. Children born full term were evaluated at ages corresponding to chronological and corrected ages of their preterm match. Results were compared between groups for the BSID-III and 2 LWL measures: accuracy (proportion of time looking at target) and reaction time (latency to shift gaze from distracter to target).Children born preterm had lower BSID-III scores than children born full term. Children born preterm had poorer performance than children born full term on LWL measures for chronological age but similar performance for corrected age. Accuracy and reaction time at 18 months' corrected age displaced preterm-full term group membership as significant predictors of BSID-III scores.Performance and rate of change on language comprehension measures were similar in children born preterm and full term compared at corrected age. Individual variation in language comprehension efficiency was a robust predictor of scores on a standardized language assessment in both groups.

  View details for DOI 10.1016/j.jpeds.2016.10.004

  View details for Web of Science ID 000390028100026

  View details for PubMedCentralID PMC5183474

• White matter microstructure of 6-year old children born preterm and full term NEUROIMAGE-CLINICAL Dodson, C. K., Travis, K. E., Ben-Shachar, M., Feldman, H. M. 2017; 16: 268–75

  Abstract

  We previously observed a complex pattern of differences in white matter (WM) microstructure between preterm-born (PT) and full-term-born (FT) children and adolescents age 9-17 years. The aim of this study was to determine if the same differences exist as early as age 6 years.We obtained diffusion MRI (dMRI) scans in children born PT at age 6 years (n = 20; 11 males) and FT (n = 38; 14 males), using two scanning protocols: 30 diffusion directions (b = 1000 s/mm2) and 96 diffusion directions (b = 2500 s/mm2). We used deterministic tractography and analyzed fractional anisotropy (FA) along bilateral cerebral WM pathways that demonstrated differences in the older sample.Compared to the FT group, the PT group showed (1) significantly decreased FA in the uncinate fasciculi and forceps major and (2) significantly increased FA in the right anterior thalamic radiation, inferior fronto-occipital fasciculi, and inferior longitudinal fasciculi. This pattern of group differences resembles findings in the previous study of older PT and FT participants. Group differences were similar across dMRI acquisition protocols.The underlying neurobiology driving the pattern of PT-FT differences in FA is present as early as age 6 years. Generalization across dMRI acquisition protocols demonstrates the robustness of group differences in FA. Future studies will use quantitative neuroimaging techniques to understand the tissue properties that give rise to this consistent pattern of WM differences after PT birth.

  View details for PubMedID 28840098

• DOCUMENTATION OF SLEEP PROBLEMS IN CHILDREN WITH ASD AND ADHD: A DEVELOPMENTAL-BEHAVIORAL PEDIATRICS RESEARCH NETWORK STUDY Won, D. C., Feldman, H. M., Huffman, L. C. BMJ PUBLISHING GROUP. 2017: 260–61

  View details for DOI 10.1136/jim-2016-000365.382

  View details for Web of Science ID 000433055100376

• DEVELOPMENTAL DIFFERENCES IN THE EARLY STAGES OF LEARNING TO READ IN CHILDREN BORN PRETERM AND FULL TERM Borchers, L. R., Marchman, V. A., Feldman, H. M. BMJ PUBLISHING GROUP. 2017: 222

  View details for DOI 10.1136/jim-2016-000365.291

  View details for Web of Science ID 000433055100288

• NONWORD REPETITION SKILLS OF YOUNG CHILDREN BORN PRETERM Gresch, L. D., Loi, E. C., Ashland, M., Marchman, V. A., Feldman, H. M. BMJ PUBLISHING GROUP. 2017: 221–22

  View details for DOI 10.1136/jim-2016-000365.290

  View details for Web of Science ID 000433055100287

• WHITE MATTER MICROSTRUCTURE ON DIFFUSION MAGNETIC RESONANCE IMAGING IN 6-YEAR-OLD CHILDREN BORN PRETERM Dodson, C. K., Travis, K. E., Feldman, H. M., Ben-Shachar, M. BMJ PUBLISHING GROUP. 2017: 291

  View details for DOI 10.1136/jim-2016-000365.454

  View details for Web of Science ID 000433055100447

• Reflections From a Member of the AAP Committee That Prepared "Guidance for Effective Discipline" PEDIATRICS Feldman, H. M. 2016; 138 (6)

  View details for DOI 10.1542/peds.2016-2741

  View details for Web of Science ID 000388924800060

• White matter properties differ in 6-year old Readers and Pre-readers. Brain structure & function Travis, K. E., Adams, J. N., Kovachy, V. N., Ben-Shachar, M., Feldman, H. M. 2016: -?

  Abstract

  Reading, an essential life skill in modern society, is typically learned during childhood. Adults who can read show white matter differences compared to adults who never learned to read. Studies have not established whether children who can read show similar white matter differences compared to children who cannot read. We compared 6-year old children who could decode written English words and pseudowords (n = 31; Readers) and 6-year old children who could not decode pseudowords and had a standard score <100 on a task for reading single words (n = 11; Pre-readers). We employed diffusion MRI and tractography to extract fractional anisotropy (FA) along the trajectory of six bilateral intra-hemispheric tracts and two posterior subdivisions of the corpus callosum. Readers demonstrated significantly increased FA within the left anterior segment of the superior longitudinal fasciculus (aSLF-L) and the right uncinate fasciculus (UF-R) compared to Pre-readers. FA in the aSLF-L was significantly correlated with phonological awareness; FA in the UF-R was significantly correlated with language. Correlations in the UF-R but not the aSLF-L remained significant after controlling for reading ability, revealing that UF-R group differences were related to both children's language and reading abilities. Taken together, these findings demonstrate new evidence showing that individual differences in white matter structure relate to whether children have begun to read.

  View details for PubMedID 27631434

• The Effect of Bilingual Exposure on Executive Function Skills in Preterm and Full-Term Preschoolers. Journal of developmental and behavioral pediatrics Loe, I. M., Feldman, H. M. 2016; 37 (7): 548-556

  Abstract

  To evaluate the effects of bilingual exposure on executive function (EF) skills, measured by parent-rating and performance-based instruments, in preterm and full-term preschoolers.Children age 3 to 5 years (mean 4.4) born preterm (PT; n = 82) and full term (FT; n = 79) had monolingual (PT-M, n = 51; FT-M, n = 53) or bilingual (PT-B, n = 31; FT-B, n = 26) language exposure. Groups were similar in age, gender and race, but PT children had lower socioeconomic status (SES) than FT children. Parents completed a language questionnaire and diary and a standardized parent rating of EF skills. Children completed EF tasks that tap response inhibition, working memory, and cognitive flexibility. ANCOVA and logistic regression examined effects on EF of birth group (PT/FT), language status (M/B), and birth group by language status interaction, controlling for age and SES.Compared to children born FT, children born PT had significantly higher parent-rated EF scores and poorer performance on all but one EF task, both indicating more EF problems. No main effects of language status and no birth group by language status interactions were significant.PT status was clearly associated with poorer EF skills, similar to many other studies. In this sample, bilingual exposure conferred neither an advantage nor disadvantage in the FT and PT group. This information may prove useful in counseling families of both PT and FT children about the impact of bilingual exposure on their children's cognitive skills.

  View details for DOI 10.1097/DBP.0000000000000318

  View details for PubMedID 27355886

• Case Series: Fractional Anisotropy Profiles of the Cerebellar Peduncles in Adolescents Born Preterm With Ventricular Dilation JOURNAL OF CHILD NEUROLOGY Travis, K. E., Leitner, Y., Ben-Shachar, M., Yeom, K. W., Feldman, H. M. 2016; 31 (3): 321-327

  Abstract

  This case series assesses white matter microstructure of the cerebellar peduncles in 4 adolescents born preterm with enlarged ventricles and reduced white matter volume in the cerebrum but no apparent injury to the cerebellum. Subjects (ages 12-17 years, gestational age 26-32 weeks, birth weight 825-2211 g) were compared to a normative sample of 19 full-term controls (9-17 years, mean gestational age 39 weeks, mean birth weight 3154 g). Tract profiles for each of the cerebellar peduncles were generated by calculating fractional anisotropy at 30 points along the central portion of each tract. One or more case subjects exhibited higher fractional anisotropy beyond the 90th percentile in the inferior, middle, and superior cerebellar peduncles. Findings demonstrate that differences in cerebellar white matter microstructure can be detected in the absence of macrostructural cerebellar abnormalities.

  View details for DOI 10.1177/0883073815592223

  View details for PubMedID 26116381

• ABNORMAL WHITE MATTER PROPERTIES IN ADOLESCENT GIRLS WITH ANOREXIA NERVOSA Golden, N. H., Travis, K., Feldman, H., Solomon, M., Nguyen, J., Mezer, A., Yeatman, J. D., Dougherty, R. F. ELSEVIER SCIENCE INC. 2016: S24–S25

  View details for DOI 10.1016/j.jadohealth.2015.10.062

  View details for Web of Science ID 000373428800045

• Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2016; 37 (1): 20-32

  Abstract

  Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment.Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group.SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group.A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.

  View details for DOI 10.1097/DBP.0000000000000242

  View details for Web of Science ID 000367826900004

• Reflections From a Member of the AAP Committee That Prepared "Guidance for Effective Discipline". Pediatrics Feldman, H. M. 2016; 138 (6)

  View details for PubMedID 27940722

• Early language processing efficiency predicts later receptive vocabulary outcomes in children born preterm. Child neuropsychology Marchman, V. A., Adams, K. A., Loi, E. C., Fernald, A., Feldman, H. M. 2016; 22 (6): 649-665

  Abstract

  As rates of prematurity continue to rise, identifying which preterm children are at increased risk for learning disabilities is a public health imperative. Identifying continuities between early and later skills in this vulnerable population can also illuminate fundamental neuropsychological processes that support learning in all children. At 18 months adjusted age, we used socioeconomic status (SES), medical variables, parent-reported vocabulary, scores on the Bayley Scales of Infant and Toddler Development (third edition) language composite, and children's lexical processing speed in the looking-while-listening (LWL) task as predictor variables in a sample of 30 preterm children. Receptive vocabulary as measured by the Peabody Picture Vocabulary Test (fourth edition) at 36 months was the outcome. Receptive vocabulary was correlated with SES, but uncorrelated with degree of prematurity or a composite of medical risk. Importantly, lexical processing speed was the strongest predictor of receptive vocabulary (r = -.81), accounting for 30% unique variance. Individual differences in lexical processing efficiency may be able to serve as a marker for information processing skills that are critical for language learning.

  View details for DOI 10.1080/09297049.2015.1038987

  View details for PubMedID 26031342

• Variations in the neurobiology of reading in children and adolescents born full term and preterm NEUROIMAGE-CLINICAL Travis, K. E., Ben-Shachar, M., Myall, N. J., Feldman, H. M. 2016; 11: 555-565

  Abstract

  Diffusion properties of white matter tracts have been associated with individual differences in reading. Individuals born preterm are at risk of injury to white matter. In this study we compared the associations between diffusion properties of white matter and reading skills in children and adolescents born full term and preterm. 45 participants, aged 9-17 years, included 26 preterms (born < 36 weeks' gestation) and 19 full-terms. Tract fractional anisotropy (FA) profiles were generated for five bilateral white matter tracts previously associated with reading: anterior superior longitudinal fasciculus (aSLF), arcuate fasciculus (Arc), corticospinal tract (CST), uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF). Mean scores on reading for the two groups were in the normal range and were not statistically different. In both groups, FA was associated with measures of single word reading and comprehension in the aSLF, AF, CST, and UF. However, correlations were negative in the full term group and positive in the preterm group. These results demonstrate variations in the neurobiology of reading in children born full term and preterm despite comparable reading skills. Findings suggest that efficient information exchange required for strong reading abilities may be accomplished via a different balance of neurobiological mechanisms in different groups of readers.

  View details for DOI 10.1016/j.nicl.2016.04.003

  View details for PubMedID 27158588

• Tract Profiles of the Cerebellar White Matter Pathways in Children and Adolescents CEREBELLUM Leitner, Y., Travis, K. E., Ben-Shachar, M., Yeom, K. W., Feldman, H. M. 2015; 14 (6): 613-623

  Abstract

  Intact development of cerebellar connectivity is essential for healthy neuromotor and neurocognitive development. To date, limited knowledge about the microstructural properties of the cerebellar peduncles, the major white matter tracts of the cerebellum, is available for children and adolescents. Such information would be useful as a comparison for studies of normal development, clinical conditions, or associations of cerebellar structures with cognitive and motor functions. The goal of the present study was to evaluate the variability in diffusion measures of the cerebellar peduncles within individuals and within a normative sample of healthy children. Participants were 19 healthy children and adolescents, aged 9-17 years, mean age 13.0 ± 2.3. We analyzed diffusion magnetic resonance imaging (dMRI) data with deterministic tractography. We generated tract profiles for each of the cerebellar peduncles by extracting four diffusion properties (fractional anisotropy (FA) and mean, radial, and axial diffusivity) at 30 equidistant points along each tract. We were able to identify the middle cerebellar peduncle and the bilateral inferior and superior cerebellar peduncles in all participants. The results showed that within each of the peduncles, the diffusion properties varied along the trajectory of the tracts. However, the tracts showed consistent patterns of variation across individuals; the coefficient of variation for FA across individual profiles was low (≤20 %) for each tract. We observed no systematic variation of the diffusion properties with age. These cerebellar tract profiles of the cerebellar peduncles can serve as a reference for future studies of children across the age range and for children and adolescents with clinical conditions that affect the cerebellum.

  View details for DOI 10.1007/s12311-015-0652-1

  View details for PubMedID 25648754

• Reading abilities in school-aged preterm children: a review and meta-analysis DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Kovachy, V. N., Adams, J. N., Tamaresis, J. S., Feldman, H. M. 2015; 57 (5): 410-419

  Abstract

  Children born preterm (at ≤32wks) are at risk of developing deficits in reading ability. This meta-analysis aims to determine whether or not school-aged preterm children perform worse than those born at term in single-word reading (decoding) and reading comprehension.Electronic databases were searched for studies published between 2000 and 2013, which assessed decoding or reading comprehension performance in English-speaking preterm and term-born children aged between 6 years and 13 years, and born after 1990. Standardized mean differences in decoding and reading comprehension scores were calculated.Nine studies were suitable for analysis of decoding, and five for analysis of reading comprehension. Random-effects meta-analyses showed that children born preterm had significantly lower scores (reported as Cohen's d values [d] with 95% confidence intervals [CIs]) than those born at term for decoding (d=-0.42, 95% CI -0.57 to -0.27, p<0.001) and reading comprehension (d=-0.57, 95% CI -0.68 to -0.46, p<0.001). Meta-regressions showed that lower gestational age was associated with larger differences in decoding (Q[1]=5.92, p=0.02) and reading comprehension (Q[1]=4.69, p=0.03) between preterm and term groups. Differences between groups increased with age for reading comprehension (Q[1]=5.10, p=0.02) and, although not significant, there was also a trend for increased group differences for decoding (Q[1]=3.44, p=0.06).Preterm children perform worse than peers born at term on decoding and reading comprehension. These findings suggest that preterm children should receive more ongoing monitoring for reading difficulties throughout their education.

  View details for DOI 10.1111/dmcn.12652

  View details for Web of Science ID 000352819600010

  View details for PubMedID 25516105

• Diagnosis of Attention-deficit/Hyperactivity Disorder by Developmental Pediatricians in Academic Centers: A DBPNet Study ACADEMIC PEDIATRICS Feldman, H. M., Blum, N. J., Gahman, A. E., Shults, J. 2015; 15 (3): 282-288

  Abstract

  To describe the developmental-behavioral pediatricians (DBPs), patients, and clinical practices used in the diagnostic assessments of attention-deficit/hyperactivity disorder (ADHD) within all 12 academic medical centers comprising Developmental-Behavioral Pediatrics Research Network (DBPNet).Between December 2011 and June 2012, all DBPs who evaluated children with ADHD or autism spectrum disorders were asked to complete a diagnostic encounter survey form for up to 10 consecutive new cases that resulted in the diagnosis of ADHD or autism spectrum disorder. Fifty-two clinicians returned one or more forms for children diagnosed with ADHD (n = 211).DBPs were generally experienced full-time academics. Children were 76.3% male, 62.3% white, 24.5% African American, and 20.7% Hispanic. Mean child age was 8.0 + 3.1 years. DBPs reviewed parent ratings of behavior in 84.4% and teacher ratings in 69.2% of cases. They reviewed or completed at least one developmental assessment in 79.2% of cases: intelligence (60.2%), academic (57.8%), fine motor or visual motor (39.3%), speech/language (34.6%), or adaptive skills (28.9%). They made the diagnosis of coexisting conditions in 82.7% of cases, including learning disabilities (31.8%), speech/language disorders (31.8%), anxiety (14.2%), externalizing disorders (10.9%), and sleep disorders (9.5%). Among 146 children not medicated before the visit, stimulant medications were initiated in 15 children (10.2%).Within DBPNet, DBPs were highly likely to complete comprehensive assessments of ADHD that went beyond the requirements of primary care practice guidelines. They typically identified coexisting developmental and learning conditions. They did not typically prescribe medication at the end of diagnostic encounters.

  View details for PubMedID 25441653

• Cerebellar White Matter Pathways are Associated With Reading Skills in Children and Adolescents HUMAN BRAIN MAPPING Travis, K. E., Leitner, Y., Feldman, H. M., Ben-Shachar, M. 2015; 36 (4): 1536-1553

  Abstract

  Reading is a critical life skill in the modern world. The neural basis of reading incorporates a distributed network of cortical areas and their white matter connections. The cerebellum has also been implicated in reading and reading disabilities. However, little is known about the contribution of cerebellar white matter pathways to major component skills of reading. We used diffusion magnetic resonance imaging (dMRI) with tractography to identify the cerebellar peduncles in a group of 9- to 17-year-old children and adolescents born full term (FT, n = 19) or preterm (PT, n = 26). In this cohort, no significant differences were found between fractional anisotropy (FA) measures of the peduncles in the PT and FT groups. FA of the cerebellar peduncles correlated significantly with measures of decoding and reading comprehension in the combined sample of FT and PT subjects. Correlations were negative in the superior and inferior cerebellar peduncles and positive in the middle cerebellar peduncle. Additional analyses revealed that FT and PT groups demonstrated similar patterns of reading associations within the left superior cerebellar peduncle, middle cerebellar peduncle, and left inferior cerebellar peduncle. Partial correlation analyses showed that distinct sub-skills of reading were associated with FA in segments of different cerebellar peduncles. Overall, the present findings are the first to document associations of microstructure of the cerebellar peduncles and the component skills of reading. Hum Brain Mapp, 2014. © 2014 Wiley Periodicals, Inc.

  View details for DOI 10.1002/hbm.22721

  View details for PubMedID 25504986

• Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., Loe, I. M. 2015; 36 (3): 207-217

  Abstract

  The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

  View details for PubMedID 25793891

• Sensory processing in preterm preschoolers and its association with executive function EARLY HUMAN DEVELOPMENT Adams, J. N., Feldman, H. M., Huffman, L. C., Loe, I. M. 2015; 91 (3): 227-233

  Abstract

  Symptoms of abnormal sensory processing have been related to preterm birth, but have not yet been studied specifically in preterm preschoolers. The degree of association between sensory processing and other domains is important for understanding the role of sensory processing symptoms in the development of preterm children.To test two related hypotheses: (1) preterm preschoolers have more sensory processing symptoms than full term preschoolers and (2) sensory processing is associated with both executive function and adaptive function in preterm preschoolers.Cross-sectional study.Preterm children (≤34weeks of gestation; n=54) and full term controls (≥37weeks of gestation; n=73) ages 3-5years.Sensory processing was assessed with the Short Sensory Profile. Executive function was assessed with (1) parent ratings on the Behavior Rating Inventory of Executive Function - Preschool version and (2) a performance-based battery of tasks. Adaptive function was assessed with the Vineland Adaptive Behavior Scales-II.Preterm preschoolers showed significantly more sensory symptoms than full term controls. A higher percentage of preterm than full term preschoolers had elevated numbers of sensory symptoms (37% vs. 12%). Sensory symptoms in preterm preschoolers were associated with scores on executive function measures, but were not significantly associated with adaptive function.Preterm preschoolers exhibited more sensory symptoms than full term controls. Preterm preschoolers with elevated numbers of sensory symptoms also showed executive function impairment. Future research should further examine whether sensory processing and executive function should be considered independent or overlapping constructs.

  View details for DOI 10.1016/j.earlhumdev.2015.01.013

  View details for Web of Science ID 000352042600011

  View details for PubMedID 25706317

• Impact of Rapid Developmental Evaluation on Access for Children With Developmental Concerns Martin-Herz, S. P., Goldfarb-Greenwood, C., DeBattista, A., Feldman, H. LIPPINCOTT WILLIAMS & WILKINS. 2015: S13–S14

  View details for Web of Science ID 000349448000049

• Myofascial structural integration therapy on gross motor function and gait of young children with spastic cerebral palsy: a randomized controlled trial Frontiers in Pediatrics: Child Health and Human Development Loi, E. C., et al 2015

  View details for DOI 10.3389/fped.2015.00074

• Studying the mechanisms of language learning by varying the learning environment and the learner LANGUAGE COGNITION AND NEUROSCIENCE Feldman, H. M. 2015; 30 (8): 915–16

  View details for DOI 10.1080/23273798.2015.1053815

  View details for Web of Science ID 000369060000003

• Myofascial structural integration therapy on gross motor function and gait of young children with spastic cerebral palsy: a randomized controlled trial FRONTIERS IN PEDIATRICS Loi, E. C., Buysse, C. A., Price, K. S., Jaramillo, T. M., Pico, E. L., Hansen, A. B., Feldman, H. M. 2015; 3

  Abstract

  Though the cause of motor abnormalities in cerebral palsy is injury to the brain, structural changes in muscle and fascia may add to stiffness and reduced function. This study examined whether myofascial structural integration therapy, a complementary treatment that manipulates muscle and fascia, would improve gross motor function and gait in children <4 years with cerebral palsy. Participants (N = 29) were enrolled in a randomized controlled trial (NCT01815814, https://goo.gl/TGxvwd) or Open Label Extension. The main outcome was the Gross Motor Function Measure-66 assessed at 3-month intervals. Gait (n = 8) was assessed using the GAITRite(®) electronic walkway. Parents completed a survey at study conclusion. Comparing Treatment (n = 15) and Waitlist-Control groups (n = 9), we found a significant main effect of time but no effect of group or time × group interaction. The pooled sample (n = 27) showed a main effect of time, but no significantly greater change after treatment than between other assessments. Foot length on the affected side increased significantly after treatment, likely indicating improvement in the children's ability to approach a heel strike. Parent surveys indicated satisfaction and improvements in the children's quality of movement. MSI did not increase the rate of motor skill development, but was associated with improvement in gait quality.

  View details for DOI 10.3389/fped.2015.00074

  View details for Web of Science ID 000209897400072

  View details for PubMedCentralID PMC4564770

• Decreased and Increased Anisotropy along Major Cerebral White Matter Tracts in Preterm Children and Adolescents. PloS one Travis, K. E., Adams, J. N., Ben-Shachar, M., Feldman, H. M. 2015; 10 (11): e0142860

  Abstract

  Premature birth is highly prevalent and associated with neurodevelopmental delays and disorders. Adverse outcomes, particularly in children born before 32 weeks of gestation, have been attributed in large part to white matter injuries, often found in periventricular regions using conventional imaging. To date, tractography studies of white matter pathways in children and adolescents born preterm have evaluated only a limited number of tracts simultaneously. The current study compares diffusion properties along 18 major cerebral white matter pathways in children and adolescents born preterm (n = 27) and full term (n = 19), using diffusion magnetic resonance imaging and tractography. We found that compared to the full term group, the preterm group had significantly decreased FA in segments of the bilateral uncinate fasciculus and anterior segments of the right inferior fronto-occipital fasciculus. Additionally, the preterm group had significantly increased FA in segments of the right and left anterior thalamic radiations, posterior segments of the right inferior fronto-occipital fasciculus, and the right and left inferior longitudinal fasciculus. Increased FA in the preterm group was generally associated with decreased radial diffusivity. These findings indicate that prematurity-related white matter differences in later childhood and adolescence do not affect all tracts in the periventricular zone and can involve both decreased and increased FA. Differences in the patterns of radial diffusivity and axial diffusivity suggest that the tissue properties underlying group FA differences may vary within and across white matter tracts. Distinctive diffusion properties may relate to variations in the timing of injury in the neonatal period, extent of white matter dysmaturity and/or compensatory processes in childhood.

  View details for DOI 10.1371/journal.pone.0142860

  View details for PubMedID 26560745

• Abnormal white matter properties in adolescent girls with anorexia nervosa. NeuroImage. Clinical Travis, K. E., Golden, N. H., Feldman, H. M., Solomon, M., Nguyen, J., Mezer, A., Yeatman, J. D., Dougherty, R. F. 2015; 9: 648-659

  Abstract

  Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.

  View details for DOI 10.1016/j.nicl.2015.10.008

  View details for PubMedID 26740918

• Abnormal white matter properties in adolescent girls with anorexia nervosa NEUROIMAGE-CLINICAL Travis, K. E., Golden, N. H., Feldman, H. M., Solomon, M., Jenny Nguyen, J., Mezer, A., Yeatman, J. D., Dougherty, R. F. 2015; 9: 648-659

  Abstract

  Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.

  View details for DOI 10.1016/j.nicl.2015.10.008

  View details for Web of Science ID 000373188400069

• Myofascial Structural Integration Therapy on Gross Motor Function and Gait of Young Children with Spastic Cerebral Palsy: A Randomized Controlled Trial. Frontiers in pediatrics Loi, E. C., Buysse, C. A., Price, K. S., Jaramillo, T. M., Pico, E. L., Hansen, A. B., Feldman, H. M. 2015; 3: 74-?

  Abstract

  Though the cause of motor abnormalities in cerebral palsy is injury to the brain, structural changes in muscle and fascia may add to stiffness and reduced function. This study examined whether myofascial structural integration therapy, a complementary treatment that manipulates muscle and fascia, would improve gross motor function and gait in children <4 years with cerebral palsy. Participants (N = 29) were enrolled in a randomized controlled trial (NCT01815814, https://goo.gl/TGxvwd) or Open Label Extension. The main outcome was the Gross Motor Function Measure-66 assessed at 3-month intervals. Gait (n = 8) was assessed using the GAITRite(®) electronic walkway. Parents completed a survey at study conclusion. Comparing Treatment (n = 15) and Waitlist-Control groups (n = 9), we found a significant main effect of time but no effect of group or time × group interaction. The pooled sample (n = 27) showed a main effect of time, but no significantly greater change after treatment than between other assessments. Foot length on the affected side increased significantly after treatment, likely indicating improvement in the children's ability to approach a heel strike. Parent surveys indicated satisfaction and improvements in the children's quality of movement. MSI did not increase the rate of motor skill development, but was associated with improvement in gait quality.

  View details for DOI 10.3389/fped.2015.00074

  View details for PubMedID 26442234

• Gait changes following myofascial structural integration (Rolfing) observed in 2 children with cerebral palsy. Journal of evidence-based complementary & alternative medicine Hansen, A. B., Price, K. S., Loi, E. C., Buysse, C. A., Jaramillo, T. M., Pico, E. L., Feldman, H. M. 2014; 19 (4): 297-300

  Abstract

  Children with spastic cerebral palsy experience difficulty with ambulation. Structural changes in muscle and fascia may play a role in abnormal gait. Myofascial structural integration (Rolfing) is a manual therapy that manipulates muscle and soft tissues to loosen fascia layers, reposition muscles, and facilitate alignment. This study aimed to document (1) gait characteristics of 2 children with cerebral palsy and (2) effects of myofascial structural integration on their gait. Children received 3 months of weekly therapy sessions by an experienced practitioner. Gait parameters were recorded at baseline and after treatment using an electronic walkway. Children with cerebral palsy demonstrated abnormal velocity and cadence, decreased step length and single support times, and increased double support time. After treatment, both children demonstrated improvement for 3 months in cadence and double support time. The objective gait analyses demonstrated temporary improvements after myofascial structural integration in children with spastic cerebral palsy.

  View details for DOI 10.1177/2156587214540466

  View details for PubMedID 24989994

• Executive function is associated with social competence in preschool-aged children born preterm or full term. Early human development Alduncin, N., Huffman, L. C., Feldman, H. M., Loe, I. M. 2014; 90 (6): 299-306

  Abstract

  Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.Cross-sectional study.Study subjects had a history of preterm birth (≤34weeks of gestation) and birth weight <2500g (n=70). Controls were born full term (≥37weeks) (n=79).Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.

  View details for DOI 10.1016/j.earlhumdev.2014.02.011

  View details for PubMedID 24661446

• Executive function mediates effects of gestational age on functional outcomes and behavior in preschoolers. Journal of developmental and behavioral pediatrics Loe, I. M., Feldman, H. M., Huffman, L. C. 2014; 35 (5): 323-333

  Abstract

  To investigate the role of executive function (EF) skills, measured by parent-rating and performance-based instruments, as mediators of the effects of gestational age (GA) on functional outcomes and behavior symptoms in preterm (PT) and full-term (FT) preschoolers.Children born PT (n = 70; mean GA, 29.6 weeks; mean birth weight, 1365 g) were compared to children born FT (n = 79) on composite measures of EF (using the Behavior Rating Inventory of Executive Function and a performance-based EF battery), adaptive function, prereading skills, and behavior symptoms. For the entire sample, mediation analyses examined the effect of GA on the outcomes with EF as mediator.Compared to children born FT, children born PT had significantly higher parent-rated EF scores and lower performance-based EF scores, both indicating more problems; furthermore, children born PT had lower adaptive function and prereading scores and more problematic behavior. GA contributed to adaptive function, prereading skills, and behavior symptoms for all children. EF acted as a mediator of GA for all 3 outcomes; different patterns emerged for parent-rated and performance-based EF evaluations. For adaptive function, both EF measures significantly mediated the effects of GA; for prereading skills, only performance-based EF was significant; for behavior symptoms, only parent-rated EF was significant.We propose standard assessment of EF, using both parent-rating and performance-based EF measures, in young PT children and other children at the risk of EF impairments. EF skills are measurable, mediate important functional outcomes, and may serve as intervention targets.

  View details for DOI 10.1097/DBP.0000000000000063

  View details for PubMedID 24906034

• Hospitalizations of Children with Autism Increased from 1999 to 2009 JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2014; 44 (5): 1087-1094

  Abstract

  We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

  View details for DOI 10.1007/s10803-013-1965-x

  View details for Web of Science ID 000336330200009

  View details for PubMedID 24122446

• Clinical practice. Attention deficit-hyperactivity disorder in children and adolescents. New England journal of medicine Feldman, H. M., Reiff, M. I. 2014; 370 (9): 838-846

  View details for DOI 10.1056/NEJMcp1307215

  View details for PubMedID 24571756

• Attention Deficit-Hyperactivity Disorder in Children and Adolescents NEW ENGLAND JOURNAL OF MEDICINE Feldman, H. M., Reiff, M. I. 2014; 370 (9): 838-846

  View details for DOI 10.1056/NEJMcp1307215

  View details for Web of Science ID 000332013000009

• Gross Motor Function Improves in Young Children with Spastic Cerebral Palsy After Myofascial Structural Integration Therapy Loi, E. C., Buysse, C. A., Hansen, A. B., Price, K. S., Jaramillo, T. M., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2014: S14–S15

  View details for Web of Science ID 000336849800055

• Pre-Reading and Reading Skills in Pre-term and Full-term 6-year old Children Durand, V. N., Travis, K. E., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2014: S7

  View details for Web of Science ID 000336849800025

• Diagnostic Assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) by Developmental-Behavioral Pediatricians (DBP) at Academic Medical Centers: A DBPNet Study Feldman, H. M., Blum, N. J., Gahman, A., Shults, J. LIPPINCOTT WILLIAMS & WILKINS. 2014: S3

  View details for Web of Science ID 000336849800011

• Diagnostic and Statistical Manual of Mental Disorders: the solution or the problem? Journal of developmental and behavioral pediatrics Reiff, M. I., Feldman, H. M. 2014; 35 (1): 68-70

  View details for DOI 10.1097/DBP.0000000000000017

  View details for PubMedID 24399102

• GROSS MOTOR FUNCTION IMPROVES AFTER MYOFASCIAL STRUCTURAL INTEGRATION THERAPY IN YOUNG CHILDREN WITH SPASTIC CEREBRAL PALSY Buysse, C. A., Loi, E. C., Hansen, A. B., Price, K. S., Jaramillo, T. M., Pico, E., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2014: 170–71

  View details for Web of Science ID 000336284900103

• SENSORY PROBLEMS IN PRETERM CHILDREN ARE ASSOCIATED WITH INCREASED RISK OF EXECUTIVE FUNCTION IMPAIRMENT Adams, J. N., Feldman, H. M., Huffman, L. C., Loe, I. M. LIPPINCOTT WILLIAMS & WILKINS. 2014: 169–70

  View details for Web of Science ID 000336284900100

• Neonatal CSF oxytocin levels are associated with parent report of infant soothability and sociability. Psychoneuroendocrinology Clark, C. L., St John, N., Pasca, A. M., Hyde, S. A., Hornbeak, K., Abramova, M., Feldman, H., Parker, K. J., Penn, A. A. 2013; 38 (7): 1208-1212

  Abstract

  Oxytocin (OT) has been linked to social behavior in rodents, non-human primates, and adult humans, but almost nothing is known about brain OT activity in human newborns or its impact on social development. To better understand the role of OT biology in human social functioning, a multi-disciplinary, longitudinal study was conducted. Cerebral spinal fluid (CSF) OT levels from 18 human neonates were evaluated and examined in relationship to social-seeking behavior at term, at 3 months, and at 6 months of age. Higher neonatal CSF OT levels were consistently associated with solicitation of parental soothing and interest in social engagement with others. This is the first study to link CSF OT levels to normative human social functioning. Research is now required to test whether early OT levels serve as a biomarker for subsequent social abnormalities.

  View details for DOI 10.1016/j.psyneuen.2012.10.017

  View details for PubMedID 23507187

• A Systematic Review of Interventions for Adults with ASD Huffman, L. C., Slay, J. A., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S10

  View details for Web of Science ID 000330358800035

• Executive Function Skills in Preterm Preschool Children Loe, I. M., Chatav, M., Alduncin, N., Chang, W. S., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2013: S7

  View details for Web of Science ID 000330358800023

• Does Multiple Language Exposure Influence Executive Function Skills in Preschool Children? Loe, I. M., Alduncin, N., Chatav, M., Chang, W. S., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S4

  View details for Web of Science ID 000330358800012

• Developmental Changes within White Matter Tracts of Healthy Children Age 9 to 16 Years Old Yeatman, J. D., Myall, N. J., Dougherty, R. F., Wandell, B. A., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S5

  View details for Web of Science ID 000330358800018

• Case series: fractional anisotropy along the trajectory of selected white matter tracts in adolescents born preterm with ventricular dilation. Journal of child neurology Myall, N. J., Yeom, K. W., Yeatman, J. D., Gaman-Bean, S., Feldman, H. M. 2013; 28 (6): 774-780

  Abstract

  This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunted ventricular dilation secondary to intraventricular hemorrhage. Subjects (ages 12-17 years, gestational age 26-29 weeks, birth weight 825-1624 g) were compared to 3 full-term controls (13-17 years, 39-40 weeks, 3147-3345 g) and 3 adolescents born preterm without ventricular dilation (10-13 years, 26-29 weeks, 630-1673 g). Tractography using a 2 region of interest method reconstructed the following white matter tracts: superior longitudinal/arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and corticospinal tract. Subjects showed increased fractional anisotropy and changes in the pattern of fractional anisotropy along the trajectory of tracts adjacent to the lateral ventricles. Tensor shape at areas of increased fractional anisotropy demonstrated increased linear anisotropy at the expense of planar and spherical anisotropy. These findings suggest increased axonal packing density and straightening of fibers secondary to ventricular enlargement.

  View details for DOI 10.1177/0883073812449693

  View details for PubMedID 22859695

• Case series: fractional anisotropy along the trajectory of selected white matter tracts in adolescents born preterm with ventricular dilation. Journal of child neurology Myall, N. J., Yeom, K. W., Yeatman, J. D., Gaman-Bean, S., Feldman, H. M. 2013; 28 (6): 771-777

  View details for DOI 10.1177/0883073812449693

  View details for PubMedID 22859695

• Attention and Internalizing Behaviors in Relation to White Matter in Children Born Preterm JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Loe, I. M., Lee, E. S., Feldman, H. M. 2013; 34 (3): 156-164

  Abstract

  Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that provides quantitative characterization of white matter tracts in the brain. This study used DTI to examine the degree of association between parent-rated scores of attention, internalizing behaviors including anxiety symptoms, and externalizing behaviors and white matter fractional anisotropy (FA) in children born preterm.Participants were aged 9 to 16 years; 25 were born at <36 weeks of gestation (mean = 28.6 wk, birth weight = 1191 g) and 20 were full term. The authors analyzed the results using Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. The authors examined the correlations between behavior scores and FA of (1) the whole skeleton and (2) the specific regions of interest.In preterm children, scores on attention and internalizing behavior scales were each associated with whole skeleton FA and several regions of interest; unfavorable scores were consistently associated with lower FA. Externalizing behaviors were not associated with whole skeleton FA, but significant associations were found within a few regions of interest. The network of significant regions for attention and internalizing symptoms was widely distributed and overlapping. In full-term children, no associations of FA and behavior were significant.Attention and internalizing behaviors in preterm children were associated with FA in a widely distributed overlapping network of white matter tracts, suggesting common underlying neurobiology. DTI contributes to understanding individual differences in attention and behavior characteristics in children born preterm.

  View details for DOI 10.1097/DBP.0b013e3182842122

  View details for PubMedID 23572166

• Neural plasticity after pre-linguistic injury to the arcuate and superior longitudinal fasciculi CORTEX Yeatman, J. D., Feldman, H. M. 2013; 49 (1): 301-311

  Abstract

  We describe the case of girl who was born prematurely and diagnosed periventricular leukomalacia, a condition characterized by severe injury to the white matter tracts primarily surrounding the ventricles. At 12 years of age, we obtained diffusion tensor imaging (DTI) data on this child as part of a research protocol. Multiple analyses of DTI data, including tractography, showed that the left and right arcuate and superior longitudinal fasciculi were missing in the child though all other major white matter tracts were present. Standardized psychometric tests at age 12 years revealed that despite early language delays, she had average scores on expressive language, sentence repetition, and reading, functions that have been hypothesized to depend on signals carried by the arcuate fasciculus. We identified intact ventral connections between the temporal and frontal lobes through the extreme capsule fiber system and uncinate fasciculus. Preserved language and reading function after serious injury to the arcuate fasciculus highlights the plasticity of the developing brain after severe white matter injury early in life.

  View details for DOI 10.1016/j.cortex.2011.08.006

  View details for PubMedID 21937035

• Effects of early language, speech, and cognition on later reading: a mediation analysis. Frontiers in psychology Durand, V. N., Loe, I. M., Yeatman, J. D., Feldman, H. M. 2013; 4: 586-?

  Abstract

  This longitudinal secondary analysis examined which early language and speech abilities are associated with school-aged reading skills, and whether these associations are mediated by cognitive ability. We analyzed vocabulary, syntax, speech sound maturity, and cognition in a sample of healthy children at age 3 years (N = 241) in relation to single word reading (decoding), comprehension, and oral reading fluency in the same children at age 9-11 years. All predictor variables and the mediator variable were associated with the three reading outcomes. The predictor variables were all associated with cognitive abilities, the mediator. Cognitive abilities partially mediated the effects of language on reading. After mediation, decoding was associated with speech sound maturity; comprehension was associated with receptive vocabulary; and oral fluency was associated with speech sound maturity, receptive vocabulary, and syntax. In summary, all of the effects of language on reading could not be explained by cognition as a mediator. Specific components of language and speech skills in preschool made independent contributions to reading skills 6-8 years later. These early precursors to later reading skill represent potential targets for early intervention to improve reading.

  View details for DOI 10.3389/fpsyg.2013.00586

  View details for PubMedID 24027549

  View details for PubMedCentralID PMC3759794

• Hospitalizations of Children with Autism Increased from 1999-2009. Journal of Autism and Developmental Disorders Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2013; on line
• Redesigning Health Care for Children with Disabilities: Strengthening Inclusion, Contribution, and Health Feldman, H. M. 2013
• Language and reading skills in school-aged children and adolescents born preterm are associated with white matter properties on diffusion tensor imaging NEUROPSYCHOLOGIA Feldman, H. M., Lee, E. S., Yeatman, J. D., Yeom, K. W. 2012; 50 (14): 3348-3362

  Abstract

  Children born preterm are at risk for deficits in language and reading. They are also at risk for injury to the white matter of the brain. The goal of this study was to determine whether performance in language and reading skills would be associated with white matter properties in children born preterm and full-term. Children born before 36 weeks gestation (n=23, mean±SD age 12.5±2.0 years, gestational age 28.7±2.5 weeks, birth weight 1184±431 g) and controls born after 37 weeks gestation (n=19, 13.1±2.1 years, 39.3±1.0 weeks, 3178±413 g) underwent a battery of language and reading tests. Diffusion tensor imaging (DTI) scans were processed using tract-based spatial statistics to generate a core white matter skeleton that was anatomically comparable across participants. Fractional anisotropy (FA) was the diffusion property used in analyses. In the full-term group, no regions of the whole FA-skeleton were associated with language and reading. In the preterm group, regions of the FA-skeleton were significantly associated with verbal IQ, linguistic processing speed, syntactic comprehension, and decoding. Combined, the regions formed a composite map of 22 clusters on 15 tracts in both hemispheres and in the ventral and dorsal streams. ROI analyses in the preterm group found that several of these regions also showed positive associations with receptive vocabulary, verbal memory, and reading comprehension. Some of the same regions showed weak negative correlations within the full-term group. Exploratory multiple regression in the preterm group found that specific white matter pathways were related to different aspects of language processing and reading, accounting for 27-44% of the variance. The findings suggest that higher performance in language and reading in a group of preterm but not full-term children is associated with higher fractional anisotropy of a bilateral and distributed white matter network.

  View details for DOI 10.1016/j.neuropsychologia.2012.10.014

  View details for PubMedID 23088817

• Tract Profiles of White Matter Properties: Automating Fiber-Tract Quantification PLOS ONE Yeatman, J. D., Dougherty, R. F., Myall, N. J., Wandell, B. A., Feldman, H. M. 2012; 7 (11)

  Abstract

  Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major white matter fascicles (tracts) in the living human brain. The health of these tracts is an important factor underlying many cognitive and neurological disorders. In vivo, tissue properties may vary systematically along each tract for several reasons: different populations of axons enter and exit the tract, and disease can strike at local positions within the tract. Hence quantifying and understanding diffusion measures along each fiber tract (Tract Profile) may reveal new insights into white matter development, function, and disease that are not obvious from mean measures of that tract. We demonstrate several novel findings related to Tract Profiles in the brains of typically developing children and children at risk for white matter injury secondary to preterm birth. First, fractional anisotropy (FA) values vary substantially within a tract but the Tract FA Profile is consistent across subjects. Thus, Tract Profiles contain far more information than mean diffusion measures. Second, developmental changes in FA occur at specific positions within the Tract Profile, rather than along the entire tract. Third, Tract Profiles can be used to compare white matter properties of individual patients to standardized Tract Profiles of a healthy population to elucidate unique features of that patient's clinical condition. Fourth, Tract Profiles can be used to evaluate the association between white matter properties and behavioral outcomes. Specifically, in the preterm group reading ability is positively correlated with FA measured at specific locations on the left arcuate and left superior longitudinal fasciculus and the magnitude of the correlation varies significantly along the Tract Profiles. We introduce open source software for automated fiber-tract quantification (AFQ) that measures Tract Profiles of MRI parameters for 18 white matter tracts. With further validation, AFQ Tract Profiles have potential for informing clinical management and decision-making.

  View details for DOI 10.1371/journal.pone.0049790

  View details for PubMedID 23166771

• White matter microstructure on diffusion tensor imaging is associated with conventional magnetic resonance imaging findings and cognitive function in adolescents born preterm DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Feldman, H. M., Lee, E. S., Loe, I. M., Yeom, K. W., Grill-Spector, K., Luna, B. 2012; 54 (9): 809-814

  Abstract

  Diffusion tensor imaging (DTI) was used to evaluate white matter architecture after preterm birth. The goals were (1) to compare white matter microstructure in two cohorts of preterm- and term-born children; and (2) within preterm groups, to determine if sex, gestational age, birthweight, white matter injury score from conventional magnetic resonance imaging (MRI), or IQ was associated with DTI measures.Participants (n=121; 66 females, 55 males) were aged 9 to 16 years. They comprised 58 preterm children (site 1, n=25; and site 2, n=33) born at less than 36 weeks' gestation (mean 29.4 wks; birthweight 1289g) and 63 term children (site 1, n=40; site 2, n=23) born at more than 37 weeks' gestation. DTI was analyzed using tract-based spatial statistics. Diffusion measures were fractional anisotropy, axial, radial, and mean diffusivity.In no region of the white matter skeleton was fractional anisotropy lower in the preterm group at either site. Within the preterm groups, fractional anisotropy was significantly associated with white matter injury score, but not sex, gestational age, or birthweight. At site 1, fractional anisotropy was associated with IQ.DTI contributes to understanding individual differences after preterm birth but may not differentiate a relatively high-functioning group of preterm children from a matched group of term-born children.

  View details for DOI 10.1111/j.1469-8749.2012.04378.x

  View details for PubMedID 22803787

• Oculomotor Assessments of Executive Function in Preterm Children JOURNAL OF PEDIATRICS Loe, I. M., Luna, B., Bledsoe, I. O., Yeom, K. W., Fritz, B. L., Feldman, H. M. 2012; 161 (3): 427-?

  Abstract

  To use objective, nonverbal oculomotor tasks to assess executive function and infer the neural basis of impairments in preterm children.Cross-sectional study of preterm children age 9-16 years (n = 69; mean gestational age 29 weeks) and full-term controls (n = 43). Tasks assessed sensorimotor function (reflexive prosaccades); resistance to peripheral distracters (fixation); response inhibition, response preparation, and execution of a voluntary saccade (antisaccades); and spatial working memory (memory-guided saccades). Group differences were analyzed using ANOVA. We used linear regression to analyze the contributions of age, sex, gestational age, and white matter category to task performance.Preterm children did not differ from controls on basic sensorimotor function, response inhibition, and working memory. Compared with controls, preterm children showed greater susceptibility to peripheral distracters (P = .008) and were slower to initiate an inhibitory response (P = .003). Regression models showed contributions of age and white matter category to task performance.Preterm children show intact basic sensorimotor function and demonstrate difficulties in processes underlying executive control, including increased distractibility and prolonged response preparation. These limitations may reflect specific neural abnormalities in fronto-subcortical executive control of behavior.

  View details for DOI 10.1016/j.jpeds.2012.02.037

  View details for PubMedID 22480696

• Research Priorities for Developmental-Behavioral Pediatrics: A DBPNet Consensus Study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Blum, N. J., Feldman, H. M., Barbaresi, W. J., Schonfeld, D. J., Hansen, R. L., Forrest, C. B. 2012; 33 (6): 509-516

  Abstract

  To achieve consensus regarding important clinical, translational, and health services research questions for the field of developmental-behavioral pediatrics (DBP).Twenty-seven developmental-behavioral pediatricians, 16 psychologists, and 12 parents participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point Likert scale. Questions were rated as consensus important questions if they had a median score of 7 and the 25th percentile was at least 6 or the coefficient of variation ≤30 (suggesting consensus). Questions were rated as potentially important if they had a median of 7, but a coefficient of variation >30 or if specific stakeholder group ratings suggested importance. After providing participants the Round II results, potentially important questions were rated a second time (Round III).In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, 10 additional questions were rated as consensus important questions. Of the 39 consensus important questions, 20 were efficacy or comparative effectiveness studies and 40% related to autism spectrum disorders.This Delphi process identified a set of high priority clinical, translational, and health services research topics for DBP that can guide research to advance the field and improve care and outcomes for children with DBP conditions.

  View details for DOI 10.1097/DBP.0b013e31825a7101

  View details for Web of Science ID 000306281500011

  View details for PubMedID 22710856

• Missed Opportunities in the Referral of High-Risk Infants to Early Intervention PEDIATRICS Tang, B. G., Feldman, H. M., Huffman, L. C., Kagawa, K. J., Gould, J. B. 2012; 129 (6): 1027-1034

  Abstract

  Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California.From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening.Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit.In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.

  View details for DOI 10.1542/peds.2011-2720

  View details for PubMedID 22614772

• Myofascial Structural Integration: A Promising Complementary Therapy for Young Children With Spastic Cerebral Palsy JOURNAL OF EVIDENCE-BASED INTEGRATIVE MEDICINE Hansen, A. B., Price, K. S., Feldman, H. M. 2012; 17 (2): 131–35

  View details for DOI 10.1177/2156587211430833

  View details for Web of Science ID 000442747800007

• Differences in neural activation between preterm and full term born adolescents on a sentence comprehension task: Implications for educational accommodations DEVELOPMENTAL COGNITIVE NEUROSCIENCE Barde, L. H., Yeatman, J. D., Lee, E. S., Glover, G., Feldman, H. M. 2012; 2: S114-S128

  Abstract

  Adolescent survivors of preterm birth experience persistent functional problems that negatively impact academic outcomes, even when standardized measures of cognition and language suggest normal ability. In this fMRI study, we compared the neural activation supporting auditory sentence comprehension in two groups of adolescents (ages 9-16 years); sentences varied in length and syntactic difficulty. Preterms (n=18, mean gestational age 28.8 weeks) and full terms (n=14) had scores on verbal IQ, receptive vocabulary, and receptive language tests that were within or above normal limits and similar between groups. In early and late phases of the trial, we found interactions by group and length; in the late phase, we also found a group by syntactic difficulty interaction. Post hoc tests revealed that preterms demonstrated significant activation in the left and right middle frontal gyri as syntactic difficulty increased. ANCOVA showed that the interactions could not be attributed to differences in age, receptive language skill, or reaction time. Results are consistent with the hypothesis that preterm birth modulates brain-behavior relations in sentence comprehension as task demands increase. We suggest preterms' differences in neural processing may indicate a need for educational accommodations, even when formal test scores indicate normal academic achievement.

  View details for DOI 10.1016/j.dcn.2011.10.002

  View details for PubMedID 22682901

• Executive function skills are associated with reading and parent-rated child function in children born prematurely EARLY HUMAN DEVELOPMENT Loe, I. M., Lee, E. S., Luna, B., Feldman, H. M. 2012; 88 (2): 111-118

  Abstract

  Preterm children are at risk for executive function (EF) problems, which have been linked to behavior and learning problems in full term children. In this study, we examine the relationship between EF and functional outcomes in preterm children.To evaluate (1) EF skills of 9- to 16-year-old children born across the spectrum of gestational age (GA), (2) relationship of degree of prematurity to EF skills, and (3) contributions of EF skills to two functional outcomes - reading scores and parent-rated child function.Preterm children <36 weeks gestation (n=72) were compared to full term children (n=42) of similar age, gender and SES, on measures of EF, reading, and parent-ratings of child function. Multiple regression models evaluated contributions to EF skills and functional outcomes.Compared to full term controls, preterm children had poorer EF performance on a complex planning and organization task and did not increase planning time as task difficulty increased. Their spatial memory capacity was not different. GA contributed to EF skills, but was mediated by IQ. EF contributed to the variance in reading skills but did not add to the variance in reading when IQ was considered. EF skills significantly contributed to the variance in parent-rated child function, but IQ did not.EF skills contribute to measures of functional outcome in this high-risk population. The use of EF skills as an early marker for learning and functional problems and as a target for intervention in children born preterm warrants future study.

  View details for DOI 10.1016/j.earlhumdev.2011.07.018

  View details for PubMedID 21849240

• Myofascial structural integraton: A promising complementary therapy for young children with spastic cerebral palsy Journal of Evidence-Based Complementary and Alternative Medicine Hansen AB, Price KS, Feldman HM 2012; 17 (2): 131-135
• REASONS FOR HOSPITALIZATION IN CHILDREN WITH CEREBRAL PALSY AND DOWN SYNDROME ACROSS CHILDHOOD Western Regional Meeting of the American-Federation-for-Medical-Research Nayfack, A., Chan, J., Huffman, L., Feldman, H., Wise, P. LIPPINCOTT WILLIAMS & WILKINS. 2012: 131–32

  View details for Web of Science ID 000298634401021

• The Developmental-Behavioral Pediatrics Research Network (DBPNet): Another Step in the Development of the Field. Journal of Developmental and Behavioral Pediatrics Blum, N. J. 2012; 33 (1): 78-83
• ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents PEDIATRICS Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M., Feldman, H. M., Ganiats, T. G., Kaplanek, B., Meyer, B., Perrin, J., Pierce, K., Reiff, M., Stein, M. T., Visser, S. 2011; 128 (5): 1007-1022

  Abstract

  Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children; the American Academy of Pediatrics first published clinical recommendations for the diagnosis and evaluation of ADHD in children in 2000; recommendations for treatment followed in 2001.

  View details for DOI 10.1542/peds.2011-2654

  View details for Web of Science ID 000296714000069

  View details for PubMedID 22003063

• Behavior problems of 9-16 year old preterm children: Biological, sociodemographic, and intellectual contributions EARLY HUMAN DEVELOPMENT Loe, I. M., Lee, E. S., Luna, F., Feldman, H. M. 2011; 87 (4): 247-252

  Abstract

  Preterm children are at risk for behavior problems. Studies examining contributions of intellectual and environmental factors to behavior outcomes in preterm children are mixed.(1) To identify the nature of maladaptive behaviors in preterm children age 9 to 16 years born across the spectrum of gestational age and birth weight (BW). (2) To examine contributions of BW as a biological factor, socioeconomic status as an environmental factor, and intelligence quotient (IQ) as indicative of intellectual ability to behavior outcomes.Using the Child Behavior Checklist, parent reports of behavior for 63 preterm children (gestational age 24 to <36 weeks) were compared to 29 full term children of similar age, gender and socioeconomic status. Multiple regression models evaluated effects of prematurity, socioeconomic status, and intellectual ability on behavioral symptom scores.Preterm children had higher total and internalizing problem scores compared to full term children. They also had lower IQ. BW was a significant predictor of total and internalizing behavior problems. Among the syndrome scales, anxious/depressed and attention problems were elevated. Socioeconomic status did not contribute to behavior scores. IQ contributed to total, but not to internalizing or externalizing, scores. IQ contributed to attention problems, but not to anxious/depressed scores.Preterm children had increased behavior problems, especially symptoms of inattention and anxiety. Lower BW predicted more behavior problems. IQ acted as a mediator between BW and attention scores, but not anxiety scores. These findings alert health care providers to assess anxiety in all preterm children regardless of intellectual ability and additional study on the influence of intellectual ability on behavioral outcomes in preterm children is needed.

  View details for DOI 10.1016/j.earlhumdev.2011.01.023

  View details for PubMedID 21316875

• Specific language and reading skills in school-aged children and adolescents are associated with prematurity after controlling for IQ NEUROPSYCHOLOGIA Lee, E. S., Yeatman, J. D., Luna, B., Feldman, H. M. 2011; 49 (5): 906-913

  Abstract

  Although studies of long-term outcomes of children born preterm consistently show low intelligence quotient (IQ) and visual-motor impairment, studies of their performance in language and reading have found inconsistent results. In this study, we examined which specific language and reading skills were associated with prematurity independent of the effects of gender, socioeconomic status (SES), and IQ. Participants from two study sites (N=100) included 9-16-year old children born before 36 weeks gestation and weighing less than 2500 grams (preterm group, n=65) compared to children born at 37 weeks gestation or more (full-term group, n=35). Children born preterm had significantly lower scores than full-term controls on Performance IQ, Verbal IQ, receptive and expressive language skills, syntactic comprehension, linguistic processing speed, verbal memory, decoding, and reading comprehension but not on receptive vocabulary. Using MANCOVA, we found that SES, IQ, and prematurity all contributed to the variance in scores on a set of six non-overlapping measures of language and reading. Simple regression analyses found that after controlling for SES and Performance IQ, the degree of prematurity as measured by gestational age group was a significant predictor of linguistic processing speed, β=-.27, p<.05, R(2)=.07, verbal memory, β=.31, p<.05, R(2)=.09, and reading comprehension, β=.28, p<.05, R(2)=.08, but not of receptive vocabulary, syntactic comprehension, or decoding. The language and reading domains where prematurity had a direct effect can be classified as fluid as opposed to crystallized functions and should be monitored in school-aged children and adolescents born preterm.

  View details for DOI 10.1016/j.neuropsychologia.2010.12.038

  View details for PubMedID 21195100

• Management of Symptoms in Children With Autism Spectrum Disorders: A Comprehensive Review of Pharmacologic and Complementary-Alternative Medicine Treatments JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C., Sutcliffe, T. L., Tanner, I. S., Feldman, H. M. 2011; 32 (1): 56-68

  Abstract

  In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms.

  View details for DOI 10.1097/DBP.0b013e3182040acf

  View details for PubMedID 21160435

• USE OF DIFFUSION TENSOR IMAGING IN THE EVALUATION OF BRAIN INJURY IN ADOLESCENTS BORN PRETERM Gaman-Bean, S., Yeatman, J., Lee, E., Yeom, K., Feldman, H. LIPPINCOTT WILLIAMS & WILKINS. 2011: 95–96

  View details for Web of Science ID 000285542500043

• MISSED OPPORTUNITIES IN HIGH RISK INFANT FOLLOW-UP? Tang, B., Huffman, L., Feldman, H., Gray, E., Kagawa, K., Gould, J. B. LIPPINCOTT WILLIAMS & WILKINS. 2011: 95

  View details for Web of Science ID 000285542500042

• Individual differences in auditory sentence comprehension in children: An exploratory event-related functional magnetic resonance imaging investigation BRAIN AND LANGUAGE Yeatman, J. D., Ben-Shachar, M., Glover, G. H., Feldman, H. M. 2010; 114 (2): 72-79

  Abstract

  The purpose of this study was to explore changes in activation of the cortical network that serves auditory sentence comprehension in children in response to increasing demands of complex sentences. A further goal is to study how individual differences in children's receptive language abilities are associated with such changes in cortical responses. Fourteen children, 10-16 years old, participated in an event-related functional magnetic resonance imaging experiment using a cross modal sentence-picture verification paradigm. We manipulated sentence difficulty and length in a 2x2 factorial design. Task-related activation covered large regions of the left and right superior temporal cortex, inferior parietal lobe, precuneous, cingulate, middle frontal gyrus and precentral gyrus. Sentence difficulty, independent of length, led to increased activation in the left temporal-parietal junction and right superior temporal gyrus. Changes in activation in frontal regions positively correlated with age-standardized receptive vocabulary scores and negatively correlated with reaction time on a receptive grammar test outside the scanner. Thus, individual differences in language skills were associated with changes in the network in response to changing task demands. These preliminary findings in a small sample of typically developing children suggest that the investigation of individual differences may prove useful in elucidating the underlying neural mechanisms of language disorders in children.

  View details for DOI 10.1016/j.bandl.2009.11.006

  View details for PubMedID 20053431

• Reading performance correlates with white-matter properties in preterm and term children DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Andrews, J. S., Ben-Shachar, M., Yeatman, J. D., Flom, L. L., Luna, B., Feldman, H. M. 2010; 52 (6): E94-E100

  Abstract

  We used diffusion tensor imaging to investigate the association between white-matter integrity and reading ability in a cohort of 28 children. Nineteen preterm children (14 males, five females; mean age 11 y 11 mo [SD 1 y 10 mo], mean gestational age 30.5 wks (SD 3.2), mean birthweight was 1455 g [SD 625]); and nine term children (five males, four females; mean age 12 y 8 mo [SD 2 y 5 mo], mean gestational age 39.6 wks (SD 1.2), and mean birthweight 3877 g [SD 473]).We tested whether fractional anisotropy in a left hemisphere temporoparietal region and in the corpus callosum correlates with birthweight and scores on the following three subtests of the Woodcock-Johnson III Tests of Achievement: word identification, word attack, and passage comprehension.Preterm children had lower reading scores than a comparison group for all reading subtests (p<0.05). We found significant correlations between birthweight and fractional anisotropy in the whole corpus callosum (p=0.001), and between fractional anisotropy and reading skill in the genu (p=0.001) and body (p=0.001) of the corpus callosum. The correlation between reading skill and fractional anisotropy in a left temporoparietal region previously associated with reading disability was not significant (p=0.095).We conclude that perinatal white-matter injury of the central corpus callosum may have long-term developmental implications for reading performance.

  View details for DOI 10.1111/j.1469-8749.2009.03456.x

  View details for PubMedID 19747208

• Diffusion Tensor Imaging: A Review for Pediatric Researchers and Clinicians JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Yeatman, J. D., Lee, E. S., Barde, L. H., Gaman-Bean, S. 2010; 31 (4): 346-356

  Abstract

  Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that allows for the visualization and characterization of the white matter tracts of the brain in vivo. DTI does not assess white matter directly. Rather, it capitalizes on the fact that diffusion is isotropic (equal in all directions) in cerebral spinal fluid and cell bodies but anisotropic (greater in one direction than the other directions) in axons that comprise white matter. It provides quantitative information about the degree and direction of water diffusion within individual units of volume within the magnetic resonance image, and by inference, about the integrity of white matter. Measures from DTI can be applied throughout the brain or to regions of interest. Fiber tract reconstruction, or tractography, creates continuous 3-dimensional tracts by sequentially piecing together estimates of fiber orientation from the direction of diffusion within individual volume units. DTI has increased our understanding of white matter structure and function. DTI shows nonlinear growth of white matter tracts from childhood to adulthood. Delayed maturation of the white matter in the frontal lobes may explain the continued growth of cognitive control into adulthood. Relative to good readers, adults and children who are poor readers have evidence of white matter differences in a specific region of the temporo-parietal lobe, implicating differences in connections among brain regions as a factor in reading disorder. Measures from DTI changed in poor readers who improved their reading skills after intense remediation. DTI documents injury to white matter tracts after prematurity. Measures indicative of white matter injury are associated with motor and cognitive impairment in children born prematurely. Further research on DTI is necessary before it can become a routine clinical procedure.

  View details for DOI 10.1097/DBP.0b013e3181dcaa8b

  View details for PubMedID 20453582

• Delayed Recognition of Profound Hearing Loss in a 7-Year-Old Girl With a Neurological Condition JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tang, B. G., Feldman, H. M., Padden, C., Israeli, N., Stein, M. T. 2010; 31 (3): S42-S45

  Abstract

  Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination. Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed. A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally. Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

  View details for DOI 10.1097/DBP.0b013e3181d82efc

  View details for PubMedID 20414074

• Delayed Recognition of Profound Hearing Loss in a 7-Year-Old Girl With a Neurological Condition JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tang, B. G., Feldman, H. M., Padden, C., Israeli, N., Stein, M. T. 2009; 30 (4): 327-330

  Abstract

  Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination.Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed.A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally.Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

  View details for PubMedID 19672159

• Using Diffusion Tensor Imaging and Fiber Tracking to Characterize Diffuse Perinatal White Matter Injury: A Case Report JOURNAL OF CHILD NEUROLOGY Yeatman, J. D., Ben-Shachar, M., Bammer, R., Feldman, H. M. 2009; 24 (7): 795-800

  Abstract

  Prematurity is associated with white matter injury. Diffusion tensor imaging, a new magnetic resonance imaging technique, identifies white matter fiber tracts and quantifies structural properties. We used diffusion tensor imaging fiber tracking to compare white matter characteristics in a 12-year-old born prematurely and full-term control. We divided fibers passing through the corpus callosum into 7 segments based on cortical projection zones and analyzed them for fractional anisotropy, axial diffusivity, and radial diffusivity. We also compared corticospinal and somatosensory tracts in the participant and control. The participant had decreased fractional anisotropy in every callosal segment, particularly in superior and posterior parietal projections. Fractional anisotropy of the corticospinal and somatosensory tracts was not lower in the participant than control. Fiber tracking allowed precise localization and visualization of white matter injuries of the corpus callosum associated with prematurity. Quantitative measures suggested myelin deficiencies across the corpus callosum, particularly in parietal projections.

  View details for DOI 10.1177/0883073808331080

  View details for PubMedID 19435729

• Oculomotor Performance Identifies Underlying Cognitive Deficits in Attention-Deficit/Hyperactivity Disorder JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Loe, I. M., Feldman, H. M., Yasui, E., Luna, B. 2009; 48 (4): 431-440

  Abstract

  To evaluate cognitive control in children with attention-deficit/hyperactivity disorder (ADHD) using oculomotor tests of executive function.Cross-sectional study of children aged 8 to 13 years with ADHD (n = 26) and controls (n = 33) used oculomotor tasks to assess sensorimotor function (visually guided saccades), resistance to peripheral distractors (fixation), response inhibition (antisaccades), and spatial working memory (memory-guided saccades).All children had intact sensorimotor function and working memory. Children with ADHD showed susceptibility to peripheral distractors and deficits in response inhibition. Increased interstimulus (IS) fixation periods on the antisaccade task were associated with improved performance and decreased reaction times on correct trials for controls but not for children with ADHD. Attention-deficit/hyperactivity disorder-combined and inattentive subtypes showed different patterns of reaction time as a function of IS periods.Response inhibition deficits in ADHD on oculomotor tasks are consistent with other studies. The failure of children with ADHD to use IS time to decrease response inhibition errors and reaction time suggests that IS time is not used to prepare a response. These findings highlight the importance of considering cognitive processing components affected by ADHD in addition to core behavioral symptoms, particularly in designing new treatment strategies.

  View details for DOI 10.1097/CHI.0b013e31819996da

  View details for PubMedID 19238098

• Functional characteristics of children diagnosed with Childhood Apraxia of Speech DISABILITY AND REHABILITATION Teverovsky, E. G., Bickel, J. O., Feldman, H. M. 2009; 31 (2): 94-102

  Abstract

  The purpose of this study was to describe the complex array of functional problems in children diagnosed by their treating speech/language pathologist with Childhood Apraxia of Speech (CAS), a poorly understood, severe speech sound disorder.We asked parents (n = 201) attending the first national parent conference on CAS to voluntarily complete a survey, which evaluated 43 functional domains from the International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY). The survey also included questions about co-existing medical, developmental, and mental health conditions and about service utilization. Data were analyzed using descriptive statistics and exploratory factor analysis.The most prevalent functional problems in addition to communication were attention (focus), vestibular function, temperament, fine hand use, maintaining attention, and learning to write. Four orthogonal factors accounted for 23% of the variance in functional problems: Cognitive and Learning Problems, Social Communication Difficulties, Behavioral Dysregulation, and Other Oral Motor Problems. Over half the sample had health, mental health, and developmental conditions. Almost all of the children used early intervention and speech/language therapy services.The ICF-CY provided a systematic approach for describing and categorizing functional problems in children with CAS. The identified factors should guide the multidisciplinary team in conducting comprehensive evaluations, rehabilitation, and long-term follow-up of children with CAS.

  View details for DOI 10.1080/09638280701795030

  View details for Web of Science ID 000263007900004

  View details for PubMedID 18720114

• Otitis Media with Effusion and Child Development: Rethinking management. Contemporary Pediatrics Feldman, H. M., Paradise, J. L. 2009; 26 (5): 40-47
• Developmental-Behavioral Pediatrics Feldman, H. M. edited by Carey, W. B., Coleman, W., Crocker, A. C., Elias, E. Elsevier,. 2009
• Early Histories of School-Aged Children With Attention-Deficit/Hyperactivity Disorder CHILD DEVELOPMENT Loe, I. M., Balestrino, M. D., Phelps, R. A., Kurs-Lasky, M., Chaves-Gnecco, D., Paradise, J. L., Feldman, H. M. 2008; 79 (6): 1853-1868

  Abstract

  In a prospective study of developmental outcomes in relation to early-life otitis media, behavioral, cognitive, and language measures were administered to a large, diverse sample of children at 2, 3, 4, 6, and 9-11 years of age (N = 741). At 9-11 years of age, 9% of the children were categorized as having attention-deficit/hyperactivity disorder (ADHD) based on parent report. Compared to the non-ADHD group, the ADHD group had higher (i.e., less favorable) scores on parent and teacher versions of the Child Behavior Checklist at all ages. Children in the ADHD group also had lower scores on cognitive and receptive language measures in preschool. The findings support the concept that ADHD is a cognitive as well as a behavioral disorder.

  View details for DOI 10.1111/j.1467-8624.2008.01230.x

  View details for PubMedID 19037954

• Academic and educational outcomes of children with ADHD JOURNAL OF PEDIATRIC PSYCHOLOGY Loe, I. M., Feldman, H. M. 2007; 32 (6): 643-654

  Abstract

  Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

  View details for DOI 10.1093/jpepsy/jsl054

  View details for Web of Science ID 000248086000003

  View details for PubMedID 17569716

• Using the language characteristics of clinical populations to understand normal language development PEDIATRIC CLINICS OF NORTH AMERICA Feldman, H. M. 2007; 54 (3): 585-?

  Abstract

  The overall purpose of this article is to describe the speech and language abilities of children who have selected clinical conditions, not only to characterize the outcomes of those conditions, but also to understand fundamental requirements for language learning in typically developing children. This developmental cognitive neuroscience analysis conceptualizes the clinical conditions as naturalistic experimental manipulations, selectively altering factors in the language-learning situation that could not otherwise be ethically manipulated in a research study.

  View details for DOI 10.1016/j.pcl.2007.02.006

  View details for PubMedID 17543911

• Tympanostomy tubes and developmental outcomes at 9 to 11 years of age NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Pitcairn, D. L., Smith, C. G., Colborn, D. K., Bernard, B. S., Kurs-Lasky, M., Janosky, J. E., Sabo, D. L., O'Connor, R. E., Pelham, W. E. 2007; 356 (3): 248-261

  Abstract

  Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older.We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age.Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests.In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].).

  View details for Web of Science ID 000243488100007

  View details for PubMedID 17229952

• The Parent’s Guide to Speech and Language Problems Feit, D. McGraw-Hill. 2007
• Academic and educational outcomes of children with ADHD AMBULATORY PEDIATRICS Loe, I. M., Feldman, H. M. 2007; 7 (1): 82-90

  Abstract

  Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

  View details for Web of Science ID 000243950000004

  View details for PubMedID 17261487

• Commentary on Hooper et al JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Paradise, J. L. 2006; 27 (4): 336-337

  View details for Web of Science ID 000239858400007

  View details for PubMedID 16906010

• Reliability in assigning ICF codes to children with special health care needs using a developmentally structured interview DISABILITY AND REHABILITATION Kronk, R. A., Ogonowski, J. A., Rice, C. N., Feldman, H. M. 2005; 27 (17): 977-983

  Abstract

  The purpose of this study was to determine if two teams of raters could reliably assign codes and performance qualifiers from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to children with special health care needs based on the results of a developmentally structured interview.Children (N = 40), ages 11 months to 12 years 10 months, with a range of health conditions, were evaluated using a structured interview consisting of open-ended questions and scored using developmental guidelines. For each child, two raters made a binary decision indicating whether codes represented an area of need or no need for that child. Raters assigned a performance qualifier, based on the ICF guidelines, to each code designated as an area of need. Cohen's kappa statistic was used as the measure of inter-rater reliability.Team I reached good to excellent agreement on 39/39 codes and Team II on 38/39 codes. Team I reached good to excellent agreement on 5/5 qualifiers and Team II on 10/14 qualifiers.A developmentally structured interview was an effective clinical tool for assigning ICF codes to children with special health care needs. The interview resulted in higher rates of agreement than did results from standardized functional assessments. Guidelines for assigning performance qualifiers must be modified for use with children.

  View details for DOI 10.1080/09638280500052849

  View details for Web of Science ID 000231160800002

  View details for PubMedID 16096251

• Developmental outcomes after early or delayed insertion of tympanostomy tubes NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Campbell, T. F., Dollaghan, C. A., Feldman, H. M., Bernard, B. S., Colborn, D. K., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Kurs-Lasky, M., Sabo, D. L., Smith, C. G. 2005; 353 (6): 576-586

  Abstract

  To prevent later developmental impairments, myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persistent effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of school-age children is unknown.We enrolled 6350 healthy infants younger than 62 days of age and evaluated them regularly for middle-ear effusion. Before three years of age, 429 children with persistent middle-ear effusion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental outcomes in 395 of these children at six years of age.At six years of age, 85 percent of children in the early-treatment group and 41 percent in the delayed-treatment group had received tympanostomy tubes. There were no significant differences in mean (+/-SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98+/-13 vs. 98+/-14); Number of Different Words test, a measure of word diversity (183+/-36 vs. 175+/-36); Percentage of Consonants Correct-Revised test, a measure of speech-sound production (96+/-2 vs. 96+/-3); the SCAN test, a measure of central auditory processing (95+/-15 vs. 96+/-14); and several measures of behavior and emotion.In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.

  View details for Web of Science ID 000231101500008

  View details for PubMedID 16093466

  View details for PubMedCentralID PMC1201478

• Concurrent and predictive validity of parent reports of child language at ages 2 and 3 years CHILD DEVELOPMENT Feldman, H. M., Dale, P. S., Campbell, T. F., Colborn, D. K., Kurs-Lasky, M., Rockette, H. E., Paradise, J. L. 2005; 76 (4): 856-868

  Abstract

  The MacArthur-Bates Communicative Development Inventories (CDI; Dale, 1996; Fenson et al., 1994), parent reports about language skills, are being used increasingly in studies of theoretical and public health importance. This study (N = 113) correlated scores on the CDI at ages 2 and 3 years with scores at age 3 years on tests of cognition and receptive language and measures from parent-child conversation. Associations indicated reasonable concurrent and predictive validity. The findings suggest that satisfactory vocabulary scores at age 2 are likely to predict normal language skills at age 3, although some children with limited skills at age 3 will have had satisfactory scores at age 2. Many children with poor vocabulary scores at 2 will have normal skills at 3.

  View details for Web of Science ID 000230493400007

  View details for PubMedID 16026501

  View details for PubMedCentralID PMC1350485

• Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence PEDIATRICS BROWN, R. T., Amler, R. W., Freeman, W. S., Perrin, J. M., Stein, M. T., Feldman, H. M., Pierce, K., Wolraich, M. L. 2005; 115 (6): E749-E757

  Abstract

  The American Academy of Pediatrics' Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder, reviewed and analyzed the current literature for the purpose of developing an evidence-based clinical practice guideline for the treatment of the school-aged child with attention-deficit/hyperactivity disorder (ADHD). This review included several key reports, including an evidence review from the McMaster Evidence-Based Practice Center (supported by the Agency for Healthcare Research and Quality), a report from the Canadian Coordinating Office for Health Technology Assessment, the Multimodal Treatment for ADHD comparative clinical trial (supported by the National Institute of Mental Health), and supplemental reviews conducted by the subcommittee. These reviews provided substantial information about different treatments for ADHD and their efficacy in improving certain characteristics or outcomes for children with ADHD as well as adverse effects and benefits of multiple modes of treatment compared with single modes (eg, medication or behavior therapies alone). The reviews also compared the effects of different medications. Other evidence documents the long-term nature of ADHD in children and its classification as a chronic condition, meriting the application of general concepts of chronic-condition management, including an individual treatment plan with a focus on ongoing parent and child education, management, and monitoring. The evidence strongly supports the use of stimulant medications for treating the core symptoms of children with ADHD and, to a lesser degree, for improving functioning. Behavior therapy alone has only limited effect on symptoms or functioning of children with ADHD, although combining behavior therapy with medication seems to improve functioning and may decrease the amount of (stimulant) medication needed. Comparison among stimulants (mainly methylphenidate and amphetamines) did not indicate that 1 class outperformed the other.

  View details for DOI 10.1542/peds.2004-2560

  View details for Web of Science ID 000229504800076

  View details for PubMedID 15930203

• Evaluation and management of language and speech disorders in preschool children PEDIATRICS IN REVIEW Feldman, H. M. 2005; 26 (4): 131-140

  View details for Web of Science ID 000232155300003

  View details for PubMedID 15805236

• Language learning with an injured brain Language, Learning and Development Feldman, H. M. 2005; 1: 265-288
• Inter-rater reliability in assigning ICF codes to children with disabilities DISABILITY AND REHABILITATION Ogonowski, J. A., Kronk, R. A., Rice, C. N., Feldman, H. M. 2004; 26 (6): 353-361

  Abstract

  The purpose of this study was to determine if independent raters would arrive at similar decisions about which codes from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to assign to children with disabilities based on the results of standard paediatric functional assessment measures.Children (N = 60), 9 months to 17.75 years old, with a range of disabilities were assessed using either the Vineland Adaptive Behavior Scales (n = 20), the Pediatric Evaluation of Disability Inventory (PEDI) (n = 20), or the School Function Assessment (SFA) (n = 20). Two raters independently determined which of 40 codes from the Activities and Participation component of the ICF applied to each child based on items and standard scores from the assessment measure. The Cohen's kappa statistic was used as the measure of inter-rater reliability.The kappa statistic was >/= 0.70, the criterion for good agreement in this study, for 23/40 codes using the Vineland, 17/40 codes using the PEDI, and 17/40 codes using the SFA. The mean kappa statistic reached >/= 0.70 for the Self care domain, using all three tools. The mean kappa statistic also reached >/= 0.70 for Learning and Applying Knowledge and Mobility using the Vineland.Independent raters reached high rates of agreement when assessment test items were structured developmentally and corresponded to a single ICF code. For domains other than Self care, alternative assessment strategies may be necessary to improve assigning ICF codes to children with disabilities.

  View details for DOI 10.1080/09638280410001658658

  View details for Web of Science ID 000220127100005

  View details for PubMedID 15204487

• Phonological memory and vocabulary learning in children with focal lesions BRAIN AND LANGUAGE Gupta, P., MacWhinney, B., Feldman, H. A., Sacco, K. 2003; 87 (2): 241-252

  Abstract

  Eleven children with early focal lesions were compared with 70 age-matched controls to assess their performance in repeating non-words, in learning new words, and in immediate serial recall, a triad of abilities that are believed to share a dependence on serial ordering mechanisms (e.g.,; ). Results for the experimental group were also compared with other assessments previously reported for the same children by. The children with brain injury showed substantial impairment relative to controls in the experimental tasks, in contrast with relatively unimpaired performance on measures of vocabulary and non-verbal intelligence. The relationships between word learning, non-word repetition, and immediate serial recall were similar to those observed in several other populations. These results support previous reports that there are persistent processing impairments following early brain injury, despite developmental plasticity. They also suggest that word learning, non-word repetition, and immediate serial recall may be relatively demanding tasks, and that their relationship is a fundamental aspect of the cognitive system.

  View details for DOI 10.1016/S0093-934X(03)00094-4

  View details for Web of Science ID 000186485600003

  View details for PubMedID 14585293

• Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels PEDIATRIC INFECTIOUS DISEASE JOURNAL Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Colborn, D. K., Bernard, B. S., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2003; 22 (4): 309-314

  Abstract

  Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management.We randomly assigned 429 children with persistent middle ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. In 402 of these children, we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech, language and cognition and in 401 of the children no significant differences in measures of psychosocial development. We then examined outcomes within subgroups of children who might have been the most severely affected, namely those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral and/or discontinuous MEE and those who had the greatest degrees of hearing loss.In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group.In otherwise normal children who have MEE, during the first 3 years of life within the durations we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years, irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss.

  View details for Web of Science ID 000182327600002

  View details for PubMedID 12690269

• Parent-reported language skills in relation to otitis media during the first 3 years of life JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Colborn, D. K., Janosky, J., Kurs-Lasky, M., Rockette, H. E., Dale, P. S., Paradise, J. L. 2003; 46 (2): 273-287

  Abstract

  As part of a larger study of the potential impact of early-life otitis media (OM) on speech, language, cognition, and behavior, we studied the degree of association between parent-reported language scores at ages 1, 2, and 3 years and the cumulative duration of middle-ear effusion (MEE) during the first 3 years of life in a demographically diverse sample of 621 children. We estimated the cumulative percentage of days with MEE from prospective monthly observations of middle-ear status and interpolations for periods between visits. For each child, parents completed the appropriate inventory of the MacArthur Communicative Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. We also evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parent reports. Scores on the new CDI-III (B. Oliver et al., in press) varied positively with sociodemographic variables and were significantly correlated with scores from the CDI used when the children were younger. Unadjusted correlations between scores at ages 1 and 2 years and the percentages of days with MEE in the respective antecedent periods were statistically nonsignificant or of questionable clinical importance. The correlations between parent-reported scores at age 3 years and children's cumulative percentage of days with MEE in Years 1, 2, and 3 combined ranged from -.187 to -.248 (all p values < .001). The percentage of days with MEE and maternal education each contributed independently to scores at age 3 years. In the light of other findings from the larger study, we think it likely that the negative associations between language measures and MEE reflect confounding factors that contribute, on the one hand, to the duration of OM in young children and, on the other hand, to slow development of their language skills.

  View details for DOI 10.1044/1092-4388(2003/022)

  View details for Web of Science ID 000184906200003

  View details for PubMedID 14700371

• Risk factors for speech delay of unknown origin in 3-year-old children CHILD DEVELOPMENT Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Paradise, J. L., Feldman, H. M., Shriberg, L. D., Sabo, D. L., Kurs-Lasky, M. 2003; 74 (2): 346-357

  Abstract

  One hundred 3-year-olds with speech delay of unknown origin and 539 same-age peers were compared with respect to 6 variables linked to speech disorders: male sex, family history of developmental communication disorder, low maternal education, low socioeconomic status (indexed by Medicaid health insurance), African American race, and prolonged otitis media. Abnormal hearing was also examined in a subset of 279 children who had at least 2 hearing evaluations between 6 and 18 months of age. Significant odds ratios were found only for low maternal education, male sex, and positive family history; a child with all 3 factors was 7.71 times as likely to have a speech delay as a child without any of these factors.

  View details for Web of Science ID 000182012100002

  View details for PubMedID 12705559

• Sentence processing in children with early unilateral brain injury BRAIN AND LANGUAGE Feldman, H. M., MacWhinney, B., Sacco, K. 2002; 83 (2): 335-352

  Abstract

  This study examined how children use word order and animacy cues to determine the agent of the action in an on-line sentence-comprehension task. The subject group included 15 children, 5-12 years old, with brain injury incurred prior to the age of 2 months; 12 had left hemisphere (LH) damage and 3 had right hemisphere (RH) damage. The comparison group included 141 children, 5-10 years old, who were at the appropriate grade for age. The task required children to listen to sentences composed of two noun phrases (N) that varied in terms of animacy and a verb phrase (V) and then to indicate the agent of the action. Three word orders were presented: NVN, VNN, and NNV. Measures included the proportion of trials in which the first noun was selected (choice) and reaction time. Word order and animacy significantly influenced choice. The effect of subject group approached significance for choice. Word order and age influenced reaction time. The children with LH injury and two children with RH injury showed a developmental delay in choosing the appropriate N as agent; one child with RH injury had mature responses. The overlapping performance of children with LH and RH injury suggests that delays in the development of sentence comprehension strategies are more likely related to reliance on a smaller than usual neural network rather than to congenital specialization of the LH.

  View details for Web of Science ID 000178828600007

  View details for PubMedID 12387801

  View details for PubMedCentralID PMC2967199

• Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder PEDIATRICS Perrin, J. M., Stein, M. T., Amler, R. W., Blondis, T. A., Feldman, H. M., Meyer, B. P., Shaywitz, B. A., Wolraich, M. L., DeSpirito, A., Homer, C. J., Wender, E., Brown, R. T., Ganiats, T. G., Grabert, B., Pierce, K., Herrerias, C. T., Homer, C. J., Baltz, R. D., Hickson, G. B., Miles, P. V., Newman, T. B., Shook, J. E., Zurhellen, W. M., Lowe, B. A., Schwalenstocker, E., Goldberg, M. J., Shiffman, R., Berger, J. E., France, F. L., Subcomm Attention-Deficit Hyperact 2001; 108 (4): 1033-1044

  Abstract

  This clinical practice guideline provides evidence-based recommendations for the treatment of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). This guideline, the second in a set of policies on this condition, is intended for use by clinicians working in primary care settings. The initiation of treatment requires the accurate establishment of a diagnosis of ADHD; the American Academy of Pediatrics (AAP) clinical practice guideline on diagnosis of children with ADHD(1) provides direction in appropriately diagnosing this disorder. The AAP Committee on Quality Improvement selected a subcommittee composed of primary care and developmental-behavioral pediatricians and other experts in the fields of neurology, psychology, child psychiatry, education, family practice, and epidemiology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Evidence-based Practice Center at McMaster University, Ontario, Canada, to develop the evidence base of literature on this topic.(2) The resulting systematic review, along with other major studies in this area, was used to formulate recommendations for treatment of children with ADHD. The subcommittee also reviewed the multimodal treatment study of children with ADHD(3) and the Canadian Coordinating Office for Health Technology Assessment report (CCOHTA).(4) Subcommittee decisions were made by consensus where definitive evidence was not available. The subcommittee report underwent extensive review by sections and committees of the AAP as well as by numerous external organizations before approval from the AAP Board of Directors. The guideline contains the following recommendations for the treatment of a child diagnosed with ADHD:

  View details for Web of Science ID 000171319600055

  View details for PubMedID 11581465

• Sexuality education for children and adolescents PEDIATRICS Hagan, J. F., Coleman, W. L., Foy, J. M., Goldson, E., Howard, B. J., Navarro, A., Tanner, J. L., Tolmas, H. C., Kaplan, D. W., Feinstein, R. A., Fisher, M. M., Klein, J. D., Olmedo, L. F., Rome, E. S., Yancy, W. S., Comm Educ Children Adolescents 2001; 108 (2): 498-502

  View details for Web of Science ID 000170211800065

• Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Colborn, D. K., Bernard, B. S., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2001; 344 (16): 1179-1187

  Abstract

  A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitis media with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion of tympanostomy tubes prevents developmental impairment.We enrolled 6350 healthy infants from 2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before the age of three years 429 children with persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if effusion persisted. In 402 of these children we assessed speech, language, cognition, and psychosocial development at the age of three years.By the age of three years, 169 children in the early-treatment group (82 percent) and 66 children in the late-treatment group (34 percent) had received tympanostomy tubes. There were no significant differences between the early-treatment group and the late-treatment group at the age of three years in the mean (+/-SD) scores on the Number of Different Words test, a measure of word diversity (124+/-32 and 126+/-30, respectively); the Percentage of Consonants Correct-Revised test, a measure of speech-sound production (85+/-7 vs. 86+/-7); the General Cognitive Index of McCarthy Scales of Children's Abilities (99+/-14 vs. 101+/-13); or on measures of receptive language, sentence length, grammatical complexity, parent-child stress, and behavior.In children younger than three years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.

  View details for Web of Science ID 000168127600001

  View details for PubMedID 11309632

• Expressive language delay in a toddler JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Stein, M. T., Parker, S., Coplan, J., Feldman, H. 2001; 22 (2): S99-S103

  View details for Web of Science ID 000168183100020

  View details for PubMedID 11332819

• Expressive language delay in a toddler PEDIATRICS Stein, M., Parker, S., Coplan, J., Feldman, H. 2001; 107 (4): 905-909

  View details for Web of Science ID 000168130000020

• Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings PEDIATRICS BROWN, R. T., Freeman, W. S., Perrin, J. M., Stein, M. T., Amler, R. W., Feldman, H. M., Pierce, K., Wolraich, M. L. 2001; 107 (3)

  Abstract

  Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent- and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting.

  View details for Web of Science ID 000167216200015

  View details for PubMedID 11230624

• Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life PEDIATRICS Paradise, J. L., Dollaghan, C. A., Campbell, T. F., Feldman, H. M., Bernard, B. S., Colborn, D. K., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2000; 105 (5): 1119-1130

  Abstract

  As part of a prospective study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between children's cumulative duration of middle ear effusion (MEE) in their first 3 years of life and their scores on measures of language, speech sound production, and cognition at 3 years of age.We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices. We intensively monitored the children's middle ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. Children who met specified minimum criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present. From among those remaining, we selected randomly, within sociodemographic strata, a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria. In subjects so selected, the estimated duration of MEE ranged from none to 65.6% of the first year of life and 44.8% of the first 3 years of life. In these 241 children we assessed language development, speech sound production, and cognition at 3 years of age, using both formal tests and conversational samples.We found weak to moderate, statistically significant negative correlations between children's cumulative durations of MEE in their first year of life or in age periods that included their first year of life, and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. However, the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2% to 2.9%, and the negative correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). We found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children's scores on measures of spontaneous expressive language, speech sound production, or other measured aspects of cognition. In contrast, by wide margins, scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children.Our findings suggest either that persistent early-life MEE actually causes later small, circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment. Findings in the randomized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.language, speech, cognition, development, otitis media, middle ear effusion.

  View details for Web of Science ID 000086902600033

  View details for PubMedID 10790473

• Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder PEDIATRICS Homer, C. J., Baltz, R. D., Hickson, G. B., Miles, P. V., Newman, T. B., Shook, J. E., Zurhellen, W. M., Lowe, B. A., Schwalenstocker, E., Goldberg, M. J., Shiffman, R., Berger, J. E., France, F. L., Perrin, J. M., Stein, M. T., Amler, R. W., Blondis, T. A., Feldman, H. M., Meyer, B. P., Shaywitz, B. A., Wolraich, M. L., DeSpirito, A., Homer, C. J., Pierce, K., Ganiats, T. G., Grabert, B., Brown, R. T., Comm Quality Improvement Subcomm 2000; 105 (5): 1158-1170

  Abstract

  This clinical practice guideline provides recommendations for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD). This guideline, the first of 2 sets of guidelines to provide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD. The Committee on Quality Improvement of the American Academy of Pediatrics selected a committee composed of pediatricians and other experts in the fields of neurology, psychology, child psychiatry, development, and education, as well as experts from epidemiology and pediatric practice. In addition, this panel consists of experts in education and family practice. The panel worked with Technical Resources International, Washington, DC, under the auspices of the Agency for Healthcare Research and Quality, to develop the evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for evaluation of the child with ADHD. Major issues contained within the guideline address child and family assessment; school assessment, including the use of various rating scales; and conditions seen frequently among children with ADHD. Information is also included on the use of current diagnostic coding strategies. The deliberations of the committee were informed by a systematic review of evidence about prevalence, coexisting conditions, and diagnostic tests. Committee decisions were made by consensus where definitive evidence was not available. The committee report underwent review by sections of the American Academy of Pediatrics and external organizations before approval by the Board of Directors. The guideline contains the following recommendations for diagnosis of ADHD: 1) in a child 6 to 12 years old who presents with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems, primary care clinicians should initiate an evaluation for ADHD; 2) the diagnosis of ADHD requires that a child meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria; 3) the assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment; 4) the assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions; 5) evaluation of the child with ADHD should include assessment for associated (coexisting) conditions; and 6) other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD but may be used for the assessment of other coexisting conditions (eg, learning disabilities and mental retardation). This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with ADHD. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decisionmaking. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.

  View details for Web of Science ID 000086902600040

  View details for PubMedID 10836893

• Measurement properties of the MacArthur Communicative Development Inventories at ages one and two years CHILD DEVELOPMENT Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Kurs-Lasky, M., Janosky, J. E., Paradise, J. L. 2000; 71 (2): 310-322

  Abstract

  In a prospective study of child development in relation to early-life otitis media, we administered the MacArthur Communicative Development Inventories (CDI) to a large (N = 2,156), sociodemographically diverse sample of 1- and 2-year-old children. As a prerequisite for interpreting the CDI scores, we studied selected measurement properties of the inventories. Scores on the CDI/Words and Gestures (CDI-WG), designed for children 8 to 16 months old, and on the CDI/Words and Sentences (CDI-WS), designed for children 16 to 30 months old, increased significantly with months of age. On several scales of both CDI-WG and CDI-WS, standard deviations approximated or exceeded mean values, reflecting wide variability in results. Statistically significant differences in mean scores were found according to race, maternal education, and health insurance status as an indirect measure of income, but the directionality of differences was not consistent across inventories or across scales of the CDI-WS. Correlations between CDI-WG and CDI-WS ranged from .18 to .39. Our findings suggest that the CDI reflects the progress of language development within the age range 10 to 27 months. However, researchers and clinicians should exercise caution in using results of the CDI to identify individual children at risk for language deficits, to compare groups of children with different sociodemographic profiles, or to evaluate the effects of interventions.

  View details for Web of Science ID 000086683800004

  View details for PubMedID 10834466

• Online measures of basic language skills in children with early focal brain lesions BRAIN AND LANGUAGE MacWhinney, B., Feldman, H., Sacco, K., Valdes-Perez, R. 2000; 71 (3): 400-431

  Abstract

  Twenty children with early focal lesions were compared with 150 age-matched control subjects on 11 online measures of the basic skills underlying language processing, a digit span task, and 6 standardized measures. Although most of the children with brain injury scored within the normal range on the majority of the tasks, they also had a disproportionately high number of outlier scores on the reaction time tests. This evidence for a moderate impairment of the basic skills underlying language processing contrasts with other evidence suggesting that these children acquire normal control of the functional use of language. Furthermore, these children scored within the normal range on a measure of general cognitive ability, suggesting that there is no particular sparing of linguistic functions at the expense of general cognitive functions. Using the MPD procedure (Valdés-Pérez & Pericliev, 1997), we found that the controls and the five clinical groups could be best distinguished with two measures of online processing (word repetition and visual number naming) and one standardized test subcomponent (the CELF Oral Directions subtest). The 12 children with left hemisphere lesions scored significantly lower than the 8 other children on the CELF-RS measure. Within the group of children with cerebral infarct, the nature of the processing disability could be linked fairly well to site of lesion. Otherwise, there was little relation between site or size of lesion and the pattern of deficit. These results support a model in which damage to the complex functional circuits subserving language leads to only minor deficits in process efficiency, because of the plasticity of developmental processes.

  View details for Web of Science ID 000085835100004

  View details for PubMedID 10716870

• The pediatrician and childhood bereavement PEDIATRICS Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 2000; 105 (2): 445-447

  View details for Web of Science ID 000085106500041

• Developmental and lesion effects in brain activation during sentence comprehension and mental rotation DEVELOPMENTAL NEUROPSYCHOLOGY Booth, J. R., MacWhinney, B., Thulborn, K. R., Sacco, K., Voyvodic, J. T., Feldman, H. M. 2000; 18 (2): 139-169

  Abstract

  The development of neurocognitive networks was examined in 2 cognitive paradigms: auditory sentence comprehension and mental rotation of alphanumeric stimuli. Patterns of brain activation were measured with whole brain echoplanar functional magnetic resonance imaging at 3 Tesla in 5 adults (20-28 years old), 7 children (9-12 years old), and 6 pediatric patients (9-12 years old) with perinatal strokes or periventricular hemorrhages. Healthy children and adults activated similar neurocognitive networks, but there were developmental differences in the distribution of activity across these networks. In the sentence task, children showed more activation in the inferior visual area suggesting an imagery strategy rather than a linguistic strategy for sentence processing. Furthermore, consistent use of a sentence comprehension strategy, whether correct or incorrect as compared to chance performance, was associated with greater activation in the inferior frontal area (Broca's) in both children and pediatric patients. In the mental rotation task, healthy adults showed more activation in the superior parietal and middle frontal areas and less activation in the supramarginal gyrus, suggesting adults were primarily engaged in visual-spatial manipulation and less engaged in the recognition of noncanonical views of stimuli. The pediatric patients showed patterns of activation consistent with organization of cognitive processing into homologous areas of the contralateral hemisphere.

  View details for Web of Science ID 000167447700001

  View details for PubMedID 11280962

• Maternal education and measures of early speech and language JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Dollaghan, C. A., Campbell, T. F., Paradise, J. L., Feldman, H. M., Janosky, J. E., Pitcairn, D. N., Kurs-Lasky, M. 1999; 42 (6): 1432-1443

  Abstract

  The present study was designed to determine whether 4 measures of children's spontaneous speech and language differed according to the educational level of the children's mothers. Spontaneous language samples from 240 three-year-old children were analyzed to determine mean length of utterance in morphemes (MLUm), number of different words (NDW), total number of words (TNW), and percentage of consonants correct (PCC). A norm-referenced, knowledge-dependent measure of language comprehension, the Peabody Picture Vocabulary Test-Revised (PPVT-R), was also included for purposes of comparison with the spontaneous measures. Three levels of maternal education were compared: less than high school graduate, high school graduate, and college graduate. Trend analyses showed statistically significant linear trends across educational levels for MLUm, NDW, TNW, and PPVT-R; the trend for PCC was not significant. The relationship of maternal education and other sociodemographic variables to measures of children's language should be examined before using such measures to identify children with language disorders.

  View details for Web of Science ID 000084182700015

  View details for PubMedID 10599625

• Parental stress and parent-rated child behavior in relation to otitis media in the first three years of life 66th Annual Meeting of the Society-for-Pediatric-Research Paradise, J. L., Feldman, H. M., Colborn, D. K., Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Janosky, J. E., Kurs-Lasky, M., Bernard, B. S., Smith, C. G. AMER ACAD PEDIATRICS. 1999: 1264–73

  Abstract

  As part of a long-term study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between parents' ratings of parent-child stress at ages 1, 2, and 3 years, and of their children's behavior problems at ages 2 and 3 years, and the children's cumulative duration of middle-ear effusion (MEE) in their first 3 years of life.We enrolled healthy infants by age 2 months who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private pediatric practices. We obtained standardized baseline measures of parental stress; we intensively monitored the children's middle-ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. We obtained parent ratings of parental stress using the Parenting Stress Index/Short Form when the children reached ages 1, 2, and 3 years, and parent ratings of children's behavior using the Child Behavior Checklist when the children reached ages 2 and 3 years.In 2278 children we found no substantial relationships between parents' ratings of parent-child stress when the children reached ages 1, 2, and 3 years, or of their children's behavior problems at ages 2 and 3 years, and the cumulative duration of the children's MEE during antecedent periods. On the other hand, ratings both of parent-child stress and of behavior problems were consistently highest among the most socioeconomically disadvantaged children and lowest among the most socioeconomically advantaged children. Ratings also tended to be highest among children whose parents' baseline stress scores were highest.Parent-child stress and children's behavior problems in the first 3 years of life, as rated by parents, bear little or no relationship to the children's previous cumulative duration of MEE.

  View details for Web of Science ID 000084069000005

  View details for PubMedID 10585976

• American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. The child in court: a subject review. Pediatrics Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 1999; 104 (5): 1145-1148

  Abstract

  When children come to court as witnesses, or when their needs are decided in a courtroom, they face unique stressors from the legal proceeding and from the social predicament that resulted in court action. Effective pediatric support and intervention requires an understanding of the situations that bring children to court and the issues that will confront children and child advocates in different court settings.

  View details for PubMedID 10545564

• Parent-reported language and communication skills at one and two years of age in relation to otitis media in the first two years of life PEDIATRICS Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Colborn, D. K., Kurs-Lasky, M., Janosky, J. E., Paradise, J. L. 1999; 104 (4)

  Abstract

  As part of a study of possible effects of early life otitis media on children's development, we attempted to determine whether levels of language and communication skills at 1 and 2 years of age are associated with the cumulative duration of middle ear effusion (MEE) in the first 2 years of life.Subjects (N = 2156) were followed at one of eight study sites in the Pittsburgh area. Middle ear status was monitored closely throughout the first 2 years of life. For each child, the cumulative percentage of days with MEE was estimated based on diagnoses at visits and interpolations for intervals between visits. For each child also, 1 or both parents completed the MacArthur Communicative Development Inventory-Words and Gestures (CDI-WG) when the child was 1 year of age and the MacArthur Communicative Development Inventory-Words and Sentences (CDI-WS) when the child was 2 years of age.Unadjusted correlations between scores on the CDI-WG and percentage of days with MEE in the first year of life were close to zero, and there were no statistically significant negative correlations. Unadjusted correlations between scores on the CDI-WS and the cumulative percentage of days with MEE in year 2 and in years 1 and 2 combined were generally negative and statistically significant, but the magnitudes of those correlations were no higher than 0.09. After adjustment for sociodemographic variables, only the Vocabulary Production Scale of the CDI-WS remained correlated significantly with the percentage of days with MEE, and the percentage of days with MEE accounted for only a negligible percentage of the variance in scores on this scale.In this diverse sample of children, parent-reported levels of language skills at 1 and 2 years of age were correlated negligibly with the cumulative percentage of days with MEE in the children's first and second years of life. otitis media, otitis media with effusion, language, communication.

  View details for Web of Science ID 000082907300028

  View details for PubMedID 10506277

• Efficacy of methylphenidate among preschool children with developmental disabilities and ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Feldman, H. M., Lurier, A., Murray, P. J. 1999; 38 (7): 805-812

  Abstract

  This was a double-blind, placebo-controlled, crossover design study of the safety and efficacy of methylphenidate (MPH) in 11 preschool children (aged 4.0-5.11 years) with developmental disabilities and attention-deficit hyperactivity disorder (ADHD).MPH doses of 0.3 and 0.6 mg/kg per dose and a placebo were given. Drug response was evaluated via teacher-completed behavior checklists and clinic-based observations of activity level, attention, and compliance to adult requests. A side effects checklist was also completed by teachers and parents.Significant improvement on teacher ratings of hyperactivity and inattention as well as clinic-based observations of activity level and compliance were associated with MPH. Eight of 11 preschool children were medication responders (based on a minimum 40% decrease between placebo and one drug condition on either the teacher-rated Conners Hyperactivity Index or the Hyperactive-Distractible subscale of the Preschool Behavior Questionnaire). Five children exhibited significant adverse drug side effects such as severe social withdrawal, increased crying, and irritability, especially at the higher dose (0.6 mg/kg).Results suggest that preschool children with developmental disabilities and ADHD respond to MPH at rates similar to those of school-age children with mental retardation and ADHD. However, this population appears to be especially susceptible to adverse drug side effects.

  View details for Web of Science ID 000081223400009

  View details for PubMedID 10405497

• A fork in the road: Decision time for behavioral pediatrics JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Kelleher, K. J., Scholle, S. H., Feldman, H. I., Nace, D. 1999; 20 (3): 181-186

  Abstract

  The rapid growth of managed care, and especially that of managed behavioral healthcare organizations (MBHOs), is likely to diminish the role of developmental-behavioral pediatrics and separate care for medical and behavioral problems. Thus, a rethinking of the practice of developmental-behavioral pediatrics is required. This study reviews the structure of MBHOs, identifies barriers to the provision of services by developmental-behavioral pediatricians, describes alternative practice models for consideration, and makes recommendations. The aims of the recommendations are to stimulate an active discussion about these issues, spark an advocacy effort, and ensure the continued participation of developmental-behavioral pediatricians in the care of children with special needs. The study concludes that managed care will push developmental-behavioral pediatricians into integration with primary care group practices or into specialty mental health networks. Immediate discussion, action, and advocacy will be required to ensure a presence in these decisions for developmental-behavioral pediatricians.

  View details for Web of Science ID 000080929700008

  View details for PubMedID 10393076

• Naltrexone and communication skills in young children with autism JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Feldman, H. M., Kolmen, B. K., Gonzaga, A. M. 1999; 38 (5): 587-593

  Abstract

  To evaluate the effect of naltrexone on communication skills of young children with autism.Twenty-four children with autism, 3.0 to 8.3 years old (mean 5.1) who were living at home and attending appropriate school programs, participated in a randomized, double-blind, placebo-controlled, crossover trial. Naltrexone, 1.0 mg/kg, or placebo was administered daily for 2 weeks. Communication was evaluated from videotaped samples of seminaturalistic parent-child interaction. Child and parent language were assessed using similar measures.In this heterogeneous sample, the median number of words the child produced on placebo was 9.5 (range 0-124). The median proportion of utterances with echolalia was 0.16. No differences were found between the naltrexone and placebo conditions in any of the measures of children or parents' communication. Significant correlations were found between the child's number of words and developmental quotient (Spearman rho = 0.58, p = .003) and between the child's and parent's number of words (rho = 0.55, p = .005).Previous studies showed that naltrexone was associated with modest reduction in hyperactivity and restlessness in this group of children with autism. In this short-term study, the medication did not lead to improvement in communication, a core deficit of autism.

  View details for Web of Science ID 000079956100021

  View details for PubMedID 10230191

• Functional organization of activation patterns in children: Whole brain fMRI imaging during three different cognitive tasks PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY Booth, J. R., MacWhinney, B., Thulborn, K. R., Sacco, K., Voyvodic, J., Feldman, H. M. 1999; 23 (4): 669-682

  Abstract

  1. Patterns of brain activation were measured with whole brain echo-planar functional magnetic resonance imaging (fMRI) at 3.0 Tesla in healthy children (N = 6) and in one child with a left-hemisphere encephalomalacic lesion as sequellae from early stroke. 2. Three cognitive tasks were used: auditory sentence comprehension, verb generation to line drawings, and mental rotation of alphanumeric stimuli. 3. There was evidence for significant bilateral activation in all three cognitive tasks for the healthy children. Their patterns of activation were consistent with previous functional imaging studies with adults. 4. The child with a left-hemisphere stroke showed evidence of homologous organization in the non-damaged hemisphere.

  View details for Web of Science ID 000080564500011

  View details for PubMedID 10390725

• Physician-family partnerships: The adaptive practice model JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Ploof, D., Cohen, W. I. 1999; 20 (2): 111-116

  Abstract

  In the traditional medical model, the physician, acting in the best interests of the patient, assumes full responsibility for delivering information, making decisions about treatment, and providing care. This model is not suitable for chronic care or preventive health maintenance. Recent alternatives to this model include participatory decision-making and family-centered care, clinical approaches in which the patient and family share the responsibility for decision-making with the physician. Research has demonstrated that patients and families vary in their willingness to make decisions about care. The Adaptive Practice model describes how compassionate and effective medical practice ranges from traditional hierarchical relationships to full patient or family control, depending on the situation. Four different clinical approaches--directing, teaching, collaborating, and supporting--result from variations in the direction of leadership and in the degree of interaction in the situation. Each approach is suitable for specific situations. For example, directing is appropriate in emergencies or crises. Supporting is appropriate when families are both knowledgeable and motivated to make decisions that affect their quality of life. Sensitive physicians assess the situation, negotiate an approach suitable to the family's and patient's needs at the time, and adjust their approach as the partnership evolves. The Adaptive Practice model provides a structure for analyzing clinical situations, choosing clinical approaches, and understanding problems in physician-family relationships when they arise.

  View details for Web of Science ID 000079667500007

  View details for PubMedID 10219690

• How pediatricians can respond to the psychosocial implications of disasters. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, 1998-1999. Pediatrics Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 1999; 103 (2): 521-523

  Abstract

  Natural and human-caused disasters, violence with weapons, and terrorist acts have touched directly the lives of thousands of families with children in the United States.1 Media coverage of disasters has brought images of floods, hurricanes, and airplane crashes into the living rooms of most American families, with limited censorship for vulnerable young children. Therefore, children may be exposed to disastrous events in ways that previous generations never or rarely experienced. Pediatricians should serve as important resources to the community in preparing for disasters, as well as acting in its behalf during and after such events.

  View details for PubMedID 9925857

• A playroom observation procedure to assess children with mental retardation and ADHD JOURNAL OF ABNORMAL CHILD PSYCHOLOGY Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1998; 26 (4): 269-277

  Abstract

  Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.

  View details for Web of Science ID 000075117800004

  View details for PubMedID 9700519

• Naltrexone in children with autism JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Buitelaar, J. K., Willemsen-Swinkels, S., Van Engeland, H. 1998; 37 (8): 800-801

  View details for DOI 10.1097/00004583-199808000-00006

  View details for Web of Science ID 000074988800006

  View details for PubMedID 9695440

• Naltrexone in children with autism - Dr. Kolmen et al. reply JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Kolmen, B. K., Felman, H. M., Handen, B. L., Janosky, J. E. 1998; 37 (8): 801-802

  View details for DOI 10.1097/00004583-199808000-00007

  View details for Web of Science ID 000074988800007

• Guidance for effective discipline PEDIATRICS Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Richtsmeier, A. J., Tolchin, D., Tolmas, H. C. 1998; 101 (4): 723-728

  View details for Web of Science ID 000072843200047

• Guidance for effective discipline. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics [Anonymous] 1998; 101 (4 Pt 1): 723-8

  Abstract

  When advising families about discipline strategies, pediatricians should use a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Corporal punishment is of limited effectiveness and has potentially deleterious side effects. The American Academy of Pediatrics recommends that parents be encouraged and assisted in the development of methods other than spanking for managing undesired behavior.

  View details for PubMedID 9521967

• Teaching pediatric residents about early intervention and special education JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Nalven, L. M., Hofkosh, D., Feldman, H., Kelleher, K. 1997; 18 (6): 371-376

  Abstract

  We compared two educational interventions (didactic lecture with handouts vs guidelines placed in patient charts) and assessed their impact on knowledge of early developmental services and identification of children eligible for these services. Forty-nine pediatric residents participated in preintervention and postintervention tests of knowledge of such services. Mean scores for all residents were 54% (pre-test) and 60% (post-test). First-year residents scored significantly lower than 2nd- and 3rd-year residents on pre- (p = .0001) and post-tests (p < .02). From our convenience sample of 1204 patients, ages newborn to 6 years, seen in the resident continuity clinic during the study period, residents identified children eligible for early developmental services. The mean percentage of identifying eligible children was 13% (range, 0-40%). We did not detect a statistically significant impact of either educational strategy. We conclude, therefore, that more comprehensive strategies are needed to change physician knowledge of and behavior toward early developmental services.

  View details for Web of Science ID 000071027400001

  View details for PubMedID 9431498

• Naltrexone in young autistic children: Replication study and learning measures JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Kolmen, B. K., Feldman, H. M., Handen, B. L., Janosky, J. E. 1997; 36 (11): 1570-1578

  Abstract

  This study expanded upon previous work on naltrexone efficacy and safety in young autistic children and assessed performance on learning measures.Eleven children with autistic disorder, aged 3.0 to 8.3 years, were studied in home, school, and outpatient laboratory, bringing to 24 the combined study sample. Naltrexone, 1.0 mg/kg, was given daily in a randomized, double-blind, crossover design. Dependent measures were parent and teacher Clinical Global Impressions (CGI) and Naltrexone Side Effects Rating Scale (SE), Conners Parent Impulsivity/Hyperactivity Factor, Teacher Hyperactivity Factor, laboratory CGI, and analysis of videotaped behavior. Learning measures were the Early Intervention Developmental Profile-Language and paired-associate learning.Comparisons between naltrexone and baseline, but not naltrexone and placebo, on parent and teacher ratings showed statistical significance. Three of 11 subjects improved in two or more settings. Side effects were mild. Administering naltrexone was a challenge. The combined study sample showed improvement on all parent measures and on Teacher CGI and SE-Restlessness compared with baseline and placebo. Eleven of the 24 children improved in two or more settings. Scores on learning measures did not change across conditions.Naltrexone was associated with modest improvement of behavior in 11 of 24 children, but learning did not improve.

  View details for Web of Science ID A1997YC34000020

  View details for PubMedID 9394942

• How the brain learns language 23rd Forum of the Linguistic-Association-of-Canada-and-the-United-States (LACUS) MacWhinney, B., Feldman, H. LINGUISTIC ASSOCIATION CANADA & UNITED STATES. 1997: 29–55

  View details for Web of Science ID A1997BJ24J00002

• The prenatal visit PEDIATRICS Stein, M. T., Aceves, J., Feldman, H. M., Hagan, J. F., Perrin, E. C., Richtsmeier, A. J., Tolchin, D., Tolmas, H. C. 1996; 97 (1): 141-142

  View details for Web of Science ID A1996TQ42400029

• Word production at age 2 years in relation to otitis media during the first two years of life 6th International Symposium on Recent Advances in Otitis Media Feldman, H. M., Paradise, J. L., Colborn, D. K., Bernard, B. S., Smith, C. G., POURBOGHRAT, K. S., Janosky, J. E., Kurs-Lasky, M. B C DECKER INC (CANADA). 1996: 328–328

  View details for Web of Science ID 000071026900138

• Ratings of behavior problems at age 2 in relation to otitis media during the first 2 years of life 6th International Symposium on Recent Advances in Otitis Media Paradise, J. L., Feldman, H. M., Bernard, B. S., Colborn, D. K., Smith, C. G., POURBOGHRAT, K. S., Janosky, J. E., Heller, C. M. B C DECKER INC (CANADA). 1996: 406–406

  View details for Web of Science ID 000071026900166

• Parent-child stress in relation to otitis media during the first two years of life 6th International Symposium on Recent Advances in Otitis Media Paradise, J. L., Feldman, H. M., Colborn, D. K., Bernard, B. S., Smith, C. G., Purboghrat, K. S., Janosky, J. E., Kurs-Lasky, M. B C DECKER INC (CANADA). 1996: 407–407

  View details for Web of Science ID 000071026900167

• METHYLPHENIDATE IN CHILDREN WITH MENTAL-RETARDATION AND ADHD - EFFECTS ON INDEPENDENT PLAY AND ACADEMIC FUNCTIONING JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1995; 7 (2): 91-103

  View details for Web of Science ID A1995RC96700002

• NALTREXONE IN YOUNG AUTISTIC-CHILDREN - A DOUBLE-BLIND, PLACEBO-CONTROLLED CROSSOVER STUDY JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Kolmen, B. K., Feldman, H. M., Handen, B. L., Janosky, J. E. 1995; 34 (2): 223-231

  Abstract

  This study evaluated the efficacy and safety of naltrexone, an opiate blocker, in the treatment of autism.Thirteen children with autistic disorder, aged 3.4 to 8.3 years (mean 5.4), were studied in home, school, and outpatient laboratory. Naltrexone, 1.0 mg/kg, was given daily in a randomized, double-blind, placebo-controlled crossover design. Dependent measures included parent and teacher Clinical Global Impressions (CGI), Conners Rating Scales, and Naltrexone Side-Effects (SE) Rating Scale; laboratory CGI, movement actometer readings, and a 10-second interval recording system analysis of on-task, communication initiations, disruptive behavior, and self-stimulation.Eight of 13 subjects improved in two or more settings. Changes in parent measures (CGI, Conners Impulsivity-Hyperactivity Factor, and SE-Restlessness) and Teacher CGI achieved statistical significance. Teacher SE-Restlessness and initiation of communication in the clinic showed a trend toward improvement. Actometer readings improved in two children who were very active at baseline. Adverse side effects were behavioral, mild, and transient. Administering the bitter tablet was a challenge.Naltrexone offers promise as an agent for modest improvement of behavior and social communication in young children with autism. Parent and teacher measures can be useful in outpatient trials to evaluate change.

  View details for Web of Science ID A1995QD09100018

  View details for PubMedID 7896655

• PARENT AND PROFESSIONAL PERCEPTIONS ABOUT STRESS AND COPING STRATEGIES DURING A CHILDS LENGTHY HOSPITALIZATION SOCIAL WORK IN HEALTH CARE Horn, J. D., Feldman, H. M., PLOOF, D. L. 1995; 21 (1): 107-127

  Abstract

  The two goals of this study were (1) to describe the stressors and coping strategies of families whose children with chronic illness require lengthy hospitalizations and (2) to compare family reports of stress and coping strategies to professionals perceptions of the same. A non-randomized sample of 13 families (13 mothers and 5 fathers) whose child with chronic illness was hospitalized for a minimum of 30 days and 11 professionals who worked with such children were interviewed in a semi-structured survey using open-ended questions. Key phrases from family interviews were organized into categories of family-reported stressors and coping strategies. Key phrases from professional interviews were categorized into family stressors and descriptions of challenging families. Families and professionals reported that personal emotions and communication problems were the most predominant stressors.

  View details for Web of Science ID A1995TA84400009

  View details for PubMedID 8553187

• PREDICTION OF RESPONSE TO METHYLPHENIDATE AMONG CHILDREN WITH ADHD AND MENTAL-RETARDATION JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Janosky, J., McAuliffe, S., BREAUX, A. M., Feldman, H. 1994; 33 (8): 1185-1193

  Abstract

  The primary purpose of this study was to predict stimulant medication response among children with attention-deficit hyperactivity disorder (ADHD) and mental retardation (MR).Forty-seven children with ADHD and MR (IQs of 48 to 77) served as subjects; ages ranged from 6.1 to 12.5 years. Subjects participated in a double-blind, placebo-controlled study of two doses of methylphenidate (0.3 and 0.6 mg/kg per dose) and a placebo. Data were collected in each child's weekday classroom and a Saturday laboratory classroom. Stepwise multiple regression analyses were used to predict drug responses in both settings.Higher parent ratings of impulsivity and activity level at baseline were associated with greater gains in weekday classroom dependent measures. Similarly, higher weekday teacher measures of activity level, impulsivity, inattention, and conduct problems at baseline were related to improvement on Saturday laboratory classroom dependent measures. Finally, gender, race, and socioeconomic status (SES) were found to be important predictors, with males, Caucasian subjects, and subjects from families of higher SES more likely to evidence clinical gains on a number of variables than other subjects.These results were generally consistent with research conducted among children with ADHD but without MR. However, factors such as race and conduct problems appear to have predictive utility specific to children with MR.

  View details for Web of Science ID A1994PH20300016

  View details for PubMedID 7982869

• LANGUAGE ABILITIES FOLLOWING PREMATURITY, PERIVENTRICULAR BRAIN INJURY, AND CEREBRAL-PALSY JOURNAL OF COMMUNICATION DISORDERS Feldman, H. M., Janosky, J. E., Scher, M. S., Wareham, N. L. 1994; 27 (2): 71-90

  Abstract

  This study compares language abilities in three groups of children who were born prematurely: children with bilateral spastic cerebral palsy associated with perinatal injury to the periventricular white matter of the brain; a group with similar brain injury but no motor impairment; and a group of controls with no brain injuries. Six boys in each group were 36 to 39 months of age at the time of the study. All achieved a standard score above 80 on the McCarthy Scales of Children's Abilities at the same age. Language samples, generated during parent-child interaction, were analyzed using the Child Language Data Exchange System. The size and diversity of the lexicon was assessed using types and tokens per minute. Morpho-syntactic skills were assessed using number of grammatical morphemes, mean length of utterance and the Index of Productive Syntax. Verbal productivity was assessed using number of utterances per minute. No significant differences were observed among any of the groups on any measure. Measures of the lexicon and morpho-syntactic skills were highly correlated with the scores on the McCarthy Scales of Children's Abilities. The data demonstrated that specific language impairments were not associated with cerebral palsy or brain injury after prematurity at this early stage of language development. However, individual children within each of the groups had delays in skill attainment that warranted language intervention.

  View details for Web of Science ID A1994QB62300003

  View details for PubMedID 7929881

• CLASSROOM-BEHAVIOR AND CHILDREN WITH MENTAL-RETARDATION - COMPARISON OF CHILDREN WITH AND WITHOUT ADHD JOURNAL OF ABNORMAL CHILD PSYCHOLOGY Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1994; 22 (3): 267-280

  Abstract

  Thirty-four children (ages 6-12 years) with moderate to borderline mental retardation were studied in a laboratory classroom setting to determine whether children identified as having attention deficit hyperactivity disorder on the basis of Conners Questionnaires differed in classroom behavior. Half of the children scored 15 or greater on both the Parent and Teacher Conners; the remaining children scored 11 or less. All were participants in a Saturday Education Program serving children with mental retardation. Direct observation of the laboratory classroom documented significant differences between groups on measures of on-task behavior and fidgetiness, especially during situations where little direct teacher feedback or supervision was available. Saturday Education Program staff, while blind as to group designation, rated the two groups as differing significantly on all scales of two standardized behavior problem checklists. Checklists by parents and teachers appear to be valid measures of classroom behavior of children with moderate to borderline mental retardation.

  View details for Web of Science ID A1994NP01500001

  View details for PubMedID 8064033

• DEVELOPMENTAL-CHANGES IN NARRATIVE AND NON-NARRATIVE DISCOURSE IN CHILDREN WITH AND WITHOUT BRAIN INJURY JOURNAL OF COMMUNICATION DISORDERS Hemphill, L., Feldman, H. M., Camp, L., Griffin, T. M., MIRANDA, A. E., Wolf, D. P. 1994; 27 (2): 107-133

  Abstract

  This study presents a set of narrative and non-narrative tasks and analytic procedures for examining the discourse development of children with perinatal brain injury and typically developing children. Three oral discourse genres were collected at ages 5, 6, and 7: script, picture description, and replica play narration. Genre performances were assessed for the presence of hypothesized genre features. Results suggest these tasks and procedures are able to characterize development in discourse abilities for both a normative group and for children with perinatal brain injury. The group of children with brain injury produced shorter discourse performance with more off-task talk. This group also showed difficulty in fully differentiating the various genre types and in creating integrated discourse performances. However, most of these children demonstrated considerable growth in control of genre features over this time period. The possible utility of these tasks and procedures for clinical assessment is discussed.

  View details for Web of Science ID A1994QB62300005

  View details for PubMedID 7929876

• DEVELOPMENTAL NEEDS OF INFANTS AND TODDLERS WHO REQUIRE LENGTHY HOSPITALIZATION AMERICAN JOURNAL OF DISEASES OF CHILDREN Feldman, H. M., PLOOF, D. L., Hofkosh, D., GOEHRING, E. L. 1993; 147 (2): 211-215

  Abstract

  To describe demographic and medical characteristics of a sample of children younger than age 3 years who required lengthy hospitalization in a tertiary care hospital. To determine the proportion of children in the sample with biologic handicaps, developmental delays, or risk factors for developmental disorders who met eligibility criteria for early intervention services based on federal law PL 99-457 and state regulations.Survey of medical records.Large, urban, tertiary care children's hospital.All 135 children younger than age 3 years hospitalized for more than 30 days during 1990 and 1991.None.The most prevalent cause of lengthy hospitalization was congenital anomaly followed by chronic and perinatal conditions; 38 patients (28%) required technology assistance at the time of discharge. Seventy-three children (54%) were eligible for early intervention services based on the presence of a biologic handicap or developmental delay. An additional 48 patients (36%) were eligible for developmental screening and periodic developmental monitoring on the basis of medical and social risk factors.Because of the high prevalence of developmental disorders and risk factors in infants and toddlers requiring lengthy hospitalizations, hospital-wide systems for identification, developmental assessment, and early intervention services should be designed and implemented.

  View details for Web of Science ID A1993KL36300031

  View details for PubMedID 7678952

• SECRETORY OTITIS-MEDIA - WHAT EFFECTS ON CHILDRENS DEVELOPMENT - A NEW STUDY 2ND INTERNATIONAL CONF OF THE EUROPEAN WORKING GROUP FOR PEDIATRIC OTORHINOLARYNGOLOGY ON THE CHILD AND THE ENVIRONMENT Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Nozza, R. J., Rockette, H. E., Janosky, J. E., Bluestone, C. D., Smith, C. G., Bernard, B. S., Colborn, D. K. ELSEVIER SCIENCE PUBL B V. 1993: 22–29

  View details for Web of Science ID A1993BY85C00004

• EARLY LANGUAGE AND COMMUNICATIVE ABILITIES OF CHILDREN WITH PERIVENTRICULAR LEUKOMALACIA AMERICAN JOURNAL ON MENTAL RETARDATION Feldman, H. M., Evans, J. L., BROWN, R. E., Wareham, N. L. 1992; 97 (2): 222-234

  Abstract

  Ten 2-year-old children with periventricular leukomalacia (PVL), a brain injury associated with prematurity, were evaluated using language samples. Five children scored less than 80 on cognitive testing (delayed). Five children with this disorder and normal cognitive scores were assessed at two ages, matched with the delayed group on CA and developmental level. The delayed group produced significantly fewer lexical tokens and spontaneous verbal utterances than did the CA-matched group. No significant differences were observed between the delayed group and either comparison group on other measures of lexicon, grammar, or communication. The data demonstrate a relation between cognitive abilities and measures of verbal productivity in children with PVL.

  View details for Web of Science ID A1992JM66100009

  View details for PubMedID 1384568

• THERE CAR - UNGRAMMATICAL PARENTESE JOURNAL OF CHILD LANGUAGE Chafetz, J., Feldman, H. M., Wareham, N. L. 1992; 19 (2): 473-480

  Abstract

  This study of parents with their children demonstrates irregular and unpredictable grammatical features in their child-directed speech. The parents were observed quarterly in parent-child interaction with their oldest child beginning when she was two-years old, and with their younger twin daughters beginning when they reached two years. Language samples were transcribed and analyzed using CHILDES. The parents used grammatical speech with adults. A high proportion (8% to 32% per session) of their utterances to the children contained non-dialectal errors, primarily omissions of closed-class items. A typical example was 'she a puppet'. The evidence suggests these parents were trying to teach their children language. Their implicit theories of language and learning led to a highly unusual variant of parentese.

  View details for Web of Science ID A1992JB24900012

  View details for PubMedID 1527212

• EFFECTS AND NONEFFECTS OF METHYLPHENIDATE IN CHILDREN WITH MENTAL-RETARDATION AND ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., BREAUX, A. M., Janosky, J., McAuliffe, S., Feldman, H., Gosling, A. 1992; 31 (3): 455-461

  Abstract

  Stimulant medication efficacy was evaluated in 14 children with attention-deficit hyperactivity disorder and IQs of 48 to 74 in a double-blind crossover study of two methylphenidate doses and placebo. Dependent measures included behavioral ratings, work output, measures of learning, attention and impulsivity, and direct observation of peer social interactions. Nine children (64%) were methylphenidate-responders, based upon the Conners Hyperactivity Index. Significant gains in on-task behavior and attentional skills were noted with methylphenidate in comparison to placebo. No improvement on measures of learning or social interactions were observed. Results extend and replicate previous research conducted by the authors.

  View details for Web of Science ID A1992HT11000012

  View details for PubMedID 1592777

• A FLUENT LANGUAGE DISORDER FOLLOWING ANTEPARTUM LEFT-HEMISPHERE BRAIN INJURY JOURNAL OF COMMUNICATION DISORDERS Feldman, H. M., Holland, A. L., BROWN, R. E. 1992; 25 (2-3): 125-142

  Abstract

  This article describes the development of language in a left-handed girl with a left middle cerebral artery infarction. Seven language samples of parent-child interaction, obtained when she was between 36 and 60 months of age, were transcribed and analyzed using the Child Language Data Exchange System. At 36 months of age, only 42 (20%) of the child's 214 utterances contained words; the other 80% were composed of jargon or interactional markers such as "uh-huh" and "uhn-uhn." Jargon incorporated familiar intonational contours and prosodic features to convey emotional states and communicative functions. Between 36 and 45 months of age, her jargon became differentiated into increasing approximations of English sentences. Simultaneously, her use of words and word combinations increased. By 54 months of age, no jargon was heard. The pattern of development observed in this child can be described as a transient jargon or fluent aphasia. It may have resulted from initial reliance on an uninjured right hemisphere. However, given the similarity between this pattern and the expressive or gestalt style of learning seen in some normal children, the pattern may also be related to other variables including characteristics of the parental input.

  View details for Web of Science ID A1992KE88400003

  View details for PubMedID 1487564

• MENTAL-RETARDATION AND ADHD PEDIATRICS VOIGT, R. G., JOHNSON, G. H., BROWN, F. R. 1992; 89 (2): 351

  View details for Web of Science ID A1992HD25500039

  View details for PubMedID 1734411

• LANGUAGE-DEVELOPMENT AFTER UNILATERAL BRAIN INJURY BRAIN AND LANGUAGE Feldman, H. M., Holland, A. L., KEMP, S. S., Janosky, J. E. 1992; 42 (1): 89-102

  Abstract

  This longitudinal study describes the growth of syntactic abilities and vocabulary size in nine children with unilateral antepartum or perinatal brain injury. Five children with left hemisphere damage (LHD) and four with right hemisphere damage (RHD), ages 15 to 48 months, were evaluated on three or more occasions. Language samples generated from parent-child interaction were transcribed, coded, and analyzed using the Child Language Data Exchange System. Individual growth trajectories were constructed by graphing three dependent variables--MLU, scores on the Index of Productive Syntax (IPSYN), and number of different words--as a function of the child's age. One subject remained in a prelinguistic stage throughout the study. Simple linear functions best described the growth of MLU, IPSYN scores, and vocabulary in the other eight children. The slopes of the individual growth trajectories, the graphic representations of rates of progress, were comparable in the eight children. Seven children showed developmental delays in initial word use and five in the onset of multiword utterances. However, by age 24 months, four children with LHD and two children with RHD had syntactic capabilities comparable to those of children without brain injuries. The developmental patterns suggested that both cerebral hemispheres may play critical roles in the very earliest stages of language acquisition. Some unilateral lesions caused little discernible effect on language outcome in the toddler-preschool years after the initial developmental delays.

  View details for Web of Science ID A1992HB88400006

  View details for PubMedID 1547471

• Organizing early intervention services in a hospital setting: The developmental support project as a parallel organization Infants and Young Children Ploof D, Feldman HM 1992; 5 (1): 28-39
• 10 YEARS OF EXTRACORPOREAL MEMBRANE-OXYGENATION - NEURODEVELOPMENTAL OUTCOME PEDIATRICS Hofkosh, D., Thompson, A. E., Nozza, R. J., KEMP, S. S., Bowen, A., Feldman, H. M. 1991; 87 (4): 549-555

  Abstract

  Cf the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores greater than or equal to 85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores less than 70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 +/- 12 [SD], IQ controls = 107 +/- 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 +/- 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 +/- 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

  View details for Web of Science ID A1991FF72700019

  View details for PubMedID 1707157

• ADVERSE SIDE-EFFECTS OF METHYLPHENIDATE AMONG MENTALLY-RETARDED CHILDREN WITH ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Feldman, H., Gosling, A., BREAUX, A. M., McAuliffe, S. 1991; 30 (2): 241-245

  Abstract

  The adverse side effects of methylphenidate were evaluated in 27 children with attention deficit hyperactivity disorder and IQs of 48 to 74 who participated in a double-blind study of two doses of methylphenidate and placebo. A checklist of 13 side effects, generated from the Physician's Desk Reference, was completed by teachers. Rates of irritability, anxiety, moodiness, and activity level decreased significantly when comparing the placebo with drug conditions. However, medication for six (22%) of the children was discontinued because of the appearance of motor tics (three children) and severe social withdrawal (two children), suggesting that mentally retarded children with attention deficit hyperactivity disorder may be at a greater risk for developing these side effects than the nonretarded population.

  View details for Web of Science ID A1991FB92100012

  View details for PubMedID 2016228

• NEURODEVELOPMENTAL OUTCOME OF CHILDREN WITH EVIDENCE OF PERIVENTRICULAR LEUKOMALACIA ON LATE MRI PEDIATRIC NEUROLOGY Feldman, H. M., Scher, M. S., KEMP, S. S. 1990; 6 (5): 296-302

  Abstract

  Fifteen children, 8 months of age or older, from a neonatal follow-up program underwent magnetic resonance imaging and neurologic, cognitive, and language evaluations. Magnetic resonance imaging findings in all children included increased white matter signal on T2-weighted images and ventricular enlargement adjacent to regions of abnormal white matter. The extent of degree of abnormal white matter signal and the degree of sulcal prominence were variable. Twelve children had cerebral palsy; 5 children, 4 of whom had cerebral palsy, manifested significant sensory impairments. The median score on cognitive testing was 89; only 2 children exhibited severe-to-profound cognitive disability. Cognitive scores were stable on retesting. The degree of motor disability was correlated with the extent of white matter signal abnormality; however, cognitive outcome was not related to the extent and degree of white matter signal abnormality or to the degree of sulcal prominence. Despite the association of a major handicapping condition and periventricular leukomalacia, cognitive and language functioning may be relatively spared.

  View details for Web of Science ID A1990EC12400002

  View details for PubMedID 2242170

• METHYLPHENIDATE IN CHILDREN WITH SEIZURES AND ATTENTION-DEFICIT DISORDER AMERICAN JOURNAL OF DISEASES OF CHILDREN Feldman, H., Crumrine, P., Handen, B. L., Alvin, R., TEODORI, J. 1989; 143 (9): 1081-1086

  Abstract

  This study assessed the safety and efficacy of methylphenidate in children with seizures and attention-deficit disorder. Ten children, aged 6 years 10 months to 10 years 10 months, without seizures while receiving a single antiepileptic drug, were evaluated in a double-blind medication-placebo crossover study with methylphenidate hydrochloride was administered at 0.3 mg/kg per dose and given at 8 AM and 12 PM on school days only. The use of methylphenidate was associated with statistically significant improvements on the Conners' Teacher Rating Scale and on the Finger Tapping Task and with trends toward improvement on the Matching Familiar Figures Test and Discriminant Reaction Time tests. No child had seizures during the study period nor subsequently for those who continued receiving psychostimulants. There were no significant changes of epileptiform features or back-ground activity on electroencephalograms and no alterations in antiepileptic drug levels. Methylphenidate may be a safe and effective treatment for certain children with seizures and concurrent attention-deficit disorder.

  View details for Web of Science ID A1989AN66100028

  View details for PubMedID 2672786

• LEXICAL LEARNING AND LANGUAGE ABILITIES IN PRESCHOOLERS WITH PERINATAL BRAIN-DAMAGE JOURNAL OF SPEECH AND HEARING DISORDERS Keefe, K. A., Feldman, H. M., Holland, A. L. 1989; 54 (3): 395-402

  Abstract

  Studies of children with early-acquired brain damage have noted limitations on language development following such damage and have raised questions regarding the process by which these children acquire language skills. The purpose of this study was to examine the effects of perinatally acquired brain damage on early language abilities and on lexical development through the use of standard assessments, language samples, and a miniature linguistic system approach to teach a novel lexicon. Four children, ages 26-41 months, with localized, perinatal brain lesions documented on ultrasound or CT scan were selected for this study and were compared to 4 matched controls. The results show no differences in the pattern of scores and learning in children with right and left brain damage. With the exception of phonological development, subjects scored below controls on all formal language measures; however, the subjects often scored at or above test norms. Brain-injured subjects were similar to controls with respect to the number of novel words that they initially learned on comprehension and production tasks and the number that they consistently comprehended. Brain-injured subjects generally acquired fewer words when the criterion was consistent accurate production. Interestingly, subjects required more exposures to novel lexical items than did controls before reaching a given level of proficiency. Production seemed to be more difficult for all children, but more so for the brain-injured subjects. It appears that the effects of early damage have an impact on many aspects of language development and that these apparent deficits may reflect the child's need for greater exposure to language skills and structures before acquiring them.

  View details for Web of Science ID A1989AK22300010

  View details for PubMedID 2755102

• LANGUAGE ABILITIES AFTER LEFT-HEMISPHERE BRAIN INJURY - A CASE-STUDY OF TWINS TOPICS IN EARLY CHILDHOOD SPECIAL EDUCATION Feldman, H., Holland, A., Keefe, K. 1989; 9 (1): 32-47

  View details for Web of Science ID A1989U273400005

• Language abilities after left hemisphere brain injury: A case study of twins Topics in Special Education Feldman HM, Keefe, KA, Holland AL 1989; 9 (1): 32-47
• ACADEMIC-ACHIEVEMENT IN CHILDREN 10 TO 12 YEARS AFTER HEMOPHILUS-INFLUENZAE MENINGITIS PEDIATRICS Feldman, H. M., Michaels, R. H. 1988; 81 (3): 339-344

  Abstract

  Academic achievement by 23 children 10 to 12 years after treatment of Haemophilus influenzae meningitis was assessed using individually administered standardized tests, review of school transcripts, and parent and teacher questionnaires. The children's performance was compared with (1) their own performance in a previous study 6 to 8 years after the illness; (2) the performance of 23 similarly aged siblings in the previous study, a comparison which served to age match subjects and sibling controls; and (3) the performance of 11 of those similarly aged siblings retested in the current study. Subjects scored in the average range on all measures. Scores were comparable to results 4 years previous in four of six academic measures, with minor deterioration in reading single words and decoding nonsense words. There were no differences between subjects in the current study and control subjects from the previous study, except in decoding nonsense words, and no differences between subjects and control subjects in the current study, except in paragraph reading accuracy. Scholastic grade point averages and scores on parent and teacher behavior problem-rating scales showed no group differences. Subjects used more school-based remedial services, although the trend did not achieve statistical significance. Parents reported spending more time with subjects than with control subjects helping with homework. These findings suggest that children who have recovered from meningitis due to H influenzae can maintain scores and grades comparable to their siblings as they progress to middle school. Their academic success may involve more school and family support to compensate for the mild differences in intelligence quotient and neuropsychologic testing found in the previous study.

  View details for Web of Science ID A1988M438800002

  View details for PubMedID 3344177

• ESTIMATING PERSONAL PERFORMANCE - A PROBLEM FOR CHILDREN WITH SCHOOL DYSFUNCTION JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H., Levine, M. D., Fenton, T. 1986; 7 (5): 281-287

  Abstract

  Children with school dysfunction typically do limited planning and fail to use potentially beneficial mediational strategies on cognitive tasks. This study tested the hypothesis that these children are poor at assessing their own performance capabilities, a deficit which might contribute to this passive learning style. Thirty children, 9-12 years old, attending a multidisciplinary clinic in a pediatric setting for school underachievement, and 30 age, grade, and socioeconomic status (SES)-matched controls were asked to predict their performance in four domains of function before they were given the opportunity to perform the tasks. Clinic subjects overestimated their performance to a greater degree than controls in two domains. This performance resembles the performance of younger children on related tasks and may be amenable to therapeutic or educational intervention.

  View details for Web of Science ID A1986E376200001

  View details for PubMedID 3771802

• Scrutinizing mental health and me. Journal of psychiatric nursing and mental health services Ryan, J. B. 1978; 16 (11): 32-35

  View details for PubMedID 213568

• HUMAN ERYTHROCYTE TRANSGLUTAMINASE PURIFICATION AND PROPERTIES BIOCHIMICA ET BIOPHYSICA ACTA Brenner, S. C., WOLD, F. 1978; 522 (1): 74-83

  View details for Web of Science ID A1978EJ17200008

  View details for PubMedID 23166

• The development of language like communication without a language models Science Goldin Meadow S, Feldman HM 1977; 197 (4301): 401-403
• The creation of a communication system: A study of deaf children of hearing parents Sign Language Studies Goldin Meadow S, Feldman HM 1975; 8: 225-234