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Yao TJ, Malee K, Zhang J, Smith R, Redmond S, Rice ML, Frederick T, Torre P, Mellins CA, Hoffman HJ, Williams PL. In Utero Antiretroviral Exposure and Risk of Neurodevelopmental Problems in HIV-Exposed Uninfected 5-Year-Old Children. AIDS Patient Care STDS 2023; 37:119-130. [PMID: 36827595 PMCID: PMC10081721 DOI: 10.1089/apc.2022.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Studies have observed neurodevelopmental (ND) challenges among young children perinatally HIV-exposed yet uninfected (CHEU) with in utero antiretroviral (ARV) exposure, without clear linkage to specific ARVs. Atazanavir (ATV) boosted with ritonavir has been a preferred protease inhibitor recommended for pregnant women, yet associations of ATV with ND problems in CHEU have been reported. Studies among early school-age children are lacking. The pediatric HIV/AIDS cohort study (PHACS) surveillance monitoring for antiretroviral therapy (ART) toxicities (SMARTT) study evaluated 5-year-old monolingual English-speaking CHEU using the behavior assessment system for children, Wechsler preschool and primary scales of intelligence, and test of language development-primary. A score ≥1.5 standard deviations worse than population norms defined a signal within each domain. Analyses of risk for signals were stratified by timing of any ARV initiation. Associations between ARV exposure and risk of ND signals were assessed using proportional odds models, adjusting for confounders. Among 230 children exposed to ARVs at conception, 15% had single and 8% had multiple ND problems; ATV exposure was not associated with higher risk of signals [adjusted cumulative odds ratio (cOR) = 0.66, confidence interval (CI): 0.28-1.56]. However, among 461 children whose mothers initiated ARVs during pregnancy, 21% had single and 12% had multiple ND problems; ATV exposure was associated with higher risk of signals (cOR = 1.70, CI: 0.82-3.54). The specific regimen tenofovir/emtricitabine/ATV was associated with higher risk (cOR = 2.31, CI: 1.08-4.97) relative to regimens using a zidovudine/lamivudine backbone combined with non-ATV ARVs. It remains important to monitor neurodevelopment of CHEU during early childhood and investigate the impact and the role of timing of in utero exposure to specific ARVs.
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Affiliation(s)
- Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Kathleen Malee
- Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Joel Zhang
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Renee Smith
- Department of Pediatrics, University of Illinois at Chicago Children's Hospital, Chicago, Illinois, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Sean Redmond
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Mabel L. Rice
- Child Language Doctoral Program, Department of Speech, Language and Hearing, University of Kansas, Lawrence, Kansas, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Toni Frederick
- Maternal, Child and Adolescent Program for Infectious Diseases and Virology, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Peter Torre
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, California, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Claude A. Mellins
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services
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Stromberg MH, Rubtsova A, Sales J, McGee R. Impact of Developmental Disability on Frequent School Absenteeism in US Children Aged 6 to 17 Years: National Survey of Children's Health, 2016 to 2017. THE JOURNAL OF SCHOOL HEALTH 2022; 92:681-691. [PMID: 35365877 DOI: 10.1111/josh.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/26/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Mary Harbert Stromberg
- Rollins School of Public Health, Emory University, 817 S Cooper Street Memphis, TN, 38104, USA
| | - Anna Rubtsova
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Atlanta, GA, 30322, USA
| | - Jessica Sales
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Atlanta, GA, 30322, USA
| | - Robin McGee
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Atlanta, GA, 30322, USA
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Ogundele MO, Morton M. Classification, prevalence and integrated care for neurodevelopmental and child mental health disorders: A brief overview for paediatricians. World J Clin Pediatr 2022; 11:120-135. [PMID: 35433298 PMCID: PMC8985496 DOI: 10.5409/wjcp.v11.i2.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/29/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
‘Neurodevelopmental disorders’ comprise a group of congenital or acquired long-term conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations, including autism spectrum disorder, attention deficit/ hyperactivity disorder, tic disorder/ Tourette’s syndrome, developmental language disorders and intellectual disability. Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability. Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm. Together these are referred to as neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBIDs) in this paper. Varying prevalence rates for NDEBID have been reported in developed countries, up to 15%, based on varying methodologies and definitions. NDEBIDs are commonly managed by either child health paediatricians or child/ adolescent mental health (CAMH) professionals, working within multidisciplinary teams alongside social care, education, allied healthcare practitioners and voluntary sector. Fragmented services are common problems for children and young people with multi-morbidity, and often complicated by sub-threshold diagnoses. Despite repeated reviews, limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research. The recently developed “Mental, Behavioural and Neurodevelopmental disorder” chapter of the International Classification of Diseases-11 offers a way forward. In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID, enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.
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Affiliation(s)
- Michael O Ogundele
- Department of Community Paediatrics, Bridgewater Community Healthcare NHS Foundation Trust, Runcorn WA7 1TW, Halton, United Kingdom
| | - Michael Morton
- Institute of Health & Wellbeing, University of Glasgow, Child and Adolescent Psychiatry, Yorkhill Hospital, Glasgow G3 8SJ, United Kingdom
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Midgley N, Mortimer R, Cirasola A, Batra P, Kennedy E. The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis. Front Psychol 2021; 12:662671. [PMID: 33986713 PMCID: PMC8110733 DOI: 10.3389/fpsyg.2021.662671] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022] Open
Abstract
Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers (28 distinct studies). When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers (82 distinct studies). The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations (small sample sizes, lack of control groups etc.), and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people.
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Affiliation(s)
- Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rose Mortimer
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Antonella Cirasola
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Prisha Batra
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Eilis Kennedy
- Research and Development Unit, Tavistock and Portman NHS Trust, London, United Kingdom
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Stone B, Dowling S, Cameron A. Cognitive impairment and homelessness: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e125-e142. [PMID: 30421478 PMCID: PMC6849546 DOI: 10.1111/hsc.12682] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/20/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
This paper reports the findings of a scoping review designed to identify research which has explored the relationship between cognitive impairment and homelessness. A systematic search of databases for articles published between 2007 and 2017 was conducted using keywords relating to cognitive impairments and homelessness. Sources were expanded using manual searches of citations and grey literature. Forty studies represented in 45 papers were selected for review using predefined inclusion criteria. Sources were subject to quality appraisal and data were extracted in line with review questions. Prevalence studies were over-represented in the review, while qualitative data were lacking. Aetiology of impairments was delineated by acquired and developmental causes. A variety of measures were employed by studies which were not validated in homeless populations. Studies did not give sufficient consideration to co-occurring disorders and overlapping symptoms between aetiologies. Because of these factors, it was difficult to conclude that all studies had accurately measured what they set out to; however, the evidence suggested that cognitive impairment was disproportionately over-represented in homeless populations. Cognitive impairment was found to be both a risk factor to and perpetuator of homelessness. Risk factors for homelessness were similar to those of the general population, though exaggerated by sequelae of certain cognitive impairments. The results of this review suggest that more attention needs to be paid to the underlying socioeconomic disadvantages, persons with cognitive impairments face which may lead to homelessness. Further research should prioritise the voice of homeless persons with cognitive impairments, to better understand both causes of homelessness and effective methods of rehabilitation.
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Karaca A, Konuk Şener D. Spirituality as a coping method for mothers of children with developmental disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 67:112-120. [PMID: 34141404 PMCID: PMC8115452 DOI: 10.1080/20473869.2019.1603730] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 06/12/2023]
Abstract
Mothers of children with developmental disabilities suffer from tremendous stress and anxiety. These mothers may use religion and spirituality as coping mechanisms to help them adjust to changes emerging in their lives as well as to resolve problems. This study evaluated the spiritual needs of mothers of children with developmental disabilities and analyzed the effect of spirituality on their lives. This is a descriptive and qualitative study carried out at the School for Children with Mental and Physical Disabilities in Turkey. The study group consisted of the mothers of 28 children with developmental disabilities. The results of the study revealed four main themes: 'The journey to acceptance;' 'The meaning/purpose of life;' 'Concerns about the future;' and 'Coping strategies.' The results of the study showed that mothers of children with developmental disabilities in Turkey often use spirituality as a coping method. Using spirituality, they were able to handle the stress of their new lives. They began to see their children as giving meaning/purpose to their lives and experienced enhanced feelings of love/commitment. The mothers were most concerned about the fate of their children after the parents had passed away.
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Affiliation(s)
- Aysel Karaca
- Duzce University, Faculty of Health Science, Duzce, Turkey
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Yoo A, Kim M, Ross MM, Vaughn-Lee A, Butler B, dosReis S. Engaging Caregivers in the Treatment of Youth with Complex Developmental and Mental Health Needs. J Behav Health Serv Res 2018. [DOI: 10.1007/s11414-018-9604-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Eapen V, Woolfenden S, Williams K, Jalaludin B, Dissanayake C, Axelsson EL, Murphy E, Eastwood J, Descallar J, Beasley D, Črnčec R, Short K, Silove N, Einfeld S, Prior M. "Are you available for the next 18 months?" - methods and aims of a longitudinal birth cohort study investigating a universal developmental surveillance program: the 'Watch Me Grow' study. BMC Pediatr 2014; 14:234. [PMID: 25241772 PMCID: PMC4190387 DOI: 10.1186/1471-2431-14-234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal developmental surveillance programs aimed at early identification and targeted early intervention significantly improve short- and long-term outcomes in children at risk of developmental disorders. However, a significant challenge remains in providing sufficiently rigorous research and robust evidence to inform policy and service delivery. This paper describes the methods of the 'Watch Me Grow' study that aims to maximise accurate early detection of children with developmental disorders through a partnership formed between policy makers, service providers and researchers. METHODS/DESIGN A mixed methods study design was developed consisting of: (1) a qualitative study of parents and health service providers to investigate barriers and enablers of developmental surveillance; (2) recruitment of a birth cohort and their longitudinal follow-up to 18 months of age to: a) assess risk factors for not accessing existing developmental surveillance programs and b) estimate the prevalence of children identified with developmental risk; (3) comparison of surveillance outcomes with a reference standard at 18 months of age to assess the diagnostic test accuracy of existing and alternative developmental surveillance tools; and (4) comparison of developmental surveillance models to inform policy recommendations. Data linkage will be used to determine the uptake and representativeness of the study participant group versus non-participants. DISCUSSION The Watch Me Grow study is expected to provide a collaborative opportunity to enhance universal developmental surveillance for early accurate identification of developmental risk. This will also provide quality evidence about identification of developmental risk and access to services to be embedded in existing practice with linkages to policy development.
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Affiliation(s)
- Valsamma Eapen
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Susan Woolfenden
- />Sydney Children’s Hospitals Network, Sydney, Australia
- />University of New South Wales, School of Women’s and Children’s Health, Sydney, Australia
| | - Katrina Williams
- />Department of Paediatrics, University of Melbourne, Melbourne, Australia
- />Developmental Medicine, Royal Children’s Hospital, Melbourne, Australia
- />Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bin Jalaludin
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />Centre for Research, Evidence Management and Surveillance, Sydney and South Western Sydney Local Health Districts, Sydney, Australia
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Cheryl Dissanayake
- />Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Emma L Axelsson
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - John Eastwood
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />Community Paediatrics, South Western Sydney Local Health District, Sydney, Australia
| | - Joseph Descallar
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />South Western Sydney Clinical School, South Western Sydney Local Health District, University of New South Wales, Sydney, Australia
| | | | - Rudi Črnčec
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
| | - Katherine Short
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />University of New South Wales, School of Women’s and Children’s Health, Sydney, Australia
- />Speech Pathology Unit, Liverpool Hospital, Liverpool, Australia
| | - Natalie Silove
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Sydney Children’s Hospitals Network, Sydney, Australia
- />Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Stewart Einfeld
- />Centre for Disability Research and Policy, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Margot Prior
- />School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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