'Developmental Delay' Reconsidered: The Critical Role of Age-Dependent, Co-variant Development

Machine learning analysis with population data for prepregnancy and perinatal risk factors for the neurodevelopmental delay of offspring

Neurodevelopmental disorders (NDD) in offspring are associated with a complex combination of pre-and postnatal factors. This study uses machine learning and population data to evaluate the association between prepregnancy or perinatal risk factors and the NDD of offspring. Population-based retrospective cohort data were obtained from Korea National Health Insurance Service claims data for 209,424 singleton offspring and their mothers who gave birth for the first time in 2007. The dependent variables were motor development disorder (MDD), cognitive development disorder (CDD) and combined overall neurodevelopmental disorder (NDD) from offspring. Seventeen independent variables from 2002 to 2007 were included. Random forest variable importance and Shapley Additive Explanation (SHAP) values were calculated to analyze the directions of its associations with the predictors. The random forest with oversampling registered much higher areas under the receiver-operating-characteristic curves than the logistic regression of interaction and non-linearity terms, 79% versus 50% (MDD), 82% versus 52% (CDD) and 74% versus 50% (NDD). Based on random forest variable importance, low socioeconomic status and age at birth were highly ranked. In SHAP values, there was a positive association between NDD and pre- or perinatal outcomes, especially, fetal male sex with growth restriction associated the development of NDD in offspring.

Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial

Importance

Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD.

Objective

To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD.

Design, Setting, and Participants

A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories.

Interventions

Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU).

Main Outcomes and Measures

Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups.

Results

The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).

Conclusions and Relevance

Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families.

Trial Registration

ClinicalTrials.gov Identifier: NCT03260816.

Integrating cultural considerations and developmental screening into an Australian First Nations child health check

The aim of the present study was to integrate cultural considerations and developmental screening into a First Nations child health check. The 'Share and Care Check,' an optimised child health check, was co-designed with a remote Aboriginal Community Controlled Health Organisation and led by Aboriginal Health Practitioners/Workers. Of 55 families who completed the Share and Care Check, the majority of participants indicated that their family/child was connected with their tribe and country. However, half of the caregivers reported that they or their child would like to know more about their tribe. The most common developmental screening outcome was no functional concerns (32.7%), followed by having one area identified as a functional concern (24.5%) and two functional concerns (16.3%). All caregivers reported that the Share and Care Check was culturally appropriate, and the majority also reported that it was helpful. Data obtained from questions regarding cultural and developmental aspects of health can assist health providers regarding the best pathway of support for a child and their family. This could ultimately contribute to closing the gap through the provision of holistic culturally appropriate services.

A systematic review and meta-analysis of early childhood intervention programs for developmental difficulties in low-and-middle-income countries

Early acknowledgment of developmental difficulties in young children strengthens both preventive and therapeutic approaches. Despite their feasibility, early intervention services are limited in Low-and-Middle-Income (LAMI) countries compared to high income countries. The aim of this study was to examine the evidence for early childhood intervention programs for developmental difficulties in children below five years in LAMI countries through a systematic review and meta-analysis. In this background, original studies published in peer-reviewed journals from 2010 to 2019 with a focus on developmental difficulties including delays and deviances; randomized research design with a clear description of the intervention and measurable outcomes, and conducted in LAMI countries were considered for the systematic review. Electronic databases, including ProQuest, PubMed, Ovid, EBSCOhost, and Google Scholar, were searched using a combination of specific keywords. PRISMA guidelines were followed to include the studies. Each of the selected study was assessed for quality before applying appropriate statistics to synthesize the data. Fourteen publications were identified from 2697 publications for the systematic review, out of which four were found compatible for a meta-analysis. The studies reviewed were conducted in Bangladesh, India, Pakistan, Uganda, Vietnam, and Zambia. A meta-analysis of four studies provided considerable evidence for the effects of early developmental intervention. This systematic review provides an evidence for early childhood intervention programs in LAMI countries. Implications of these findings for the early childhood programs are discussed in this article.

Educational status, testosterone replacement, and intelligence outcomes in Klinefelter syndrome

Most male hypergonadotropic hypogonadism associated with infertility can be attributed to a single genetic condition such as Klinefelter syndrome (KS). This disease's wide phenotypic variability is frequently associated with mosaic 47,XXY lineages and testosterone replacement. Early diagnosis and treatment have been associated with better cognitive and intellectual outcomes, but the scope of this influence requires further investigation.

Objective

This study aimed to investigate the intelligence profile of a cohort of patients with KS, considering the influence of educational level and clinical variables.

Methods

Twenty-nine (9-65 years) individuals were submitted to the measures of intelligence quotient (IQ) (Wechsler's Scales) and adaptive behavior (Vineland-II). Linear regression analysis included the participants' educational level and clinical variables (i.e., comorbidities and use of testosterone) as predictors and intellectual performance and adaptive behavior as outcomes.

Results

Scores varied from intellectual deficiency to average ranges (82.5+15.8). There were significant differences between adult's and children's IQ and between verbal and nonverbal indexes. The level of education predicted both IQ and adaptive behavior. Testosterone replacement therapy and absence of seizures predicted only adaptive behavior.

Conclusions

The level of education and hormonal therapy can be selectively implicated in the intellectual variability in KS.

Disability in Childhood, Special Education Histories, and Lifetime Health Outcomes in the United States

Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p < .05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives.

Early parenting intervention accelerates inhibitory control development among CPS-involved children in middle childhood: A randomized clinical trial

Children at risk for neglect or abuse are vulnerable to delays in inhibitory control development. Prior findings suggest that early parenting interventions that target parental sensitivity and responsiveness during infancy can improve executive function outcomes of high-risk children during preschool years; however, little is known about how persistent these gains are through middle childhood. Participants included 76 CPS-involved children who were randomly assigned to either the ABC intervention (N = 32) or the Developmental Education for Families (DEF) control intervention (N = 44), and 53 low-risk children. Children completed the Stop Signal Reaction Time (SSRT) paradigm at ages 8 and 10. Intervention group predicted performance on the SSRT at age 8 such that children who received the ABC intervention and children in the low-risk group performed significantly better than children who received the DEF intervention (ABC vs. DEF: Cohen's d = 0.92; low-risk group vs. DEF: d = 0.56). The performances of the ABC and the low-risk groups were not statistically different. There were no significant group differences in SSRT performance at age 10. These findings demonstrate that the ABC intervention has long-term beneficial effects on inhibitory control development in children with a history of early caregiving adversity. A video abstract of this article can be viewed at https://youtu.be/P9oLyfo7pYA.

Differential Diagnosis in Children with Autistic Symptoms and Subthreshold ADOS Total Score: An Observational Study

BACKGROUND

Children with autism spectrum disorder (ASD) share some symptoms with children with other neurodevelopmental disorders (ie, intellectual disability or communication disorders or language disorders). These similarities can make difficult to obtain an accurate diagnosis, which is essential to give targeted treatments to the patients. We aim to verify in our study if children with autistic traits who undergo to Autism Diagnostic Observation Schedule had specific clinical diagnosis.

PATIENTS AND METHODS

We selected 73 children tested with ADOS-G or ADOS-2, for the presence of autistic symptoms. The whole sample did not reach the cut-off of ADOS and did not receive the ASD diagnosis, according to DSM-5.

RESULTS

Results of this study showed that in order of frequency and early diagnosis, communication disorders (CD), mild intellectual disability (mID) and the attention deficit hyperactivity disorders (ADHD) represent the most common final clinical diagnosis in children with autistic traits.

CONCLUSION

Our results showed as the CD was the common diagnosis of these children and that often associated with younger age. Moreover, analyses of ADOS domains and the difference of individual items between groups did not show the capacity to differentiate between different neurodevelopmental disorders in terms of differential diagnosis, and this confirms the need for integrating multiple sources of information during the diagnostic process.

Prospective growth and developmental outcomes in infants born to mothers with multiple sclerosis

BACKGROUND

The importance of supporting pregnancy-related decisions in multiple sclerosis (MS) patients has increasingly been recognized and hence the need for prospective data on pregnancy and pediatric outcomes in this patient population.

OBJECTIVE

To assess prospective growth and developmental outcomes of infants born to mothers with multiple sclerosis (IMS).

METHODS

PREG-MS is a prospective multicenter cohort study in New England, United States. We followed 65 women with MS and their infants with up to 12 months consistent pediatric follow-up. Pediatric, neurologic, and demographic information was obtained via structured telephone interviews and validated with medical records.

RESULTS

No differences in infant weights and lengths with World Health Organization (WHO) 50th percentile standards were observed (p > 0.05). However, larger head circumference (HC) measurements than WHO standards were reported in cohort infants (p < 0.05). There was no association between HC and markers of maternal MS activity, demographic, or social factors. No irreversible pediatric developmental abnormalities were observed.

CONCLUSION

This first prospective study on pediatric anthropometry in IMS suggests a possible increase in HC compared to WHO standards without an increase in irreversible developmental abnormalities. The observations are exploratory and require confirmation with larger prospective studies in diverse groups of MS patients.

Neonatal EEG linked to individual differences in socioemotional outcomes and autism risk in toddlers

Research using electroencephalography (EEG) as a measure of brain function and maturation has demonstrated links between cortical activity and cognitive processes during infancy and early childhood. The current study examines whether neonatal EEG is correlated with later atypical socioemotional behaviors or neurocognitive delays. Parental report developmental assessments were administered to families with children ages 24 to 36 months who had previously participated in a neonatal EEG study (N = 129). Significant associations were found between neonatal EEG (higher frequencies in the frontal polar, temporal, and parietal brain regions) and BITSEA ASD risk scores. Infants with lower EEG power in these brain areas were more likely to have higher risk of socioemotional problems. When examining sex differences, significant links were found for males but not for females. These results demonstrate some promising associations between early neural biomarkers and later risk for atypical behaviors, which may shape early neurobehavioral development and could lead to earlier identification and intervention.