The case for screening for diabetes distress, depression, and anxiety

Our goal was to determine the prevalence of anxiety and depression in a sample of U.S. military veterans with type 2 diabetes and elevated diabetes distress (DD). Cross-sectional analyses were conducted. The association between DD and anxiety and depression was assessed with logistic regression. Almost 80% of persons with elevated DD had clinically significant anxiety or depression symptoms. The odds of depression and anxiety increased with DD severity. Given the large overlap of depression and anxiety with elevated DD, we recommend providers screen for all three conditions and, if positive, connect to resources for diabetes self-management and/or clinical treatment.

Early communication development in infants and toddlers with Fragile X syndrome

BACKGROUND AND AIMS

Individuals with fragile X syndrome (FXS) characteristically struggle with language and communication throughout the life course, but there is limited research on the development of communication before 24 months. The purpose of this study is to describe the early communication of infants and toddlers with FXS using the Communication and Symbolic Behavior Scales-Caregiver Questionnaire (CSBS-CQ), a standardized communication screening measure, as compared to the reported normative data of the CSBS-CQ and identify the percentage of infants and toddlers who scored within the range of concern. Documenting how children with FXS perform on screening measures can provide a quick snapshot of skills to help clinicians determine the need for services.

METHODS

Participants were 22 infants and toddlers with FXS between 6 and 29 months. Performance on the CSBS-CQ was compared to the measure's normative data. The CSBS-CQ was completed by mothers, and children were administered the Mullen Scales of Early Learning. Because co-occurring autism is common in FXS, the presence of autism was determined using a clinical best estimate procedure.

RESULTS

Overall and within the domains and subdomains of the CSBS-CQ, infants and toddlers with FXS had significantly lower scores than the normative data. Further, 68.2% of our sample was in the range of concern for their overall communication score. The presence of autism led to consistently lower scores, and more infants and toddlers with FXS + autism scored within the range of concern.

CONCLUSIONS

Our findings suggest that delays in early communication are evident in comparison to typically developing norms before 24 months. These findings also emphasize that infants and toddlers with FXS would likely benefit from early language intervention given that 68.2% of our sample was in the range of concern for their overall communication score.

IMPLICATIONS

Early identification and developmental monitoring of children with FXS will help to determine concerns in communication and other domains of development. While early communication broadly may not be an early indicator of autism in FXS, some specific skills, such as eye gaze, may serve as such an indicator. Screening measures, like the CSBS-CQ, may help monitor both early communication impairments and autism symptoms. Infants and toddlers with FXS, regardless of autism status, will benefit from early language interventions.

Psychometric properties of the parent's versions of the SDQ and the PANAS-X in a community sample of Portuguese parents

This study examined the psychometric properties of the parent's versions of the Strengths and Difficulties Questionnaire (SDQ) and the Positive and Negative Affect Schedule-Extended Form (PANAS-X) in a community sample of Portuguese parents. A total of 1100 SDQ and PANAS-X were collected from an online sample of 761 parents, whose ages ranged from 23 to 65 years (M = 42, SD = 5). Confirmatory factor analyses provided evidence of the internal factor structure of both the SDQ and the PANAS-X and invariance of the factor structure across age and gender groups, with the exception of the SDQ, which failed to provide evidence of invariance between genders. Internal reliability and discriminant validity were confirmed for both measures, although convergent validity was only confirmed for the PANAS-X. Concurrent validity was also confirmed by comparing the results from the SDQ dimensions and the PANAS-X broad dimensions subscales.

ASD symptoms in toddlers and preschoolers: An examination of sex differences

Although considerable work has documented higher prevalence rates of autism spectrum disorder (ASD) in boys, fewer studies have focused on sex differences within samples of young children at-risk for ASD. This study examined sex differences in ASD symptom domains and ASD screening outcomes among toddlers (18-35 months) and preschoolers (36-72 months) with ASD-related concerns. Participants included 480 children between 18 and 72 months evaluated by university-based ASD specialty clinics. Results revealed significant sex differences in severity of social communication (SC) deficits across age groups. Within the toddler group, girls diagnosed with ASD displayed greater SC deficits according to standardized observation and clinician severity ratings. Within the preschool group, girls diagnosed with ASD were rated by parents as having more severe SC deficits, but these differences were not corroborated by standardized observations or clinician ratings. No sex differences emerged for severity of restricted repetitive behaviors (RRBs) for either age group. Across the entire referred sample, boys and girls did not differ in terms of scores on commonly used screening instruments. Importantly, results suggest that two of the most commonly used ASD screeners (i.e., Modified-Checklist for Autism in Toddlers-Revised with Follow-up and Social Communication Questionnaire ) may underidentify RRBs in toddler and preschool-aged girls as screening scores were only influenced by severity of SC deficits. Greater SC deficits in young girls with ASD along with its impact on screening status suggests greater attention be placed on the under-identification of ASD in girls as well as current screening measures' ability to tap into the topography of ASD symptoms across genders. Autism Res 2020, 13: 157-166. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we found that young girls diagnosed with autism spectrum disorder tend to have greater social communication deficits than young boys and that these differences vary by age. Specifically, toddler-aged girls receive higher clinician ratings of social communication deficits when compared to boys, while preschool-aged girls receive higher parent ratings of social communication deficits. For girls, current screening tools seem to be more highly influenced by severity of social communication deficits than by restricted repetitive behaviors.

Assessing the sensitivity and specificity of cognitive screening measures for people with Parkinson's disease

INTRODUCTION

While cognitive impairment is a recognised feature of Parkinson's disease (PD), few studies have evaluated the validity of brief cognitive screening measures compared to a comprehensive neuropsychological assessment. This studies aim was to evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE), Modified Mini-Mental State Examination and Dementia Rating Scale (DRS-2) to detect cognitive impairment in individuals with PD.

METHOD

Fifty-eight participants were administered the MMSE, 3MS, DRS-2 and a neuropsychological battery. ROC analyses were conducted to assess their effectiveness in classifying cognitive impairment.

RESULTS

None of the three measures demonstrated good sensitivity or specificity to detect single domain cognitive impairment. For detecting impairment on two or more cognitive domains, the MMSE and DRS-2 yielded excellent sensitivity (88%) and specificity (78% and 76% respectively), at cut-off scores of 28 and 136 respectively. The 3MS demonstrated excellent sensitivity (88%) and good specificity (60%) at cut off score of 94.

CONCLUSION

The MMSE and DRS-2 have excellent discriminant ability to classify multi-domain cognitive impairment in PD, however, their ability to detect more focal cognitive impairment is limited. Given that focal domain may be an indicator that could be useful in early detection of cognitive impairment for people with PD, this finding has implication for the use of these measures as screening tools in clinical practice.

A review of telephone-administered screening tests for dementia diagnosis

Dementia screening measures serve an important role in epidemiological research, clinical trials, identifying patients for more comprehensive assessment, and monitoring progression. Telephone-administered measures allow increased flexibility. Although there are several extant telephone-administered measures that offer the promise of efficient detection of cognitive impairment, research evidence supporting their use is limited. We review telephone-based cognitive screening instruments for detecting dementia or mild cognitive impairment, critically review the evidence for their validity, and make recommendations for future research directions. Most measures reviewed do a good job of classifying patients as likely to have dementia or likely to be neurologically healthy. However, with sensitivity values ranging from 38% to 100% and specificity values ranging from 79% to 100%, there is considerable variability in the measures available. Future validation studies should reflect the populations most likely to benefit from a telephone-based measure, namely community-dwelling elderly who have not yet been identified as being cognitively impaired.