Assessing progress during treatment for young children with autism receiving intensive behavioural interventions

This study examined progress after 1 year of treatment for children with autism who received a mean of 36 hours per week one-to-one University of California at Los Angeles Applied Behavior Analysis (UCLA ABA) treatment.

Two types of service provision were compared: an intensive clinic based treatment model with all treatment personnel (N = 23), and an intensive parent managed treatment model with intensive supervision only (N = 21).

A non-concurrent multiple baseline design across participants (N = 13) examined whether progress was associated with ABA treatment or confounders. Between intake and follow-up, children in both groups improved significantly on IQ, visual-spatial IQ, language comprehension, expressive language, social skills, motor skills and adaptive behaviour. There were no significant differences between the two groups on any of the measures at follow-up.

Mean IQ for participants in both groups increased by 16 points between intake and follow-up. These findings are consistent with previous studies demonstrating the benefits of ABA treatment.

Diane Hayward K Young Autism Project, UK

Svein Eikeseth Akershus University College, Norway,

Catherine Gale UK Young Autism Project, UK

Sally Morgan UK Young Autism Project, UK

Models linking nutritional deficiencies to maternal and child mental health

The primary goal of this article was to illustrate how nutritional deficiencies can translate into adult or child mental health problems. Whereas brain development and function play an essential role in the etiology and maintenance of mental health problems, what is required are models that go beyond nutrition-brain relations and integrate the contributions of nutritionally related contextual and behavioral characteristics. Four such models are presented.

The multiple risks model derives from evidence showing covariance between nutritional deficiencies and other life stressors. Given that poorly nourished adults may be less able to actively cope with stressors, nutritional deficiencies may accentuate the negative impact of stress exposure on mental health. The cross-generational model is based on evidence showing less adequate patterns of mother-child interactions when mothers are poorly nourished. Impairments in mother-child interactions increase the likelihood of child mental health problems and the risk of subsequent child nutritional deficiencies.

The attachment model derives from evidence showing that poorly nourished infants may be less likely to elicit the types of maternal child-rearing patterns that translate into secure infant-mother attachments. Insecure attachments in infancy are associated with an increased risk of both short-term and long-term child mental health problems. The temperament model is based on evidence documenting that certain patterns of infant temperament are related to an increased risk of later behavioral problems. Infant nutritional deficiencies can influence the development of temperament, and certain temperament patterns can contribute to an increased risk of infant nutritional deficiencies.

Theodore D Wachs1,2,3
1 From Purdue University, Department of Psychological Sciences, Purdue University, West Lafayette, IN.

2 Presented at the symposium "Maternal and Child Mental Health: Role of Nutrition," held at Experimental Biology 2008, San Diego, CA, 8 April 2008.

3 Reprints not available. Address correspondence to TD Wachs, Department of Psychological Sciences, Purdue University, West Lafayette, IN

Literacy and Child Health

Arch Pediatr Adolesc Med. 2009;163(2):131-140

Objectives: To assess the prevalence of low health literacy among adolescents, young adults, and child caregivers in the United States, the readability of common child-health information, and the relationship between literacy and child health.

Data Sources: MedLine, Educational Resources Information Center, National Library of Medicine, PsychInfo, Harvard Health Literacy Bibliography, and peer-reviewed abstracts from the Pediatric Academic Societies Annual Meetings.

Study Selection : A systematic review using the following key words: health literacy, literacy, reading skill, numeracy, and Wide Range Achievement Test.

Main Outcome Measures: Descriptive studies that used at least 1 valid measure of health literacy, studies that assessed the readability of child health information, and observational or experimental studies that included a validated measure of health literacy, literacy, or numeracy skills and an assessment of child health–related outcomes.

Results: A total of 1267 articles were reviewed, and 215 met inclusion and exclusion criteria. At least 1 in 3 adolescents and young adults had low health literacy; most child health information was written above the tenth-grade level. Adjusted for socioeconomic status, adults with low literacy are 1.2 to 4 times more likely to exhibit negative health behaviors that affect child health, adolescents with low literacy are at least twice as likely to exhibit aggressive or antisocial behavior, and chronically ill children who have caregivers with low literacy are twice as likely to use more health services.

Conclusions: Low caregiver literacy is common and is associated with poor preventive care behaviors and poor child health outcomes. Future research should aim to ameliorate literacy-associated child health disparities

Cognitive-behavioral family treatment for childhood obsessive-compulsive disorder: a 7-year follow-up study

J Anxiety Disord. 2009 Oct;23(7):973-8. Epub 2009 Jun 26

This study evaluated the long-term durability of individual and group cognitive-behavioral family-based therapy (CBFT) for childhood obsessive-compulsive disorder (OCD). Thirty-eight participants (age 13-24 years) from a randomized controlled trial of individual or group CBFT for childhood OCD were assessed 7 years post-treatment.

Diagnostic, symptom severity interviews and self-report measures of OCD, anxiety, and depression were administered. Seven years after treatment, 79% of participants from individual therapy and 95% from group therapy had no diagnosis of OCD. These results are near identical to results found at 12 and 18 months follow-ups of the same sample.

No significant differences were found between treatment conditions, self-reports of symptom severity, except that depressive symptoms were significantly more pronounced for individual treatment condition, and those in the older age group (19-24 years of age). Results suggest that -behavioral family-based therapy for obsessive-compulsive disorder is effective 7 years post-treatment

Pathways Health and Research Centre, PO Box 5699, West End, Brisbane, QLD, 4101, Australia

Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy

Maternal intake of omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) during pregnancy has decreased, possibly contributing to a current increased risk of childhood allergy.

Aim: To describe the effects of maternal omega-3 long-chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy.

Methods: One hundred and forty-five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo-controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25(th) gestational week to average 3-4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed.

Results: The period prevalence of food allergy was lower in the omega-3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE-associated eczema (omega-3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05).

Conclusion: Maternal omega-3 fatty acid supplementation may decrease the risk of food allergy and IgE-associated eczema during the first year of life in infants with a family history of allergic disease>

Furuhjelm C, Warstedt K, Larsson J, Fredriksson M, Böttcher MF, Fälth-Magnusson K, Duchén K.
Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden

Risk of Childhood Asthma in Relation to the Timing of Early Child Care Exposures.

OBJECTIVE: To examine whether early child care exposure influences the risk for development of asthma. STUDY DESIGN: Longitudinal data from 939 children and their families from the National Institute of Child Health and Development Study of Early Child Care and Youth Development were analyzed. Exposure to other children in the primary child care setting as an infant (before 15 months) and as a toddler (16-36 months) were assessed as risk factors for persistent or late-onset asthma by age 15 via logistic regression.

RESULTS: The number of children in the child-care environment when the child was a toddler was significantly associated with odds of asthma, even after adjusting for respiratory illnesses and other risk factors (P < .05). The fewer the children exposed to as toddlers, the higher the probability of persistent or late-onset asthma by age 15. C

ONCLUSIONS: This study supports the theory of a protective effect of exposure to other children at an early age, especially as a toddler, on the risk of asthma. This effect appears to be independent of the number of reported respiratory tract illnesses, suggesting that other protective mechanisms related to the number of children in the child care environment may be involved

Department of Public Health Sciences (M.G.) and the Department of Pediatrics (M.G., J.B., P.H.), University of Virginia School of Medicine, Charlottesville, VA

Maternal occupational exposure to extremely low frequency magnetic fields and the risk of brain cancer in the offspring

OBJECTIVES: To examine the contribution of maternal occupational exposure to extremely low frequency magnetic fields (ELF-MF) shortly before and during pregnancy on the incidence of childhood brain tumors.

METHODS: A total of 548 incident cases and 760 healthy controls recruited between 1980 and 2002 from two Canadian provinces (Québec and Ontario) were included in this study, and their mothers were interviewed. Quantitative occupational ELF-MF exposure in microTesla units was estimated using individual exposure estimations or a job exposure matrix. We used three metrics to analyze exposure: cumulative, average, and maximum level attained.

RESULTS: Using the average exposure metric measured before conception, an increased risk was observed for astroglial tumors (OR = 1.5, 95% CI = 1.0-2.4). During the entire pregnancy period, a significantly increased risk was observed for astroglial tumors as well as for all childhood brain tumors with the average metric (OR = 1.6, 95% CI = 1.1-2.5 and OR = 1.5, 95% CI = 1.1-2.2, respectively). Based on job titles, a twofold risk increase was observed for astroglial tumors (OR = 2.3, 95% CI = 0.8-6.3) and for all childhood brain tumors (OR = 2.3, 95% CI = 1.0-5.4) among sewing machine operators.

CONCLUSIONS: Results are suggestive of a possible association between maternal occupational ELF-MF exposure and certain brain tumors in their offspring

The brain regulation mechanism of error monitoring in impulsive children with ADHD--an analysis of error related potentials

The objective of this study was to investigate the brain mechanism involved in the regulation of impulsivity in children with Attention Deficit and Hyperactivity Disorder (ADHD) through error detection as well as error monitoring. The subjects in this study included 7-11-year-old impulsive ADHD children as well as normal children and adult controls. Error related negativity (ERN) and error positivity (Pe) were measured. ERN peak latency from the children groups was delayed significantly when compared with the adult group; however, no significant difference in ERN amplitude was found among the three groups. Impulsive ADHD children had the earliest peak latency of Pe. In addition, the average Pe amplitude in impulsive children was significantly smaller than in adults (Cz and Pz), and smaller than in normal children (Pz). Late conscious cognitive processing of error is significantly weaker in impulsive ADHD children, suggesting a serious deficit of late error monitoring, rather than error detection.

Zhang JS, Wang Y, Cai RG, Yan CH.
Department of Child and Adolescent Healthcare, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Children's Environmental Health, Kongjiang Road 1665, Shanghai 200092

Study finds vaccination records are not an accurate predictor of protection

CLEVELAND – May 5, 2009 – A study by the division of global child health at Case Western Reserve University School of Medicine cautions adoptive parents not to rely solely on vaccination records when gauging their internationally adopted children's immunizations. In the study, "Predictive Value of Immunization Records and Risk Factors for Immunization Failure in Internationally Adopted Children," division chief, Anna Maria Mandalakas, M.D., M.S., and her colleagues examined immunization records in international adoptees and found that the records may not accurately predict if a child is protected from disease – even with what appears to be a valid written immunization record, a child may lack immunization.

In the study of 465 children with valid records, the researchers looked at the predictive value of immunization records in children from China, Russia, and Guatemala and identified those whose records might fail, that is, those records which would not accurately reflect the immunities present in the children's body. Multiple factors may lead to the inaccuracies: falsification of vaccine certificates, inaccurate entries, lack of vaccine potency, and impaired immune response, which could be linked to stress or malnutrition. They also examined whether a child's birth country had an impact on the records' accuracy. This was found to not be an effective measure of protection.

Serologic testing, a type of blood test that identifies antibodies, was conducted on the children in the study and the results found that the immunization levels did not consistently match those of their written records. The tests for diphtheria, pertussis (whooping cough), tetanus, polio, measles, and hepatitis B immunity rates ranged from 58.3 percent to 94.6 percent. The results indicated written records overestimate a child's protective immunity.

"Based on our findings, I recommend prospective parents try to obtain a vaccination record prior to the child's arrival in the U.S. to help guide US based evaluation of their child's immunization status," says Dr. Mandalakas, associate professor of pediatrics, epidemiology and biostatics at the Case Western Reserve University School of Medicine.

Underimmunization is a major topic of concern for the parents of the more than 247,000 children adopted into the United States in the last 15 years. Currently, some guidelines suggest that if a record appears to be valid, the pediatrician can assume it is valid. This study found that this assumption is often incorrect.

The study concludes the responsibility of ensuring a child's immunization status falls on the shoulders of the adoptive parents to take their child to a pediatrician or an adoption health specialist to determine an appropriate plan for that child. Testing provides a clear understanding of which vaccines were given and those a child is lacking.

"International vaccination records for adoptive children should not be accepted as evidence of a child's immunity," say Dr. Mandalakas. "I recommend parents work closely with their physicians to chart a revaccination plan for their child based on the findings of antibody testing. Failure to properly immunize children puts them at risk when these diseases are reintroduced into the community."

Sleep quality, duration and behavioral symptoms among 5-6-year-old children.

Child and Adolescent Mental Health, National Institute for Health and Welfare, P.O. Box 30, Lintulahdenkuja 4, 00271, Helsinki, Finland,

The objective of the present study was to examine whether parent-reported short sleep duration and sleeping difficulties are related to behavioral symptoms among pre-school aged children. The study is a cross-sectional survey of 297 families with 5-6-year-old children. The Sleep Disturbance Scale for children was used to measure sleep duration and sleeping difficulties, and the Child Behavior Checklist and Teacher's Report Form were used to measure attention problems, and internalizing and externalizing symptoms. In multivariate logistic regression models, short sleep duration was according to parental reports related to inattention (adjusted odds ratio 4.70, 95% CI 1.58-14.00), internalizing (adjusted odds ratio 3.84, 95% CI 1.32-11.21), and total psychiatric symptoms (adjusted odds ratio 3.53, 95% CI 1.23-10.17) while according to teacher's reports it was almost significantly related to internalizing symptoms (adjusted odds ratio 4.20, 95% CI 0.86-20.51). Sleeping difficulties were strongly related to all subtypes of psychiatric symptoms according to parental reports (adjusted odds ratios ranging from 6.47 to 11.71) and to externalizing symptoms according to teachers' reports (adjusted odds ratio 7.35, 95% CI 1.69-32.08). Both short sleep duration and sleeping difficulties are associated with children's behavioral symptoms. Intervention studies are needed to study whether children's behavioral symptoms can be reduced by lengthening sleep duration or improving sleep quality.