Journal Of Developmental And Behavioral Pediatrics[JOURNAL]
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200 papers
How Often do Youth ask Their Providers the Questions They Checked on an Attention-Deficit Hyperactivity Disorder Question Prompt List?
Adjei AA, Carpenter DM, Thomas KC … +7 more , Sayner R, Annis IE, Tudor G, Garcia N, Leslie LK, Coyne I, Sleath B
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41649353 · Publisher ↗
OBJECTIVE: To describe the questions youth with attention-deficit hyperactivity disorder (ADHD) checked on a question prompt list and evaluate the extent to which youth asked these questions during medical visits. METHOD...
OBJECTIVE: To describe the questions youth with attention-deficit hyperactivity disorder (ADHD) checked on a question prompt list and evaluate the extent to which youth asked these questions during medical visits. METHODS: English-speaking adolescents (N = 102) aged 11 to 17 years with ADHD were enrolled from 2 pediatric primary care clinics in North Carolina; this work focuses on the 52 adolescents in the intervention group. Adolescents who received the intervention watched an educational video and completed a prompt list before visits. Medical visits were recorded, transcribed, and coded for questions asked during visits. The questions adolescents checked on the prompt list were compared with the questions they asked during visits. RESULTS: Adolescents checked an average of 5.6 questions on the prompt list. Forty percent of adolescents who checked a question asked at least 1 question they checked during visits. The most common questions adolescents checked and asked about ADHD were, "Should I reduce my screen time to help with ADHD?" (50.0%) and "Will I grow out of ADHD?" (34.4%). The most common questions adolescents checked and asked about ADHD treatment were, "Should I take my ADHD medicine before I play sports?" (33.3%), "Should I take my ADHD medicine while I am at school?" (28.6%), and "Would talking to a counselor help my ADHD?" (28.6%). CONCLUSION: Adolescents with ADHD have many questions about ADHD; however, about 60% (n = 31) did not ask any of the questions they checked on the prompt list. Future research should examine how to encourage youth who receive a question prompt list intervention to ask questions during visits.
School Readiness Promotion in Primary Care: Latino Parent Feedback on Interventions and Programs.
Peterson JW, Estrada Sanchez G, Postigo M … +6 more , Underwood Carrasco VI, Robles A, Hernandez-Zepeda V, Reyes N, Stevenson E, Zuckerman KE
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41631737 · Publisher ↗
OBJECTIVE: To explore the feasibility and acceptability of interventions to promote school readiness (SR) in primary care through qualitative analysis of "SR Design Maps" created by Latino families. METHOD: Caregivers pa...
OBJECTIVE: To explore the feasibility and acceptability of interventions to promote school readiness (SR) in primary care through qualitative analysis of "SR Design Maps" created by Latino families. METHOD: Caregivers participated in design thinking to assess benefits, barriers, and desirable characteristics of eight SR interventions to create a final SR Design Map. Qualitative analysis included a content analysis to determine the frequency of each intervention and deductive theme analysis to create a summary of key features, content, and timing preferences. Two coders completed analysis in the source language. RESULTS: Participants included 32 Latino caregivers from four Oregon clinics with primarily US born children with preschool experience. Most caregivers were monolingual Spanish or bilingual-speakers, born in Mexico, with a high school education or higher. Across 16 distinct "SR Design Maps," 100% included SR Coaching, preschool navigation, library information, and a community coordinator; most included a SR Checklist (92%), TipsByText (88%), and parent groups (81%). The most desired and feasible interventions were Coaching, preschool navigation, SR Checklist, library information, and TipsByText. A "future state" model compiles caregiver preferences from birth to age 5 years. CONCLUSION: Latino families gave detailed feedback to integrate multiple SR interventions from pregnancy to 5-year-old well-child visits. Families were most interested in an overview of SR skills (SR Checklist), tips for early math and literacy at home (SR Coaching, TipsByText), preschool information and application support, and reminders about library programs. These findings inform a culturally responsive package of interventions to promote SR in primary care.
Challenging Case: "Digital Addiction" in a Neurodivergent Adolescent.
Tariq M, Genovese A, Augustyn M
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41630379 · Publisher ↗
Adam is a 15-year-old boy who was born prematurely, with prenatal substance exposure, and was diagnosed in early childhood with combined-type attention-deficit hyperactivity disorder and oppositional defiant disorder. He...
Adam is a 15-year-old boy who was born prematurely, with prenatal substance exposure, and was diagnosed in early childhood with combined-type attention-deficit hyperactivity disorder and oppositional defiant disorder. He was not found to meet criteria for fetal alcohol spectrum disorder. Despite treatment with stimulant medications and other adjunctive medications, Adam experienced ongoing difficulties with impulse control, sleep, and aggression. Adam was introduced to digital devices at an early age, resulting in unfiltered, poorly supervised, and prolonged screen exposure.Over time, Adam's digital use escalated into late-night gaming and engaging with social media platforms. Attempts by parents and other caregivers to apply parental controls were inconsistent because of family instability and ongoing caregiver substance use. Exposure to disturbing online content (including violence and conspiracy narratives) disrupted Adam's sleep and resulted in increased emotional lability, often triggering nightmares and severe irritability.The school also implemented restrictions on electronic device use (including phones and laptops). Related disciplinary consequences contributed to social stress and peer conflict. In addition, the patient disclosed a history of childhood sexual trauma, which occurred during unsupervised online interactions, further deepening his reliance on digital environments as a coping mechanism. Subsequent identification and treatment of posttraumatic stress disorder helped to alleviate some of the associated distressing emotional symptoms for Adam but did not alter his compulsive use of digital technology.Finally, when consistent efforts were made to limit Adam's screen time, it provoked severe mood dysregulation, aggressive outbursts, and even suicidal ideation.How can clinicians effectively manage digital addiction in a neurodivergent adolescent when restricting device use provokes severe emotional dysregulation and suicidal ideation?What multimodal treatment strategies can balance behavioral containment with trauma-informed care?How can families and clinicians collaboratively establish digital boundaries that promote recovery without triggering psychological destabilization?What does this case reveal about the need for early screening, prevention, and family education regarding digital addiction in neurodivergent youth?
Retrospective Review of Children's Diagnostic Assessments for Autism Spectrum Disorder in British Columbia: Are we Identifying Co-occurring Motor Deficits?
Christiansen AL, Fishman I, Hutchison SM … +2 more , Mickelson E, Zwicker JG
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41589751 · Publisher ↗
OBJECTIVES: Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, a dual diagnosis of autism spectrum disorder (ASD) and developmental coordination disorder (D...
OBJECTIVES: Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, a dual diagnosis of autism spectrum disorder (ASD) and developmental coordination disorder (DCD) has been permitted. This study assessed the prevalence of DCD in children with ASD and whether DCD diagnosis increased after the publication of the DSM-5. METHODS: We retrospectively reviewed data from 19,307 children (≤19 years) assessed for ASD in the province of British Columbia in Canada between 2010 and 2019 (N = 19,307). Data from 2010 to 2013 (DSM-4 in place, n = 6532) and 2014 to 2019 (after publication of DSM-5, n = 12,775) were analyzed separately. RESULTS: From 2010 to 2013, only 1.1% (37/3261) of children diagnosed with ASD received a co-diagnosis of DCD. Children who were assessed for ASD but not given a diagnosis, 2.4% (62/2559) received a DCD diagnosis. After the publication of the DSM-5 (2014-2019), diagnosis of DCD in children diagnosed with ASD showed a modest increase to 2.8% (172/6152). For children without an ASD diagnosis, 2.9% (99/3396) were given a DCD diagnosis. CONCLUSION: This study demonstrates consistently low rates of DCD diagnosis across 2 periods: before and after the publication of the DSM-5. Despite a modest increase, the prevalence of ASD + DCD co-diagnoses after the introduction of DSM-5, DCD rates remain significantly lower than reported in the literature. This discrepancy suggests significant and persistent underdiagnosis of DCD in children with ASD in British Columbia.
The Role of Developmental-Behavioral Clinicians in FASD Diagnosis and Management: Insights From a National Survey.
Senturias Y, Lipman C, Burkhart K … +2 more , Wilaisakditipakorn TJ, Bothe D
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41588715 · Publisher ↗
OBJECTIVE: To examine the role of developmental and behavioral pediatric clinicians in diagnosing and managing Fetal Alcohol Spectrum Disorders (FASD), identify barriers related to diagnostic system variability and clini...
OBJECTIVE: To examine the role of developmental and behavioral pediatric clinicians in diagnosing and managing Fetal Alcohol Spectrum Disorders (FASD), identify barriers related to diagnostic system variability and clinician preparedness, and propose a functional framework to complement existing diagnostic systems based on findings from the 2023 Society of Developmental and Behavioral Pediatrics (SDBP) survey. METHODS: An anonymous survey of SDBP members assessed diagnostic practices, clinician preparedness, and training needs regarding FASD. Responses were analyzed descriptively to identify patterns in diagnostic system use and perceived training adequacy. RESULTS: Of 913 members surveyed, 199 responded (22%), with 97 reporting active involvement in FASD care. Among these, 34% used the University of Washington 4-Digit Code, 34% used Diagnostic and Statistical Manual of Mental Disorders-5 criteria, and 26% followed the Hoyme guidelines. Only 24% felt "very prepared" to diagnose FASD, whereas 58% desired additional training in both diagnosis and management. The lack of a standardized diagnostic framework contributed to variability in clinical practice and clinician confidence. CONCLUSION: Findings highlight significant gaps in clinician confidence and the lack of standardized diagnostic practices. This article underscores the importance of enhancing FASD education within medical and psychology training and proposes adopting a functional classification system (FASD levels 1, 2, and 3) to bridge existing diagnostic frameworks and promote consistency in care. Strengthening clinician capacity in FASD recognition and management is essential to improving early identification, timely intervention, and long-term outcomes for affected children.
The Interplay Between Screen Time and Outdoor Play on Preschool Children's Cognitive and Social-emotional Development.
Moldenhauer R, Boyd M, Hwang Y … +7 more , Wiebe S, Zheng Y, Rinaldi CM, Potter M, Li J, Dorn K, Carson V
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41570278 · Publisher ↗
OBJECTIVE: To (1) identify distinct profiles (i.e., subgroups) of screen time (ST) and outdoor play (OP) in a sample of preschool children, and (2) examine the mean differences in specific domains of cognitive and social...
OBJECTIVE: To (1) identify distinct profiles (i.e., subgroups) of screen time (ST) and outdoor play (OP) in a sample of preschool children, and (2) examine the mean differences in specific domains of cognitive and social-emotional development between these profiles. METHOD: Baseline data from the Technology and Development in Early Childhood study were used. Participants were 352 preschool children (3-4 years) and their parents living in Western Canada. ST (television [TV]/video viewing and video/computer games) and OP for both weekdays and weekend days were parent-reported. Social-emotional development outcomes (emotional, cognitive, and behavioral self-regulation) and demographic covariates were assessed by questionnaire. Cognitive development outcomes (language, response inhibition, working memory, and self-control) was assessed by 4 short games played during a recorded virtual meeting. Latent profile analysis was conducted. RESULTS: Four profiles were identified: (1) low ST/medium-high OP, (2) high TV/high OP, (3) medium ST/low OP, and (4) high ST/medium-high OP. Profile 1 was selected as the reference group. For response inhibition, the medium ST/low OP ( M = 10.3, SE = 2.0; p = 0.03) and high ST/medium-high OP ( M = 2.8, SE = 3.7; p < 0.01) profiles scored significantly lower than the reference group ( M = 15.3, SE = 1.0). For self-control, the high TV/high OP ( M = 65.5, SE = 3.2; p = 0.03) and medium ST/low OP ( M = 63.8, SE = 4.8; p < 0.05) profiles scored significantly lower than the reference group ( M = 74.2, SE = 2.1). For behavioral self-regulation, the high TV/high OP ( M = 3.6, SE = 0.1; p < 0.01) profile scored significantly lower than the reference group ( M = 3.9, SE = 0.04). CONCLUSION: Children with the combination of lower ST and higher OP had more advanced cognitive and social-emotional development for some outcomes.
Musical Hallucinations in a Preadolescent With ADHD: A Case Report.
Boonchooduang N, Phetsena M, Mekpoti N … +1 more , Louthrenoo O
J Dev Behav Pediatr · 2026 Jan-Feb 01 · PMID 41570264 · Publisher ↗
BACKGROUND: Musical hallucinations are a rare auditory phenomenon, with fewer than 50 pediatric cases reported in the literature. They are particularly uncommon in children without hearing impairment or psychosis. CASE P...
BACKGROUND: Musical hallucinations are a rare auditory phenomenon, with fewer than 50 pediatric cases reported in the literature. They are particularly uncommon in children without hearing impairment or psychosis. CASE PRESENTATION: A Thai girl with ADHD, diagnosed at age 5 years and treated with methylphenidate, presented with a 1-week history of bilateral musical hallucinations. The hallucinations consisted of instrumental music without lyrics, were nonpulsatile, occurred predictably during specific hours, and were emotionally distressing. Audiologic evaluation showed normal hearing bilaterally, and EEG showed normal background activity with no epileptiform changes during hallucination episodes. She also exhibited frequent eye blinking consistent with simple motor tics. Developmental assessment revealed some developmental delays, with a KBIT-2 composite IQ of 87, showing a moderate discrepancy between verbal (79) and nonverbal (98) domains, potentially reflecting both neurodevelopmental vulnerabilities and sociolinguistic factors. Initial nonpharmacological interventions including media restriction and behavioral techniques were unsuccessful. Low-dose risperidone (0.25 mg/day) led to complete resolution of hallucinations, tics, and associated emotional distress within 3 weeks. She remained symptom-free at the 3-month follow-up. CONCLUSION: Musical hallucinations can occur in children with ADHD even in the absence of hearing impairment, epilepsy, or psychosis. Early recognition, comprehensive evaluation, and multidisciplinary management are essential. When symptoms cause significant distress, low-dose risperidone may be an effective treatment. Recognizing the structured and nonpsychotic nature of musical hallucination in neurodevelopmental contexts may help avoid misdiagnosis and guide appropriate intervention.
Adolescent Psychotic Experiences and Adverse Mental Health Outcomes in Young Adulthood in a General Population Sample.
Rodriguez KM, Eaton WW, Margolis RL … +2 more , Althoff KN, Musci RJ
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41569063 · Publisher ↗
OBJECTIVE: To estimate the risk of incident depressive, anxiety, psychotic disorders, and suicide attempts associated with adolescent psychotic experiences. METHODS: A nested case-control design was used within the Avon...
OBJECTIVE: To estimate the risk of incident depressive, anxiety, psychotic disorders, and suicide attempts associated with adolescent psychotic experiences. METHODS: A nested case-control design was used within the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth-cohort study that recruited expectant mothers from 1991 to 1992. Participants were 8822 offspring of ALSPAC mothers who completed the Psychosis-like Symptoms Questionnaire, which assessed Psychotic Experiences (PEs). Depressive disorders were assessed using the Short Mood and Feelings Questionnaire, anxiety disorders using the generalized anxiety disorder (GAD) Assessment and the Clinical Interview Schedule-Revised, and psychotic disorders using the PLIKS structured interviews. Risk of incident depressive disorder, GAD, psychotic disorder, and suicide attempts were compared between participants who had ever versus never reported a PE and those who reported persistent versus transient PEs. RESULTS: Adolescent PEs were associated with increased risk for incident depressive disorder (adjusted hazard ratio [aHR] = 1.62, 95% confidence interval [CI] = 1.42-1.84), GAD (aHR 1.23, 95% CI = 1.03-1.47), psychotic disorder (adjusted odds ratio [aOR] = 5.08, 95% CI = 2.02-12.79), and suicide attempts (aHR = 2.11, 95% CI; 1.70-2.62). Persistent PEs (compared with transient) were associated with increased risk for depressive disorder (aHR = 1.81, 95% CI = 1.55-2.12), GAD (aHR = 1.34, 95% CI = 1.07-1.68), and psychotic disorder (aOR = 7.39, 95% CI = 2.43-22.19) but not suicide attempts. CONCLUSION: Adolescent PEs are a risk factor for multiple mental disorders and suicide attempts, with persistent PEs conferring greater risk. Identifying interventions for adolescents who report PEs, particularly persistent PEs, could lessen the burden of multiple mental health disorders and suicide attempts.
Associations Between Dietary Patterns and Mental Health Symptoms in Early Childhood: Findings From the CHILD Cohort Study.
Campisi SC, Chen ZH, Simons E … +6 more , Mandhane P, Moraes TJ, Turvey SE, Subbarao P, Miliku K, Korczak DJ
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41569048 · Publisher ↗
OBJECTIVE: To determine the earliest developmental stage at which the association between unhealthy dietary patterns and depressive symptoms emerges, given that this relationship is well-documented in adolescents and adu...
OBJECTIVE: To determine the earliest developmental stage at which the association between unhealthy dietary patterns and depressive symptoms emerges, given that this relationship is well-documented in adolescents and adults but remains understudied in young children. METHODS: Children (N = 2360; mean age of 5.1[SD = 0.2] years; 48% female) enrolled in the CHILD birth cohort study were included. Parent-reported data on demographics, dietary intake, sleep, physical activity, mental health outcomes (Child Behavior Checklist [CBCL]), and family variables (parental education, household income, maternal depressive symptoms) were collected. Missing covariate data with <15% missingness were handled using multiple imputations by chained equations. Dietary patterns were derived using Principal Component Analysis with a varimax rotation to enhance interpretability. Multiple regression was used to test the association between dietary patterns and mental health outcomes while accounting for covariates. RESULTS: Three dietary patterns were identified: "Prudent" (high in vegetables, fruits, legumes, eggs, and fish); "Western-like" (high in fast foods, meats, and sugar-sweetened beverages); and "Refined Grain-Snack" (high in refined grains, dairy, and salty snacks). For the full sample, the mean CBCL subscale scores were as follows: Total Problems = 41.37[9.22], Internalizing Problems = 44.69[9.18], and Externalizing Problems = 39.78[9.65]. Greater adherence to the prudent pattern was associated with fewer Total Problems (β = -0.10, p = 0.003), Internalizing Problems (β = -0.10, p = 0.001), and Externalizing Problems (β = -0.08, p = 0.016 in fully adjusted models. CONCLUSION: Findings suggest that the relationship between mental health and diet is observable in young children, highlighting a potential opportunity for preventive interventions. Longitudinal research is needed to determine the temporal association between dietary patterns and mental health symptoms.
Black Mothers' Perspectives on the Early Childhood Screening Process and the Modified Checklist for Autism in Toddlers in Primary Care.
Yates Flanagan A, Hill T, Childs M … +3 more , Wozniak-Kelly SN, Guthrie W, Wallis KE
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41569042 · Publisher ↗
OBJECTIVE: To understand Black mothers' perspectives on the autism screening process with the Modified Checklist for Autism in Toddlers (M-CHAT) and preferences in provider communications and interactions around autism s...
OBJECTIVE: To understand Black mothers' perspectives on the autism screening process with the Modified Checklist for Autism in Toddlers (M-CHAT) and preferences in provider communications and interactions around autism screening. METHOD: This qualitative study thematically analyzed semi-structured interviews of Black mothers (N = 11) whose child screened positive on an autism screener administered as part of a routine well-child visit in primary care. All interviews were audio-recorded, transcribed, and entered into NVivo software for data management and analysis. Coders achieved an average of over 95% agreement in double-coded transcripts across all thematic codes. RESULTS: Results from a qualitative thematic analysis of Black mothers' experiences with and preferences for early autism screening in primary care produced 5 primary themes: (1) preference for the pediatrician to report positive screening results, (2) desire to discuss developmental concerns with family members, (3) online resources as key information resources on autism and child development juxtaposed to, (4) valuing face-to-face time with early childhood providers, and (5) barriers to completing the M-CHAT. CONCLUSION: Black mothers described their preferences for completing autism screening for their children and emphasized the role of the pediatrician, family members, and online resources in providing information about child development and autism concerns. Trust in the pediatrician emerged as a salient theme, which runs counter to prior narratives that describe earned mistrust between Black caregivers and medical providers. Results can inform the improvement of early autism screening processes and health care communication for underrepresented families in primary care settings.
Conscientiousness and Glycemic Control in Youth With Type 1 Diabetes: The Mediating Role of Technology.
Rebollo Román Á, Tabernero Urbieta C, Villaécija J … +1 more , Luque Salas B
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41560301 · Publisher ↗
OBJECTIVE: Type 1 diabetes (T1DM) requires insulin administration, adjusting doses depending on multiple lifestyle factors. Studies show that personality traits influence glycemic management in patients with T1DM. The ev...
OBJECTIVE: Type 1 diabetes (T1DM) requires insulin administration, adjusting doses depending on multiple lifestyle factors. Studies show that personality traits influence glycemic management in patients with T1DM. The evidence regarding the relationship between conscientiousness, a personality trait associated with self-discipline, remains limited. The objective of this study was to investigate this relationship in children and adolescents with T1DM. METHODS: One hundred eighteen children and adolescents diagnosed with T1DM (42.4% girls, mean age 15.79 ± 1.98 years) were recruited for this study. Conscientiousness was measured using a 13-item shortened version of the Big Five Questionnaire. Glycemic management was evaluated with data obtained from intermittently scanned continuous glucose monitoring (isCGM). RESULTS: Higher levels of conscientiousness are associated with a better glycemic management and a greater adherence to isCGM usage in our study. Besides, greater adherence to isCGM correlates with a better glycemic management. We found a model where constant adherence to isCGM across the study period mediates the relationship between conscientiousness and glycemic management. CONCLUSION: Our results highlight the importance of assessing personality traits and integrating this information into the therapeutic education of adolescents with T1DM to improve their glycemic management.
Attention-Deficit/Hyperactivity Disorder and Disruptive Behavior in a Child With Eosinophilic Esophagitis and Failure to Thrive.
Mittal S, Noone A, Asquith S … +4 more , Moua MK, Mork K, Fogler JM, Diekroger EA
J Dev Behav Pediatr · 2026 Jan-Feb 01 · PMID 41502056 · Full text
Ryan is a 6-year-old boy with a history of eosinophilic esophagitis (EoE) and poor weight gain referred to developmental-behavioral pediatrics (DBP) for attention-deficit/hyperactivity disorder (ADHD) and oppositional de...
Ryan is a 6-year-old boy with a history of eosinophilic esophagitis (EoE) and poor weight gain referred to developmental-behavioral pediatrics (DBP) for attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Ryan's mother was concerned about Ryan's defiance and daily emotional outbursts, which could last up to an hour. Ryan's teachers frequently contacted the family due to disruptive behavior, impulsivity, and sneaking food.Ryan was born prematurely at 28 weeks and required nasogastric feeds for 1 month in the NICU. He has a history of reflux requiring proton pump inhibitors and failure to thrive at age 2 (currently at 6% for BMI). At age 4, he was evaluated by pediatric gastroenterology and subsequently diagnosed with EoE. Complete elimination of dairy, wheat, soy, eggs, nuts, and seafood/shellfish was recommended as per standard of care for EoE. The diet was difficult for the family and Ryan to maintain, and Ryan often had tantrums around foods/snacks. He would sneak into the pantry to eat things he was not supposed to, causing significant parent-child conflict. Food restrictions were particularly challenging at school. Ryan would ask classmates for their cheese sticks and cookies; snacks he was not allowed to eat. Despite a 504 plan in place, his teachers were unable to monitor his intake.Parent and teacher behavior rating scales were consistent with ADHD-combined type and ODD. Cognitive and academic testing demonstrated academic underachievement in math and reading; however, these results were thought to be an underrepresentation of his true abilities due to easy distractibility and impulsivity observed during assessments. Behavioral therapy, IEP evaluation, and trial of ADHD medication were recommended.Given his poor weight gain and inability to swallow tablets, a nonstimulant, guanfacine immediate release (IR) was initiated. Guanfacine was helpful, but titration was limited due to daytime sedation. Ryan was placed on homebound services due to frequent EoE flares and concerns that school could not adequately monitor food restrictions.GI recommended elemental formula as his primary source of intake due to nonadherence to diet. Ryan required a gastrostomy tube (g-tube) due to his refusal to drink elemental formula. Although EoE symptoms improved, Ryan had increased oppositional and defiant behaviors with his homebound teacher and parents. An extended-release oral liquid methylphenidate stimulant was started in conjunction with guanfacine and resulted in significant improvement of ADHD symptoms. Ryan experienced weight loss and decreased BMI to 3%. Periactin was initiated to help with appetite and sleep quality.After 3 months, Ryan started feeding therapy and behavioral therapy with a family component. He was also approved for home nursing support and respite hours. Several months later, Ryan endorsed missing his friends and wanting to go back to school. He agreed to sign a behavioral contract stating that if he returned to school, he would not sneak/steal food.What are some recommendations to consider for addressing Ryan's behavioral challenges?
Challenging Case: Complex Developmental Care and Management in a Child With a Chromosomal Deletion.
Poudel I, Lipton LR, Tucker EZ … +1 more , Augustyn M
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41481102 · Publisher ↗
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Demographic Predictors of Diagnostic Timing in Autism Spectrum Disorder and Co-occurring Mental Health Conditions: Evidence From Pediatric Electronic Health Records.
Long EE, Gaffrey MS
J Dev Behav Pediatr · 2026 May-Jun 01 · PMID 41481095 · Publisher ↗
OBJECTIVE: The present study examined the diagnostic sequencing of co-occurring autism spectrum disorder (ASD) and mental health diagnoses in youth and the impact of demographic factors on diagnostic patterns. METHODS: D...
OBJECTIVE: The present study examined the diagnostic sequencing of co-occurring autism spectrum disorder (ASD) and mental health diagnoses in youth and the impact of demographic factors on diagnostic patterns. METHODS: Data were extracted from the electronic health record of youth (n = 3357) under age 18 years in a pediatric health care system in the midwestern United States. Patients with co-occurring ASD and mental health disorders were categorized based on the order in which they were diagnosed: ASD first, mental health disorder first, or concurrent diagnoses. T -tests and linear and multinomial regressions were used to examine whether age at ASD diagnosis differed based on the presence of a mental health disorder and to examine demographic variables as predictors of diagnostic patterning. RESULTS: ASD was diagnosed 3 years later in youth with a mental health disorder, t(13,464) = 34.26, p < 0.001. Youth were most often diagnosed with a mental health disorder before ASD. Girls were 0.65 times less likely than boys to receive an ASD diagnosis first compared with a mental health diagnosis first ( p = 0.006) and were diagnosed with ASD later than boys (B = 0.97, p = 0.006). Black and multiracial Hispanic children were more likely than White children to receive an ASD diagnosis first compared with a mental health diagnosis (odds ratios 1.37-1.93) and were diagnosed with ASD earlier. Minoritized children were more likely to receive externalizing diagnoses. CONCLUSION: Findings highlight issues of diagnostic overshadowing in the diagnosis of ASD and co-occurring mental health conditions, and elucidate demographic groups who may be at risk for late diagnosis of ASD.
Positive Childhood Experiences Among Children and Youth With Special Health Care Needs.
Boswell EK, Patel M, Farrell T … +1 more , Crouch E
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41452326 · Publisher ↗
OBJECTIVE: Positive childhood experiences (PCEs) are protective events against the impact of childhood trauma. Previous research has found that children and youth with special health care needs (CYSHCN) are more likely t...
OBJECTIVE: Positive childhood experiences (PCEs) are protective events against the impact of childhood trauma. Previous research has found that children and youth with special health care needs (CYSHCN) are more likely to experience adverse childhood experiences, but the prevalence of PCEs among this population has not been examined. Therefore, this study seeks to evaluate the prevalence of PCEs among CYSHCN. METHODS: Cross-sectional data from the 2021 to 2022 National Survey of Children's Health (n = 47,207) was used to evaluate differences in the prevalence of PCEs between CYSHCN and non-CYSHCN, and to evaluate predictors of PCE exposure among CYSHCN. Rao-Scott χ 2 test and multivariable logistic regression, using appropriate survey weights, were used. RESULTS: Compared with non-CYSHCN, CYSHCN had lower odds of having at least one PCE (adjusted odds ratio [aOR]: 0.35, 95% Confidence Intervals [CIs]: 0.15‒0.83), and having specific types of PCEs: having constructive social engagement (aOR: 0.24, 95% CIs: 0.21‒0.27), having nurturing and supportive relationships (aOR: 0.80, 95% CIs: 0.72‒0.89), living in a safe, stable, and equitable environment (aOR: 0.75, 95% CIs: 0.68‒0.82), and creating social and emotional competency (aOR: 0.62, 95% CIs: 0.56‒0.69). Among CYSHCN, children of color, those with greater poverty, and those with more complex needs have lower odds of experiencing most PCEs. CONCLUSION: The results of this study indicate a need for programs aimed at fostering resilience among CYSHCN. There is also a need for additional research creating better measures of evaluating PCEs among CYSHCN and examining how PCEs mitigate the effects of adverse childhood experiences in this population.
Maternal Perinatal Depressive Symptoms, Prenatal Maternal Selective Serotonin Reuptake Inhibitor Antidepressants, and Executive Functions in Children: A 12-Year Longitudinal Study.
Hutchison SM, Brain U, Grunau RE … +2 more , Diamond A, Oberlander TF
J Dev Behav Pediatr · 2026 Jan-Feb 01 · PMID 41439673 · Publisher ↗
OBJECTIVE: To determine whether mothers' depressive symptoms with or without exposure to selective serotonin reuptake inhibitor (SSRI) antidepressant treatments during pregnancy were associated with executive functions (...
OBJECTIVE: To determine whether mothers' depressive symptoms with or without exposure to selective serotonin reuptake inhibitor (SSRI) antidepressant treatments during pregnancy were associated with executive functions (EFs) in offspring at 6 and 12 years of age. METHODS: A prospective cohort of 191 mothers and their children participated in the study. Clinician-rated reports of mothers' depressive symptoms were obtained spanning the third trimester during pregnancy to 12 years later. Children's EFs were measured using 2 computer-based tasks (Flanker/Reverse Flanker, Hearts and Flowers [HF]) and mothers' reports of EFs using the Behavior Rating Inventory of Executive Function (BRIEF) when the child was 6 and 12 years old. RESULTS: Longitudinal analyses showed that all children were both faster and more accurate on both Flanker/Reverse Flanker and HF with age. Fewer maternal prenatal depressive symptoms were associated with better accuracy on HF in children at 6 years of age and better EF skills as measured by the BRIEF at 6 and 12 years. Mothers' ratings of their children at 12 years indicated more executive dysfunction in children with prenatal SSRI exposure than for children without prenatal SSRI exposure, but this was no longer significant once prenatal depressive symptoms were taken into account. CONCLUSION: Prenatal and later depressive symptoms, not prenatal SSRI exposure, seems to affect offspring that continues into preadolescence, highlighting the importance of long-term mental health follow-up in mothers to ensure optimal development of children's EFs and hence their optimal development in school, in social relations, and in life generally.
The Prospective Relationship Between Childhood Self-control and Adult Parenting Behaviors: A Thirty-year Follow-up Study.
Kuehn M, Johnson SB, Raghunathan R … +4 more , Voegtline KM, Thomas TC, Ialongo NS, Musci RJ
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41433216 · Full text
OBJECTIVE: To examine whether self-control in first grade predicts later parenting. METHOD: Participants were first graders enrolled in a universal preventive intervention trial in 1993 to improve behavior and school ach...
OBJECTIVE: To examine whether self-control in first grade predicts later parenting. METHOD: Participants were first graders enrolled in a universal preventive intervention trial in 1993 to improve behavior and school achievement. By 2023, n = 221 participants were parents of children aged 4 to 15 years. Pre-intervention, self-control was assessed using the Teacher Observation of Classroom Adaptation-Revised. Latent profile analysis identified 3 profiles of childhood self-control: high (n = 101, 45.7%), inattentive (n = 87, 39.4%), and inattentive/hyperactive (n = 33, 14.9%). The association between self-control profiles and later parent-rated discipline consistency and enjoyment of parenting from the Structured Interview of Parent Management Skills and Practices was evaluated using latent profile regression. The association between self-control and observed parent sensitivity, intrusiveness, and positive/negative regard for the child was explored in a subset (n = 81). RESULTS: The high and inattentive childhood self-control profiles were more likely to discipline consistently versus the inattentive/hyperactive profile (Wald(2) = 8.55, p = 0.01). Self-control did not predict enjoyment of parenting (Wald(2) = 3.30, p = 0.19). Compared with the high profile, the inattentive/hyperactive and inattentive profiles exhibited greater positive regard for the child (Wald(2) = 11.03, p = 0.004). CONCLUSION: Childhood self-control may provide a foundation for discipline consistency as a parent. Individual differences in regulatory functioning that pose challenges in childhood might confer unexpected parenting benefits, underscoring the need for a life course perspective.
Sexual Health and Transition Needs in an Adolescent Girl With Attention-deficit Hyperactivity Disorder and Smith-magenis Syndrome.
Meneses V, Durante JC, García GG … +2 more , Diekroger E, Fogler J
J Dev Behav Pediatr · 2025 Nov-Dec 01 · PMID 41396259 · Full text
Lucia is a 13-year-old girl with Smith-Magenis syndrome (SMS), including hearing loss, axonal polyneuropathy, and urinary incontinence, followed for management of attention-deficit hyperactivity disorder (ADHD) with comb...
Lucia is a 13-year-old girl with Smith-Magenis syndrome (SMS), including hearing loss, axonal polyneuropathy, and urinary incontinence, followed for management of attention-deficit hyperactivity disorder (ADHD) with combined presentation, in the context of intellectual disability and mood differences. Lucia was diagnosed with SMS at age 6 years and has a history of global developmental delay, bilateral toe walking, bilateral hearing impairment, sleep difficulties, and emotional and behavioral challenges. She received early intervention therapies, attended a preschool program for children with disabilities, and is currently in special education with Speech and Language Therapy and hearing services. In addition, she enjoys attending a mainstream reading class with inclusion support and delights in music and sewing. Socially, she has tended to prefer younger children or adults. Lucia has persistent low frustration tolerance and anxiety, becoming emotionally dysregulated at school and self-injurious at home when she feels she is different from peers or unable to be successful in activities. Her nervousness and agitation has limited her participation in choir and crafts. At home, Lucia becomes fixated on tasks and routines and then is unable to complete activities of daily living promptly and effectively. Lucia was prescribed short-acting methylphenidate for ADHD but had trembling extremities and heard voices when on therapeutic doses. She did better on methylphenidate Osmotic-controlled Release Oral Delivery System (OROS) 18 mg by mouth daily, which her family administered intermittently, as they value using less medication. Guanfacine extended release was trialed, but Lucia experienced worsening anxiety. Lucia and her family have received referrals for mental health counseling in the past, but her parents have not have been able to pursue them because of cost and their busy work schedules. Lucia lives with her mother, originally from South America, who is employed in child care, and father, from the Midwest, employed in a factory. Lucia's mother accompanies her to her appointment and states, "Her hands shake with higher doses of medications, but she is very distractible and spends too long in the bathroom, stuffing toilet paper in her nose. I am not sure what will happen when she grows up. A boy who likes her brings her gifts, and she says she wants to be married and have children someday." Her mother emphasizes that Lucia increasingly demonstrates a desire to be independent and expressed happiness upon reaching menarche, as she seems to understand it as a marker of maturity. On examination, Lucia smiles nervously and bites her nails, yet engages well when discussing books, music, and sewing. She has notable speech articulation differences and is impulsive in her speech and movements. Lucia's mother is interested in gynecological counseling and potentially birth control, given concerns about Lucia's vulnerability. How would you begin to advise Lucia's family about behavioral and medication management?
Trends in US School-aged Children's Mental Health and Health Care, 2016-2021.
Lebrun-Harris LA, Donney JF, Ghandour RM … +3 more , Ali MM, Robinson L, Kaminski JW
J Dev Behav Pediatr · 2025 Nov-Dec 01 · PMID 41396258 · Publisher ↗
OBJECTIVES: To examine recent trends and patterns in school-aged children's mental health and health care-related measures. METHODS: Data came from the 2016 to 2021 National Survey of Children's Health (n = 155,178). Adj...
OBJECTIVES: To examine recent trends and patterns in school-aged children's mental health and health care-related measures. METHODS: Data came from the 2016 to 2021 National Survey of Children's Health (n = 155,178). Adjusted logistic regression models were used to test for significant time trends and between-group differences. Measures included mental, emotional, behavioral conditions (MEB; depression, anxiety, behavioral/conduct problems), positive indicators of mental/emotional well-being, and mental health care access/utilization. RESULTS: In 2021, 20.4% of children aged 6 to 17 years (over 10 million) had at least 1 current MEB, up from 18.1% in 2016 (+13%; trend p < 0.001). Two-thirds (68.8%) of children with an MEB received treatment/counseling in the past year. Over half (53.6%) of children had difficulty getting mental health care, up from 44.0% in 2018 trend p < 0.001; 6.4% had unmet mental health care needs, up from 4.3% in 2016 (trend p = 0.01). Four of 5 positive indicators significantly decreased over time (range: -8% to -14%; trend p < 0.001). Across 2016 to 2021, access to mental health treatment was lower for publicly insured, uninsured, lower income, and racial/ethnic minority children. CONCLUSION: An increasing burden of MEB conditions in children aged 6 to 17 years has been accompanied by stagnant rates of mental health treatment and increasing challenges in accessing services. Access to treatment varied across population subgroups, indicating gaps in access to prevention, diagnosis, and treatment.
Do Irritability and Sensory Over-responsivity Mediate Sleep Problems in Preschool Anxiety Disorders? A Comprehensive Investigation.
Yurumez E, Cikili-Uytun M, Efendi GY … +3 more , Konsuk-Unlu H, Aktas-Altunay S, Oztop DB
J Dev Behav Pediatr · 2026 Mar-Apr 01 · PMID 41380038 · Publisher ↗
OBJECTIVE: This study examined whether irritability and sensory over-responsivity (SOR) mediate the relationship between anxiety disorders and sleep problems in preschool-aged children. Although previous research has dem...
OBJECTIVE: This study examined whether irritability and sensory over-responsivity (SOR) mediate the relationship between anxiety disorders and sleep problems in preschool-aged children. Although previous research has demonstrated a link between anxiety and sleep disturbances, the specific contributions of irritability and SOR remain unclear. METHODS: The sample included 45 preschool children (24-72 months, 44.4% male) diagnosed with anxiety disorders and 85 healthy controls (24-72 months, 50.6% male). Diagnoses were determined using the Preschool Age Psychiatric Assessment, a structured DSM-5-based clinical interview. Parents completed the Child Behavior Checklist 1.5 to 5 to assess behavioral and emotional symptoms, including sleep problems and irritability. RESULTS: Children with anxiety disorders showed significantly higher levels of irritability ( p = 0.003) and SOR ( p < 0.05) compared with controls. Sleep problems were more frequent in the anxiety group compared with the controls ( p = 0.003). Multiple regression analyses revealed that irritability and SOR significantly mediated the relationship between anxiety and sleep problems ( p < 0.001). CONCLUSION: The irritability and SOR seem to play key mediating roles in the development of sleep problems among preschoolers with anxiety disorders. These findings highlight the importance of addressing regulatory and sensory-emotional functioning in the assessment and treatment of young children with anxiety and sleep difficulties.
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