Journal Of Developmental And Behavioral Pediatrics[JOURNAL]
Sun
200 papers
The Coexistence of Adverse Childhood Experiences, Positive Childhood Experiences, and Parent-reported Attention-deficit/Hyperactivity Disorder Severity: National Survey of Children's Health.
Hong SJ, Vu MH, Vanderbilt D … +3 more , Yin L, Imagawa KK, Deavenport-Saman A
J Dev Behav Pediatr · 2025 Sep-Oct 01 · PMID 40633056 · Full text
OBJECTIVE: Children with higher adverse childhood experiences (ACEs) experience more severe parent-reported attention-deficit/hyperactivity disorder (ADHD). Positive childhood experiences (PCEs) help to build resilience...
OBJECTIVE: Children with higher adverse childhood experiences (ACEs) experience more severe parent-reported attention-deficit/hyperactivity disorder (ADHD). Positive childhood experiences (PCEs) help to build resilience and mitigate the impact of ACEs on ADHD. Prior studies have measured the 2 constructs as independent factors, but no research has examined their combined influence on children with ADHD. The first aim was to categorize children with different levels of parent-reported ADHD severity into classes based on shared characteristics of ACE and PCE promoters. The second aim was to examine the relationship between the classes and ADHD severity. METHODS: Participants included children 6 to 17 years with data on the 2019 National Survey of Children's Health ADHD severity questionnaire (n = 19,715; weighted n = 49,149,269). Latent class analysis (LCA) identified subgroups of children experiencing patterns among PCE promoters and ACEs, which were measured as independent variables in an adjusted ordinal regression model to estimate their composite effects on ADHD severity. RESULTS: Using LCA, one class belonging to children with low ACEs and high PCE promoters (class 1) and another belonging to children with high ACEs and low PCE promoters (class 2) were identified. Class 2 was 2.2 times more likely to have more severe ADHD (aOR 2.2; 95% confidence interval, 1.8-2.6). CONCLUSION: Findings suggest ACEs and PCE promoters do not operate independently; children with high ACEs had low PCE promoters and had more severe parent-reported ADHD. Clinicians should consider actively screening for the presence of ACEs and PCEs in all children, especially those with high ADHD severity, and build strong alliances with families.
Food Insecurity Before and During the COVID-19 Pandemic and Early Childhood Development.
Lambert JO, Perrin EM, Sturner R … +2 more , Howard BJ, Johnson SB
J Dev Behav Pediatr · 2025 Nov-Dec 01 · PMID 40633055 · Full text
OBJECTIVE: To describe changes in household food security status among families with young children before and during the COVID-19 pandemic, when many families experienced changes in food security status because of pande...
OBJECTIVE: To describe changes in household food security status among families with young children before and during the COVID-19 pandemic, when many families experienced changes in food security status because of pandemic disruptions and relief programs, and to investigate the association between household food insecurity (FI) before and/or during the pandemic and developmental milestone attainment. METHOD: We used an interrupted time series design to evaluate the association between household FI and developmental milestone attainment before and during the pandemic. Our sample included US children 0 to 5 years with FI and developmental screenings prepandemic (June 2017 to February 2020) and intrapandemic (May 2020 to May 2022) in the Comprehensive Health and Decision Information System. Children with no food insecurity were compared to children with only intrapandemic (new), only prepandemic (resolved), or both intrapandemic and prepandemic (persistent) FI. RESULTS: We found lower developmental milestone attainment only in the persistent FI group, with significantly lower communication (adjusted difference = -0.17; 95% CI, -0.33 to -0.01) and personal-social (adjusted difference = -0.15; 95% CI, -0.30 to -0.01) scores, versus children with no FI. There were no differences in developmental milestone attainment in any domains for children with new or resolved FI compared to children with no FI. CONCLUSION: Using the pandemic as a natural experiment to study how changes in household food security status are associated with development, we found that persistent, but not transient, household FI is associated with suboptimal early childhood development. To promote healthy development, pediatricians should promptly intervene to address FI and advocate for governmental programs that promote food security.
Discussing Race With Families With Young Children: Pediatric Clinician Attitudes and Practice.
Lee GS, Nguyen MC, Glusman M … +7 more , Cohen A, Shearman N, Anderson A, Crosh C, Truong T, Ramos T, Erickson E
J Dev Behav Pediatr · 2025 Jul · PMID 40627852 · Publisher ↗
OBJECTIVE: To describe clinician attitudes and practices regarding discussions about race-related topics with families of children aged 0 to 5 years. METHODS: The authors distributed a survey to the Reach Out and Read (R...
OBJECTIVE: To describe clinician attitudes and practices regarding discussions about race-related topics with families of children aged 0 to 5 years. METHODS: The authors distributed a survey to the Reach Out and Read (ROR) medical provider network to assess clinicians' prior education, attitudes and clinical practice discussing the impact of racism on child health, racial identity formation, and development of ethnic-racial pride. The authors report item response frequencies with a sub-analysis of respondent race, ethnicity, level of training, and practice region and setting. RESULTS: Six hundred fifty-two surveys with 80% or more completion rate were analyzed. Over 90% of respondents agreed that racism affects child health. Although most agreed that clinicians have a role in discussing the impact of racism on a child's health, racial identity formation, and development of ethnic-racial pride with families, the majority did not regularly do so. Barriers included lack of time and education, clinician discomfort, and fear of damaging the therapeutic relationship. Many agreed that receiving education about these topics was very important, but fewer than 25% had prior education or knew of resources. Nearly 90% agreed that books and ROR can support these discussions; 79% were interested in additional ROR training. CONCLUSION: Although surveyed clinicians agree that they have a role in discussing race-related topics with families with infants and young children, they do not feel equipped to have these discussions. Pediatricians are interested in incorporating culturally diverse, developmentally appropriate books, and ROR to discuss issues related to race.
The Effectiveness of the Integrated Caregiver Language Intervention Program via Telepractice for Toddlers and Caregivers.
Hancer H, Tokgoz-Yilmaz S
J Dev Behav Pediatr · 2025 Sep-Oct 01 · PMID 40623298 · Publisher ↗
OBJECTIVE: Although active involvement of the caregiver is crucial in early intervention for toddlers at risk for developmental language disorders (DLD), challenges in accessing and participating in these programs often...
OBJECTIVE: Although active involvement of the caregiver is crucial in early intervention for toddlers at risk for developmental language disorders (DLD), challenges in accessing and participating in these programs often exist. Telepractice offers a potential solution to address this issue. This study aims to examine the effectiveness of an Integrated Caregiver Language Intervention Program via Telepractice (ICLIP-T). METHODS: A quasi-experimental model with a pretest-posttest format and matched control groups was used. The ICLIP-T, comprising basic language modelling strategies and environmental arrangements, was developed. The session protocol included a video analysis of strategies from previous sessions, a discussion of new strategies, and a question-answer segment. The ICLIP-T intervention was conducted with 21 dyads (study group) over a 12-week period, with each session lasting 45 minutes. The outcomes were analyzed for both caregivers and toddlers and compared with those of the 21 dyads in the control group. RESULTS: Significant differences were observed between the pretest and posttest language scores of toddlers in the study group, and in comparison with those of the control group. Furthermore, the study group revealed significant differences in caregivers' strategies between the pretest and posttest assessments. CONCLUSION: These results suggest that the language scores of toddlers at risk for DLD improved after the implementation of ICLIP-T by caregivers. Therefore, ICLIP-T should be conducted with larger cohorts and in toddlers with varying severities of DLD to confirm its utility.
Qualitative Methods: Centering Patient Voices in Developmental and Behavioral Pediatrics Research.
Underwood Carrasco VI, Culver JN, Junqua J … +3 more , Zuckerman KE, Martin-Herz SP, Peterson JW
J Dev Behav Pediatr · 2025 May · PMID 40623127 · Publisher ↗
Qualitative design can be an integral method for developmental and behavioral pediatric (DBP) researchers to understand and better comprehend participant experiences. Qualitative methods are meant to be flexible, iterati...
Qualitative design can be an integral method for developmental and behavioral pediatric (DBP) researchers to understand and better comprehend participant experiences. Qualitative methods are meant to be flexible, iterative, and collaborative, allowing the research team to learn through the data collection process as they connect with and gain insight from participants, or those with lived experience of the phenomenon. Even so, guidance is unclear on how to rigorously and thoughtfully implement these methods within DBP. This article aims to use common qualitative reporting guidelines to advise early career researchers on how to use qualitative design from study conception to results dissemination through a study case example in DBP.
Engagement With Recommended Developmental Follow-up and Supports Among Infants With Intrauterine Opioid Exposure.
Mascarenhas M, Peacock-Chambers E, Fraiman YS … +2 more , Kerzner LS, Schiff DM
J Dev Behav Pediatr · 2025 Jun · PMID 40601929 · Full text
OBJECTIVE: Describe the engagement of opioid-exposed infants (OEI) with recommended developmental surveillance and supports in the first year of life. METHODS: We conducted a single-site retrospective cohort study of OEI...
OBJECTIVE: Describe the engagement of opioid-exposed infants (OEI) with recommended developmental surveillance and supports in the first year of life. METHODS: We conducted a single-site retrospective cohort study of OEI delivered between 2016 and 2021, linking birth hospitalization, developmental follow-up (DFU) clinic, and early intervention (EI) records. Primary outcomes were attendance at DFU clinic and evaluation by EI. We used multivariable modified Poisson regression to examine how birthing parent-, infant-, and clinic-level factors are associated with service engagement. RESULTS: Of 256 OEI, 75% engaged in at least 1 developmental service. Referral and attendance rates at the DFU clinic were 69% and 33%, respectively. Ninety-three percent were referred to EI, 73% evaluated and 58% enrolled in services. EI evaluation was positively associated with prolonged infant hospitalization (adjusted risk ratio [aRR] 1.01; CI, 1.002-1.01) and exposure to antidepressants (aRR 1.23; CI, 1.02-1.49) and cocaine (aRR 1.28; CI, 1.09-1.50). Probability of attendance at DFU was higher for infants born to parents receiving care at an integrated perinatal substance use clinic (aRR 2.13; CI, 1.07-4.24) and exposed to antipsychotics (aRR 1.73; CI, 1.12-2.67), whereas those remaining in parental custody had lower probability of engagement (aRR 0.62; CI, 0.39-0.97). CONCLUSION: Three-quarters of the OEI engaged in developmental surveillance services in the first year of life. Factors relating to disease severity, location of birthing parent care, birthing parent co-exposures, and parental custody were associated with engagement. Efforts to improve engagement in recommended follow-up should elicit the perspectives of caregivers to better understand the mechanisms that drive these differences.
Prenatal Substance Exposure and Positive Developmental Delay Screening Among Patients in Foster Care.
Malthaner LQ, McLeigh JD, Knell G … +3 more , Jetelina KK, Atem F, Messiah SE
J Dev Behav Pediatr · 2025 Jun · PMID 40587873 · Publisher ↗
OBJECTIVE: Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and h...
OBJECTIVE: Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE. METHODS: Data were extracted from patient medical records of a primary care clinic for children in foster care between January 1, 2018, and December 31, 2021. Cox proportional hazards regression generated hazard of positive developmental delay screening using the Ages and Stages Questionnaire-3 among those who with and without PSE controlling for sex, race, ethnicity, prematurity, caregiver type, as well as interaction between PSE and prematurity and PSE and race. RESULTS: The sample included 975 patients. 60.4% had PSE, and 62.6% had a positive developmental delay screening at least once. 52.9% were male, and 45.5% were White. Those who had PSE but were nonpremature had 1.14 (95% confidence interval, 1.01-1.29) times the hazard of positive developmental delay screening compared with those without PSE and prematurity. However, those with PSE and prematurity had 2.01 times the hazard of positive developmental delay screening than those without either condition. CONCLUSION: Children in foster care with PSE are at risk for positive developmental delay screening compared with those without; however, those with both PSE and prematurity are at extra risk. This interaction should be considered when making inferences regarding developmental delay screening in this population.
Infant Distress From the Still-Face and its Association With Increased Problem Solving: Implications for Early Resilience.
Silletti F, Jiang Q, Koire A … +7 more , Musso P, Coppola G, Cassibba R, Mittal L, Erdei C, Roffman JL, Liu CH
J Dev Behav Pediatr · 2025 Jun · PMID 40561426 · Publisher ↗
OBJECTIVE: This study aimed to investigate the relationship between infants' negative affect and problem-solving skills, along with the moderating role of mothers' perceived social support. METHODS: The sample consisted...
OBJECTIVE: This study aimed to investigate the relationship between infants' negative affect and problem-solving skills, along with the moderating role of mothers' perceived social support. METHODS: The sample consisted of 110 infants (49% females) and their mothers, who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study at 2 time points: T1 (peripartum period, from late second trimester to 6 months postpartum) and T2 (when the infants were 8-10 months old). We used the Face-to-Face Still-Face (FFSF) procedure as an observational task to assess infant negative affect (T2) and maternal reports of their perceived social support (T1 and T2) and infants' problem-solving skills (T2). Spearman correlations and moderation analysis with PROCESS macro were performed in SPSS, controlling for maternal education, maternal age, maternal mental health (depression and anxiety at T1 and T2), and child sex. RESULTS: We found that infant negative affect was positively ( b = 1.88, p = 0.045) associated with problem-solving after controlling for other variables, whereas there was no evidence for a relationship with mothers' perceived social support ( b = 0.73, p = ns). Notably, in testing the interaction between negative affect during FFSF and social support ( b = 1.13, p = 0.001), the findings reveal more optimal problem-solving skills in infants whose mothers reported at T1 moderate ( b = 2.98, p = 0.003) or high ( b = 4.11, p = 0.001) social support. There was no evidence of a moderating role of mothers' perceived social support at T2 ( b = 0.32, p = ns). CONCLUSION: Results show that infant negative affect may reflect their capacity for problem-solving and that bolstering social support for perinatal women may enhance their infants' problem-solving abilities. Findings highlight that children's negative affect in stressful situations, such as the FFSF context, may serve as a coping mechanism and offer new insights into the intergenerational transmission of resilience.
Challenging Case January 2025: An Autistic Youth With ARFID During the COVID Pandemic.
Lim T, Cheng A, Bern E … +2 more , Aw M, Augustyn M
J Dev Behav Pediatr · 2025 Sep-Oct 01 · PMID 40526912 · Publisher ↗
Andrew is a 12-year-old boy living in Southeast Asia with autism spectrum disorder (minimally verbal), who first presented with new symptoms of low mood and anhedonia during the COVID pandemic. This was associated with l...
Andrew is a 12-year-old boy living in Southeast Asia with autism spectrum disorder (minimally verbal), who first presented with new symptoms of low mood and anhedonia during the COVID pandemic. This was associated with loss of appetite, which culminated in him eventually refusing to eat any food or swallow any liquids (including saliva). He would hold his saliva in his mouth in the daytime and refused to swallow. He would spit out the saliva when instructed to do so. Because of his worries about swallowing his saliva involuntarily during sleep, he also experienced insomnia. If he managed to fall asleep, he would involuntarily swallow his saliva.Three months from his initial symptoms, he was relocated by his family, to another southeast Asian country for specialty care. At this time, he also refused to speak. He went from intermittently accepting some foods, to being completely averse to any food or fluid intake. He was diagnosed with avoidant restrictive food intake disorder. Because of his acute refusal to eat or drink, a nasogastric tube was inserted and subsequently a gastrostomy tube for enteral nutrition. With this intervention, he was able to maintain good weight and nutrition.Simultaneously, he began treatment in a multidisciplinary feeding and nutrition program. Genetic testing done for concerns of neurological regression yielded a variant of unknown significance. He also began an anti-depressant and sleep medication.During this period, he returned to his country of origin and was no longer able to receive direct in-person specialty feeding support, but did have a dedicated caregiver. He was seen once every few months either in-person or by telehealth by the multidisciplinary feeding and nutrition clinic in the second country. His caregiver was taught to implement behavior strategies with a goal of him resuming oral food intake eventually.What factors should be considered when evaluating a child with co-existing neurodevelopmental and psychiatric conditions, who completely stops eating or drinking in the midst of a global pandemic? What feeding approach would be helpful in managing a complex case like this? What feeding interventions can be actualized at home to reintroduce solids? How did the pandemic impact access to services?
In-home Tele-assessment for Autism in Toddlers: Validity, Reliability, and Caregiver Satisfaction with the TELE-ASD-PEDS.
Gangi DN, Corona L, Wagner L … +3 more , Weitlauf A, Warren Z, Ozonoff S
J Dev Behav Pediatr · 2025 Jun · PMID 40526421 · Full text
OBJECTIVE: This study focused on in-home use of a tele-assessment tool for autism diagnosis in young children, the TELE-ASD-PEDS (TAP). Psychometric properties, caregiver experiences, and perceptions of feasibility were...
OBJECTIVE: This study focused on in-home use of a tele-assessment tool for autism diagnosis in young children, the TELE-ASD-PEDS (TAP). Psychometric properties, caregiver experiences, and perceptions of feasibility were examined among families likely to experience barriers to in-person evaluation. METHODS: One hundred eighty-two children between 18 and 42 months of age were recruited because of positive screening, primary care concerns, or early intervention referral. All participants completed initial tele-assessment including the TAP. Approximately 2 weeks later, a second visit was conducted: 92 were randomized to a repeat TAP administration by telehealth and 90 were randomized to an in-person evaluation. Caregivers completed surveys regarding challenges with technology and satisfaction with telehealth assessment. RESULTS: Overall, 77% of the sample was diagnosed with autism spectrum disorder (n = 140). There were few diagnostic disagreements (n = 10, 6%) between initial and second evaluations, with disagreements equally distributed between second visit type. Diagnostic outcomes (autism vs no autism) agreed between telehealth and in-person evaluation for 94% of cases, kappa = 0.82. Outcomes agreed between 2 telehealth visits for 94% of cases, kappa = 0.84. Test-retest reliability of total TAP scores across 2 administrations was strong, intraclass correlation coefficient = 0.85. Very few caregivers reported challenges with technology during telehealth appointments (<6%); 92% reported that there was nothing they would change about the telehealth visit. Examiners also reported high satisfaction with telehealth assessments. CONCLUSION: In-home use of the TAP is valid, reliable, feasible, and acceptable to caregivers. Findings support the continued use of telehealth assessment for autism in toddlers, which can reduce disparities in access to timely diagnostic services.
In Their Own Words: Qualitative Study of Parenting During the COVID-19 Pandemic.
Tucker Q, Sege R, Stephens A … +4 more , Suthar T, Purdue EL, Browne CH, Burstein D
J Dev Behav Pediatr · 2025 Jun · PMID 40526415 · Full text
OBJECTIVE: The authors aimed to understand the experience of parents and caregivers during COVID-19, including the challenges they faced and what helped them cope using the Strengthening Families (SF) Approach and Protec...
OBJECTIVE: The authors aimed to understand the experience of parents and caregivers during COVID-19, including the challenges they faced and what helped them cope using the Strengthening Families (SF) Approach and Protective Factors Framework's five factors: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children. METHODS: The Family Snapshot Survey was developed to assess the impact of COVID-19 on family life, including items for quantitative analysis and 2 open-ended responses. This national survey of 9000 parents recruited from an opt-in internet panel was conducted in 3 waves of 3000 in November 2020, February 2021, and July 2021 using the online YouGov platform. The 2 open-ended responses are analyzed here using qualitative thematic analysis based on the SF Approach and Protective Factors Framework for caregivers with children aged 0 to 5 years. RESULTS: The SF factors were used to classify 770 responses, with many responses identified as containing multiple factors, representing their interrelated nature. A lack of concrete support was the most frequent challenge, and parental resilience was the most frequent support. CONCLUSION: Access or lack of access to concrete support in times of need underscored many of the strengths and challenges, respectively. Participants described interactions between individual protective factors that allowed for safety, stability, or positive experiences. In future community policy creation, policymakers may look at how programs interact and allow families to access multiple protective factors at once, with a critical need for providing these concrete supports.
Co-occurring Anxiety in a Child With Autism and ADHD.
Daffner-Deming M, Savant D, Blakey-Armstrong A … +4 more , Thom RP, Howe YJ, Fogler J, Diekroger EA
J Dev Behav Pediatr · 2025 Jun · PMID 40493916 · Full text
KM is an 11-year-old autistic boy followed by a developmental-behavioral pediatrician (DBP) practicing within a multidisciplinary autism center. He had been prescribed various attention-deficit hyperactivity disorder (AD...
KM is an 11-year-old autistic boy followed by a developmental-behavioral pediatrician (DBP) practicing within a multidisciplinary autism center. He had been prescribed various attention-deficit hyperactivity disorder (ADHD) medications over the years, most recently dextroamphetamine-amphetamine extended-release capsule 10 mg daily.KM initially presented to the DBP for diagnostic confirmation of autism and ADHD at the age of 7 years. His school had conducted a detailed evaluation the year prior, indicating skills in the borderline range for cognitive, adaptive, and language functioning. Based on his developmental history, physical examination, review of school-based testing, and parent- and school-completed standardized questionnaires, he met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for autism spectrum disorder and ADHD with combined presentation.When KM was between the ages of 8 and 10 years, he trialed several medications, including methylphenidate (which led to emotional lability), dextroamphetamine sulfate oral solution (which caused irritability), and clonidine (which led to destructive behavior). Notably, KM's parents were divorced and had differing opinions and experiences surrounding the efficacy and tolerability of his medications, which made medication trials more complex. He eventually was stabilized on extended-release dextroamphetamine-amphetamine at the age of 9 years, which both parents agreed was helpful for improving attention, despite the medication triggering a new self-injurious behavior of punching himself.At the age of 10 years, after 1 year of stability on dextroamphetamine-amphetamine extended-release capsule 10 mg daily, his parents chose not to refill the medication, to see whether it was still helpful for him. They observed that he seemed much "happier" with improved mood and decreased anxiety when dextroamphetamine-amphetamine was withheld; however, they did note worsened hyperactivity. A few weeks later, he began demonstrating increased symptoms of anxiety such as somatization and externalizing behaviors. This included frustration, aggression, and oppositionality, especially in anticipation of and/or when confronting anxious stimuli.His neuropsychologist and DBP collaborated to create a behavior monitoring plan to help his parents clarify and track his symptoms across households, with the goal of monitoring symptom severity and differentiating ADHD from anxiety-related symptoms. Because of this, his parents identified hyperactivity and impulsivity as KM's most problematic symptoms; therefore, dextroamphetamine-amphetamine extended-release 10 mg daily was restarted. Although this was effective for his hyperactivity, ongoing monitoring suggested that his anxiety symptoms continued to be clinically significant. The DBP consulted a psychiatrist who advised a trial of escitalopram in conjunction with dextroamphetamine-amphetamine. Several weeks after starting escitalopram 5 mg per day, KM exhibited reduced anxious thoughts and decreased aggression, but ongoing symptoms of inattention.Considering KM's complex presentation, how do we approach neuropsychological assessment, behavioral and therapeutic support, and psychopharmacology?
Complex ADHD in a Child With Tic Disorder.
Lackey T, Ihyembe D, Riemenschneider Z … +4 more , Caceres T, Lewis-Esquerre JM, Fogler J, Diekroger EA
J Dev Behav Pediatr · 2025 Jun · PMID 40493907 · Full text
Jaxon is a healthy 12-year-old boy who is referred to your clinic for medication management. He was diagnosed with ADHD using a validated questionnaire at age 9 years. He is currently prescribed OROS methylphenidate 54 m...
Jaxon is a healthy 12-year-old boy who is referred to your clinic for medication management. He was diagnosed with ADHD using a validated questionnaire at age 9 years. He is currently prescribed OROS methylphenidate 54 mg capsules once daily in the morning, which he has taken for 3 years. This has generally worked well to improve his attention, focus, task persistence, and task completion. However, his parents now report increasing disruptive behaviors over the past 18 months, both at home and at school. There have been no major stressors over this period nor significant life changes or trauma in Jaxon's history.Jaxon's teachers report that although he remains in his seat, he constantly "squirms" and moves about. He also makes quick, jerky movements with his hands several times each class period. They report no specific trigger or activity for when this movement occurs, but report it being more intense when Jaxon is working hard to concentrate and stay focused. His mother also reports noticing the frequency increase if Jaxon thinks he is in trouble or when he is very excited (e.g., when he is playing video games). His parents share home videos to support these concerns.His teachers report problems with attention, fidgeting, and talking out of turn. They also report that his movements distract and disrupt the class. These reports are most often from his afternoon classes. Academically, he is doing well. He turns in most of his work, but his grades have dropped this semester. His teacher reports that he seems to lack the focus to complete his assignments and he rushes through them to go to the next activity.When you talk to Jaxon, he reports that he likes school, but he does not like how often he gets into trouble. He admits he gets embarrassed during quiet time when his hands randomly "move without me moving them."When observing Jaxon, you notice that he fidgets in his seat, often moving his hands over anything that is holding his attention (toys, papers). He is also verbally impulsive, interrupting the discussion with his mother multiple times during the visit. Twice, you witness a brisk single jerk of his right hand. It originates at the wrist and rotates away from his body with his hand closed. There was no accompanying vocalization with this movement.His parents are requesting a medication adjustment or change. What would you do?
Triple Nudge for Improving ADHD Assessment: A QI Initiative Using Reminders, Workflow Changes, and EMR Integration.
Charleowsak P, Thongseiratch T, Tripidok P
J Dev Behav Pediatr · 2025 Sep-Oct 01 · PMID 40456111 · Publisher ↗
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Developmental Behavioral Clinicians' Perspectives on Education Transitions for Young Children With Developmental Disorders.
Cohen SS, Olson J, Guetterman TC
J Dev Behav Pediatr · 2025 Sep-Oct 01 · PMID 40456102 · Full text
OBJECTIVE: The purpose of this study was to explore developmental behavioral clinicians' (DBP) perspectives on transitions between education programs for children age 8 and younger with developmental disabilities. METHOD...
OBJECTIVE: The purpose of this study was to explore developmental behavioral clinicians' (DBP) perspectives on transitions between education programs for children age 8 and younger with developmental disabilities. METHOD: We used a qualitative descriptive design to systematically gather and analyze DBP clinicians' perspectives. Most of the 25 participants were members of the Society for Developmental and Behavioral Pediatrics (SDBP). Interviews were conducted between June and October, 2022. Audio recordings of the interviews were transcribed. We used MAXQDA software for thematic analysis. RESULTS: We organized categories regarding barriers and facilitators of educational transitions according to the child and family and broader community levels and identified four major themes: (1) acknowledging that families play critical roles in education transitions; (2) communicating effectively at the intersections of the families and education and health care systems; (3) helping families navigate health and education systems and make education transitions; and (4) overcoming systems-level issue. CONCLUSION: Organizational and systemic barriers often impede DBP clinicians' ability to be involved with education transition activities. Education transitions often exacerbate underlying inequities in access to assessment, care, and outcomes among children with developmental disabilities from historically minoritized populations. Our data prompted us to propose a new framework that features the intersections among child and family, health care, and education teams. We found innovative ways for coordinating education transitions by cultivating relationships among children and families and professionals in health care and education systems.
The Case for Structured Data in Developmental-Behavioral Pediatrics: Project STANDARD (Structured Approach to Neurodevelopmental Care and Clinical Research Data).
Barbaresi W, Bannett Y, Blum NJ … +17 more , Chong SC, Clark J, Dall M, Epstein JN, Fellinger J, Froehlich TE, Hofer J, Holzinger D, Huang P, Kang Y, Aishworiya R, Reilly M, Reynolds AM, Roberts G, Sideridis G, Swain D, Weitzman C
J Dev Behav Pediatr · 2025 May · PMID 40439618 · Publisher ↗
Neurodevelopmental and behavioral problems (NBPs) such as attention-deficit hyperactivity disorder and autism spectrum disorder are highly prevalent in children and adolescents. Clinical care for NBPs is characterized by...
Neurodevelopmental and behavioral problems (NBPs) such as attention-deficit hyperactivity disorder and autism spectrum disorder are highly prevalent in children and adolescents. Clinical care for NBPs is characterized by unwarranted variation, a limited number of systematic approaches to measuring outcomes and evidence-based treatments, and significant challenges to conducting large, longitudinal clinical research studies. Clinical documentation of care provided to children with NBPs can be lengthy and time-consuming, lacks standardization, and often does not include precise details about clinically and scientifically important information (e.g., diagnostic criteria, services provided, response to treatment). The lack of standardization and missing data limit the utility of clinical documentation to support clinical research and quality improvement.
Exploring the Genetic Role of MECP2 Mutations on Phenotypic Presentation in Males: A Case Report.
Aslam H, Balasubramaniam S, McDunnah P … +1 more , Harrison M
J Dev Behav Pediatr · 2025 May · PMID 40403194 · Publisher ↗
OBJECTIVE: The purpose of this study was to explore the genotypic and phenotypic presentation of males with MECP2 -related neurodevelopmental disorders. When variants in the MECP2 gene are discovered in patients, Rett sy...
OBJECTIVE: The purpose of this study was to explore the genotypic and phenotypic presentation of males with MECP2 -related neurodevelopmental disorders. When variants in the MECP2 gene are discovered in patients, Rett syndrome becomes a possible diagnosis. Rett syndrome, however, does not encapsulate all phenotypic variations in MECP2 gene mutations, and specific diagnosis can become tricky especially in the male population as mutations in the gene were historically thought to affect females only. The authors present a rare case of a male with a previously unpublished genetic variant resulting in a distinct clinical presentation not meeting the criteria for typical or atypical Rett syndrome. METHODS: This patient's institutional electronic medical record was accessed, and information was reviewed. RESULTS: It was discovered that this patient had a maternally inherited variant in his MECP2 gene, resulting in a unique and previously undescribed form of MECP2 -related neurodevelopmental disorder, presenting with language regression followed by speech apraxia and motor discoordination. DISCUSSION/CONCLUSION: Literature reports on various phenotypes associated with MECP2 gene mutations and elaborates on previously identified forms of typical and atypical Rett syndrome. Through this case report, the authors uncovered a pathogenic variant in MECP2 resulting in a rare phenotype of MECP2 -related neurodevelopmental disorder that has not previously been described. This should encourage clinicians to think more broadly when approaching diagnosis of children with developmental differences. This also reinforces that Rett syndrome or MECP2 mutations can often present on a spectrum, and it may be beneficial to modify diagnostic criteria to reflect this.
Perceived Barriers to Medication Adherence in Adolescents and Young Adults with Attention-Deficit Hyperactivity Disorder: Adapting the Customized Adherence Enhancement Intervention.
Church E, Abdallah S, Kamimura-Nishimura K … +3 more , Levin JB, Chela A, McVoy M
J Dev Behav Pediatr · 2025 May · PMID 40397954 · Full text
OBJECTIVE: Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study...
OBJECTIVE: Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study aimed to adapt Customized Adherence Enhancement (CAE), a psychosocial intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD. METHODS: Phase 1 included focus groups with AYAs, caregivers, and health care providers who treat AYAs with ADHD (N = 19). Prompts included barriers and facilitators of medication adherence, impact of ADHD, and reasons treatment regimens may be difficult to maintain. Focus groups were recorded, transcribed, and thematically coded. Phase 2 included cognitive interviews with AYAs with ADHD to assess acceptability and usability of the intervention (N = 6). RESULTS: Main themes were AYAs' perception of ADHD and its negative impact on work, sports performance, and interpersonal relationships. Barriers of adhering to medication were limited access, physiological side effects, difficulty following medication routines, and having comorbidities. Facilitators to medication adherence were having more knowledge about ADHD, benefits from medication adherence, and using external prompts. CONCLUSION: As untreated or undertreated ADHD negatively affects morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Results informed the adaptation of an existing intervention (CAE) to target AYAs with ADHD and can be applied to adherence interventions more broadly.
Clinical Presentation and Questions of Identity, Camouflaging, and Self-diagnosed Autism in a Nonbinary Young Adult.
Sharma A, Fogler J, Van Scoyoc A … +2 more , Phelps R, Augustyn M
J Dev Behav Pediatr · 2025 May · PMID 40397946 · Publisher ↗
Vee is a nonbinary (sex assigned at birth: female) 16-year-old 11th grader presenting for their initial multidisciplinary team assessment (including developmental-behavioral pediatrics and psychological assessment). Vee'...
Vee is a nonbinary (sex assigned at birth: female) 16-year-old 11th grader presenting for their initial multidisciplinary team assessment (including developmental-behavioral pediatrics and psychological assessment). Vee's family first became concerned about their development when they were in pre-kindergarten. The school had concerns related to autism and provided Vee with an Individualized Education Plan (IEP) for autism-related services, although a formal medical diagnosis was never made. Vee "lost" the autism classification and associated services when they were in the first grade and no longer qualified for an IEP. However, concerns regarding social skills and identity persist 10 years later, and Vee is now questioning whether they are on the autism spectrum. Vee has carried historical diagnoses of obsessive-compulsive disorder (OCD), anxiety, depression, attention-deficit hyperactivity disorder, and specific learning disabilities-none of these diagnoses entirely explaining or satisfying Vee's long-standing sense of neither understanding nor being understood by others. Although symptoms of OCD, including intrusive thoughts, have significantly improved with therapeutic intervention, Vee still struggles with mood and anxiety. Their anxious tendencies include hair pulling and storing the hair in boxes. They "hate" school and often engage in school refusal; this has notably worsened since Vee entered middle school. Upon the start of high school, Vee disclosed that they identify as nonbinary to their parents, best friends, and school counselor.Vee struggles with social interactions, especially in novel social situations, and there is a history of bullying. They have 2 best friends, who both recently moved away. Most of their friends are in the online community. Vee has always preferred independent play, loves anime and rescuing animals, and is very imaginative and artistic. Vee has an early history of lining up items, toe-walking, and sensory sensitivities to loud noises, aesthetics of rooms and clothing, and textures of clothing. Vee can be aggressive toward their mother when they are frustrated and may even punch walls. They are not aggressive with any other individuals. Her mother wonders where "nonbinary begins and neurodiversity ends, never mind just being a teenager!"During the course of the assessment, which included Module 4 of the Autism Diagnostic Observation Schedule, Second Edition, Vee used little to no eye contact to manage their social interactions. They spoke in a flat monotone, and their use of gestures was greatly reduced for age; their gestures were also stiff and poorly coordinated. During the course of the assessment, Vee narrated their thought process in what they characterized as their "vocal stim": silly voices, catch-phrases and blurted swear-words. Vee explained how they use their vocal stim at different times to discharge nervous energy, entertain friends, and cope with challenging situations. Vee and their family are desperately seeking an answer to why they are so "different" from other young adults. Ultimately, the team conferred a diagnosis of autism spectrum disorder, much to the relief and expressed appreciation of Vee and their family. How can the team proceed from here and support Vee and their family?
Disparity in Internet Access Among Parents With Disabilities in the United States.
Li FS, Davidson S, Williams Z … +4 more , Heyman M, Duffy L, Stevens JD, Mitra M
J Dev Behav Pediatr · 2025 Jul-Aug 01 · PMID 40315438 · Publisher ↗
OBJECTIVE: Internet access is critical for reaching most modern-day resources and systems. Yet many do not have consistent access, including people with disabilities. This can have an outsized impact on children, which C...
OBJECTIVE: Internet access is critical for reaching most modern-day resources and systems. Yet many do not have consistent access, including people with disabilities. This can have an outsized impact on children, which COVID-19 lockdowns revealed in 2020 to 2021. However, internet access for parents with disabilities and their children is not well-studied. This study aims to fill that gap. METHODS: We used 2018 to 2022 American Community Survey data. Parents are defined as adults with a co-residing minor for whom they are presumed responsible, and are classified as with or without disabilities. Outcomes include presence of any home internet access and home high-speed internet access, and were analyzed by the presence of disability and type of disability. RESULTS: Results from modified Poisson regression analysis reveals that disabled parents are 1.79 times as likely as nondisabled parents to not have any home internet access ( p < 0.001) and 1.40 times as likely to not have home high-speed internet access ( p < 0.001). Adjustment for sociodemographic factors somewhat alleviated these disparities, but even after controlling for urbanicity, poverty, program participation, and family employment status, statistically significant disparities remained for most disability subtypes. Parents with hearing disabilities were most likely to lack home internet access. CONCLUSION: Among US parents, disability status is associated with lacking any home internet access and lacking home high-speed internet access. Given the importance of internet access in nearly all aspects of modern society for children and families, continued and increased support for programs that assist parents with disabilities may be an avenue for improving access.
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