Journal of Developmental and Behavioral Pediatrics最新文献

{"title":"Precision Medicine in Pediatric Attention-Deficit/Hyperactivity Disorder: A Systematic Review of Behavioral, Neurobiological and Genetic Diagnostic Biomarkers.","authors":"Marija Pranjić, Virginia Peisch, Nikolina Vukšić, Sambridhi Subedi, Anne B Arnett","doi":"10.1097/DBP.0000000000001403","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001403","url":null,"abstract":"<p><strong>Objective: </strong>Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and a common presenting concern in primary and developmental pediatric care. However, objective diagnostic tools are currently not available, leading to delayed and missed diagnoses. The current systematic review aimed to determine whether objective indices can serve as diagnostic markers for pediatric ADHD.</p><p><strong>Method: </strong>We conducted a systematic review of objective behavioral, neurobiological, and genetic biomarkers that could inform a precision medicine approach to diagnosis of pediatric ADHD. Following the PRISMA guidelines, we searched three major databases (MEDLINE, PsycInfo, and Scopus) for articles published between 2012 and 2024 that evaluated diagnostic biomarkers with a translational aim.</p><p><strong>Results: </strong>A total of 111 studies met inclusion criteria, including 42 behavioral, 44 neuroimaging, and 25 genetic studies. Among behavioral studies, measures of physical activity achieved discriminant validity in the good to excellent range. Neuroimaging biomarkers were strongest when machine learning and multiple-features models were used. A particularly promising direction involved task-based NIRS paradigms targeting cognitive control. The results of the genetic studies underscored the complexity of the genetic architecture of ADHD, implicating rare and common variants, as well as epigenetic mechanisms. MicroRNA and methylation profiles demonstrated the strongest accuracy, overall.</p><p><strong>Conclusion: </strong>Our systematic review identified promising candidate diagnostic markers for ADHD across behavioral, neuroimaging, and genetic methods. Multimethod approaches are likely to yield the strongest diagnostic accuracy. The complexity and cost of these approaches limits potential for implementation of a precision medicine approach to pediatric ADHD diagnosis in primary care settings.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap in Autism Diagnosis: An Evaluation of a Novel Primary Care Training Model.","authors":"Julie Bickel, Jonathan Hatoun, Margaret Fry, Lisa Prock, Louis Vernacchio, Laura Burckett Patane, Ashley Coop, Carol Weitzman","doi":"10.1097/DBP.0000000000001417","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001417","url":null,"abstract":"<p><strong>Objective: </strong>The current study assesses the impact of an educational program designed to train primary care clinicians (PCCs) to diagnose children between age 18 and 36 months at high risk for autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>Two cohorts of PCCs completed an 8-session training over a 9-month period. Clinicians were surveyed at baseline and 3 months after training completion. Information was collected regarding PCCs knowledge of ASD, their diagnostic beliefs, and perceived comfort and competence regarding all aspects of an ASD diagnostic evaluation.</p><p><strong>Results: </strong>A total of 35 participants completed training, and 29 (82%) completed presurvey and postsurvey. At baseline, 89% of PCCs reported no additional training in developmental behavioral pediatrics or diagnosing children with ASD, although 31% had diagnosed a child with ASD in the past year. After training, PCCs reported significantly greater comfort diagnosing ASD in children between age 18 and 36 months with mild ASD (2.31 vs 3.02, p < 0.0001), moderate ASD (3.03 vs 3.83, p < 0.001), and severe ASD (3.45 vs 4.34, p < 0.0001). PCCs also reported a significant increase in their knowledge and perceived competence in completing an autism evaluation, including taking an autism history, completing a structured observation, scoring the Childhood Autism Rating Scale-Second Edition, writing a letter of medical necessity, and discussing findings with families.</p><p><strong>Conclusion: </strong>After training, PCCs reported a significant improvement in their knowledge, comfort, and competence regarding all aspects of diagnosing young children 18 to 36 months of age at high risk of ASD. PCCs can help to improve access to services for young children at risk for ASD.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus Training Priorities for Developmental-Behavioral Pediatric Mini-fellows.","authors":"Nathan J Blum, Carissa Jackel, Nicole Jaffe, David Perlman, Olusimidele Ayeni, Kelly Chiu, Sarah DeHaan, Desiree Evans, Kathleen Hughes, Melanie Jungblut, Lena van der List","doi":"10.1097/DBP.0000000000001410","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001410","url":null,"abstract":"<p><strong>Objective: </strong>Identify training priorities for primary care clinicians who commit to a minimum of 300 hours of training in developmental-behavioral pediatrics (DBP mini-fellows).</p><p><strong>Methods: </strong>Eight mini-fellows from 13 DBP fellowship training programs funded by the Health Resources and Services Administration participated in a focus group discussion of training priorities (round 1) resulting in 105 potential priorities. One faculty member from each funded program (13 faculty) and all 14 mini-fellows in Spring, 2024 were invited to complete a survey to rate the importance of each of 105 suggested priorities on a 9-point Likert scale (round 2). Training priorities rated as 6 or higher by 60% of mini-fellows and/or faculty were retained for the round 3 survey, which included the mean score on the item from mini-fellows and faculty and asked the group to rate the items on the 9-point Likert scale considering the round 2 ratings. Items in round 3 with a median score of at least 7 and a 25th percentile score of at least 6 were categorized as consensus training priorities.</p><p><strong>Results: </strong>In round 2, 68 of 105 items met criteria to advance. In round 3, 46 of these 68 qualified as consensus training priorities. Many priorities related to care for children with autism spectrum disorder, attention-deficit hyperactivity disorder, and/or systems-based practice. Seven items not rated as consensus priorities by the full group, did meet criteria among mini-fellows.</p><p><strong>Conclusion: </strong>This study identified high priority topics for training mini-fellows that can provide foundational guidance for developing mini-fellow training curricula.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Childhood Experiences and Behavioral and Emotional Problems in Adolescents With and Without Autism.","authors":"Lisa D Wiggins, Carolyn DiGuiseppi, Katie Overwyk, Brian Barger, Gabriel Dichter, Maureen Durkin, Kristina Hightshoe, Eric Moody, Cy Nadler, Patrick Powell, Nuri Reyes, Angela M Thompson-Paul, Kayla N Anderson","doi":"10.1097/DBP.0000000000001414","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001414","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to examine differences in caregiver-reported adverse childhood experiences (ACEs) in adolescents with and without autism and explore associations between ACEs and behavioral and emotional problems in those with ACEs.</p><p><strong>Methods: </strong>Children were classified as having autism, another developmental disability (DD), or population comparison (POP) after a comprehensive evaluation in the Study to Explore Early Development (SEED) between 2 to 5 years of age. Caregivers of these same children completed the SEED Teen survey and answered questions about ACEs and current behavioral and emotional problems at 12 to 16 years of age.</p><p><strong>Results: </strong>Adolescents with autism (n = 198) and other DD (n = 330) were more likely than POP (n = 330) to experience income insufficiency (29.8%, 25.2%, and 12.2%, respectively) and parental divorce (29.3%, 25.7%, and 18.4%, respectively) (all p < 0.05). Living with someone with an alcohol or drug problem was associated with conduct problems only in adolescents with autism; living in a family that received financial assistance was associated with hyperactivity problems only in adolescents with other DD. Living with anyone experiencing mental illness, suicidality, or severe depression was associated with conduct and emotional problems in all 3 study groups.</p><p><strong>Conclusion: </strong>Families of children with atypical development may need more financial and emotional/marital support than others. Moreover, adolescents with autism and other DD could benefit from behavioral supports in response to a few specific ACEs while addressing household mental health problems could have widespread benefits that improve pediatric health. These findings can be used to encourage evidence-based programs and practices to prevent ACEs and offer supports when needed.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Life Neurodevelopment of Infants Across a Wide Gestational Age Range.","authors":"Peggy H Y Chan, C M Lai, H S Lam, Patrick C M Wong","doi":"10.1097/DBP.0000000000001411","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001411","url":null,"abstract":"<p><strong>Objective: </strong>Neural development differs between in-utero and ex-utero environments. Length of gestational age (GA) is associated with brain development and early life neurodevelopmental outcomes, affecting both preterm and term infants. This study aimed to examine a wide range of GA and provide a more comprehensive understanding of its effects on various developmental domains.</p><p><strong>Method: </strong>Four hundred fifty-four infants who were born at 24 to 41 weeks of GA were included in this analysis. Cognitive, language, and motor development between 8 and 30 months of age were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Associations between GA and outcomes were analyzed using linear and logistic mixed-effects models.</p><p><strong>Results: </strong>GA was positively associated with all examined developmental domains with a small-sized effect (Pearson's correlation coefficients: 0.08-0.15; p < 0.05). After adjusting for covariates, linear mixed-effect models estimated that each additional week of GA was associated with an increase in Bayley III composite scores: cognitive (0.6 points), language (0.6 points), and motor (0.62 points). Logistic mixed-effect models showed that after adjusting for the covariates, each additional week of GA reduced the adjusted odds ratio of delay in 1 of the language subdomains (i.e., receptive communication) by 13%.</p><p><strong>Conclusion: </strong>We found a small impact of GA on cognitive, language, and motor development across a wide range of GA. Language and its subdomains seem particularly sensitive to the effects of prematurity. Thus, regular monitoring and parent-based early intervention, especially in the language domain, are warranted for early-term and preterm infants.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review of Dixon and Stein's Encounters With Children, 5th ed.","authors":"Jnev Biros, Carrie W Kelly","doi":"10.1097/DBP.0000000000001415","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001415","url":null,"abstract":"","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Essential Guide to Raising Complex Kids With ADHD, Anxiety, and More by Elaine Taylor-Klaus.","authors":"Julia Garcia, Madison Farley","doi":"10.1097/DBP.0000000000001413","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001413","url":null,"abstract":"","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Metabolic Monitoring of Atypical Antipsychotics in a Developmental and Behavioral Pediatrics Ambulatory Clinic.","authors":"Joanna E Dreyer, Jeffrey J Glasheen, Lucas E Orth, Karen Garay, Ada Z Koch, Ann Reynolds","doi":"10.1097/DBP.0000000000001412","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001412","url":null,"abstract":"<p><p>Atypical antipsychotics are high-risk medications with serious side effects including weight gain, hyperlipidemia, and insulin resistance. Safe use in youth with autism spectrum disorder and other neurodevelopmental disorders is especially important due to inherent risks of high obesity rates and barriers to a healthy lifestyle. Metabolic monitoring rates are low in this population in part due to difficulties with obtaining labs and other vitals. In our Developmental and Behavioral Pediatrics clinic, 31% of patients had once-yearly metabolic monitoring parameters completed. We aimed to increase metabolic monitoring rates through multi-disciplinary interventions. A pharmacist provided educational presentations to staff, the pharmacist identified patients needing monitoring and provided recommendations to the medical provider, nursing staff notified families by phone if labs were needed, and child life support services were offered. Average once-yearly metabolic monitoring rates increased from 31% to 64% 1 year after beginning interventions. Three educational presentations were provided, 183 recommendations for monitoring were made on 141 patients, and nursing made 38 phone calls to families. Of the 141 patients identified as needing monitoring at the time of clinic visit, 72 (51%) obtained the monitoring parameters within 3 months. Abnormal metabolic labs requiring additional action were found in 31/72 (43%) patients. Patients with in-person visits were more likely to obtain labs overall and on the day of clinic visit than those with telehealth appointments. Using a multidisciplinary approach within a Developmental and Behavioral Pediatrics clinic, metabolic monitoring rates in patients taking atypical antipsychotics greatly improved.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for Outcome Data Collection and Access in a Pediatric Autism Learning Health Network Registry.","authors":"Donna S Murray, Julia S Anixt, Vijay Vasudevan, Lynn L Cole, Angie Fedele, Arun Karpur, Wendy L Cornell, Lisa M Latten, Eric M Butter, Daniel L Coury","doi":"10.1097/DBP.0000000000001401","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001401","url":null,"abstract":"<p><strong>Objective: </strong>Health professionals participating in learning health networks collect data for informing clinical decision-making, research, and quality improvement (QI). To optimize the collection and use of clinical and Parent Reported Outcome (PRO) data for these purposes, it is important to understand the priorities of patient registry \"end users\" (clinicians, researchers, and patients/families).</p><p><strong>Methods: </strong>The analysis used a sequential mixed-methods approach with parent (n = 93) and clinician (n = 167) surveys followed by targeted interviews (parent n = 9, clinician/researcher n = 7) completed at Autism Care Network (ACNet) sites to better understand current use of registry data and parent/clinician priorities.</p><p><strong>Results: </strong>Sixty percent of parents reported receiving behavioral data regarding their child from their health provider in the past, and 90% felt these data would help them understand their child's behavior. Among data access options parents preferred an online portal (72%) and/or the clinic's electronic medical record (59%). Parents indicated willingness to complete surveys longitudinally if the assessments correlated with their child's specific areas of difficulty. Priorities for clinicians included easy access to the data (84%), meaningful connection to clinical outcomes (81%), and measures that can demonstrate change in symptoms over time (76%) and that are easy for families to complete (80%). Both groups recommend assessing parenting stress and social determinants of health.</p><p><strong>Conclusion: </strong>Consideration of end-user priorities can improve patient registry data collection, analysis, and utilization. Families may be more willing to participate if they can receive direct benefit by accessing their own data and clinicians use this data to optimize clinical care.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Study on Prenatal Opioid Exposure: A Review of Neurodevelopmental Consequences.","authors":"Quyen Cao, Julie Kable","doi":"10.1097/DBP.0000000000001407","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001407","url":null,"abstract":"<p><strong>Objective: </strong>A systematic review using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted to evaluate the potential adverse impacts on neurodevelopment associated with prenatal opiate exposure.</p><p><strong>Method: </strong>After applying exclusion criteria to the identified collection of studies, 86 studies were included in this review. Each article was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. Results were grouped into 6 neurobehavioral function domains (executive, language, general development, motor, neurosensory, and socioemotional) and 1 neuroimaging domain.</p><p><strong>Result: </strong>Risk difference analyses showed the neurosensory domain in children prenatally exposed to opioid had highest risk of impairment (76.9%), whereas the executive domain had lowest risk (44.8%). The meta-analysis of pooled estimates after statistical adjustments associated with the Egger's test results showed effect size (Hedge's g) was largest in the socioemotional domain (-1.14; 95% CI, -1.61 to -0.66) and smallest in the general development domain (-0.44; 95% CI, -0.70 to -0.18). Neuroimaging studies on prenatal exposure to opioid were limited and varied in the techniques and topographical focus in their approaches, resulting in a heterogenous body of literature.</p><p><strong>Conclusion: </strong>Maternal opioid use during pregnancy can serve as a risk indicator for an at-risk child and the potential need for monitoring the child's neurodevelopmental growth. The conclusions related to the direct teratogenic effects of maternal opioid use, however, are often limited by poor experimental and statistical controls used to address other substances and social adversity that co-occur with opioid use.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}