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Objective: To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Based on Centers for Disease Control and Prevention's Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes. Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program. Conclusions: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support. [ABSTRACT FROM AUTHOR]

Youths with autism spectrum disorders ( ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day-to-day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy ( MST) is a comprehensive family- and community-based treatment approach that has been effective with other difficult-to-treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model. [ABSTRACT FROM AUTHOR]

Patterns of current psychotropic medication use among 5,181 children with autism spectrum disorders (ASD) enrolled in a Web-based registry were examined. Overall, 35% used at least one psychotropic medication, most commonly stimulants, neuroleptics, and/or antidepressants. Those who were uninsured or exclusively privately insured were less likely to use ≥3 medications than were those insured by Medicaid. Psychiatrists and neurologists prescribed the majority of psychotropic medications. In multivariate analysis, older age, presence of intellectual disability or psychiatric comorbidity, and residing in a poorer county or in the South or Midwest regions of the United States increased the odds of psychotropic medication use. Factors external to clinical presentation likely affect odds of psychotropic medication use among children with ASD. [ABSTRACT FROM AUTHOR]

Increasing numbers of children diagnosed and treated for autism spectrum disorders (ASDs) has impacted both neuropsychologists and educators. Though both play key evaluative and treatment roles, there is no available method or process in place enabling the translation of the neuropsychological report recommendations into a format educational teams can easily use, leading to a gap between neuropsychological recommendations and educational planning. In the following, we review the areas evaluated by a neuropsychologist when assessing a child with an ASD, discuss the domains targeted by educational teams when designing an educational plan, and then present a process that has met with some success creating a “bridge” between the diagnostic/assessment process and the subsequent academic planning. Though presented in the context of ASD, the process described can be used by neuropsychologists for various populations to facilitate partnerships with educators that result in improved care for the child. [ABSTRACT FROM AUTHOR]

This study describes the relationship between parenting stress and behavior in children with Joubert syndrome, a rare genetic neurodevelopmental disorder. Parents (N = 43) reported severely impaired child adaptive behaviors. Most children did not show maladaptive behaviors, but a subset of approximately 20% displayed significant problems in areas such as inattention, overactivity, social withdrawal, and atypical behaviors. Mothers (59%) and fathers (40%) reported elevated levels of parenting stress. A hierarchical regression, including demographics, adaptive behavior, and maladaptive behavior, predicted 67% of the variance in mothers' stress and 40% of the variance in fathers' stress. Maladaptive behaviors uniquely contributed to maternal and paternal stress. The child's adaptive behavior level contributed significantly to parenting stress for mothers but not for fathers. Findings provide a better understanding of the impact of child behavior on parents caring for a child with Joubert syndrome. [ABSTRACT FROM AUTHOR]

This study provides descriptive information in the areas of oromotor abilities and communication to better understand the spectrum of disability in individuals with Joubert syndrome. Participants included 21 individuals with the diagnosis of Joubert syndrome (mean age 10.45 years). Participants completed oromotor and receptive language measures. In addition, all of the participants' speech and gesture communication from a narrative task was coded and analyzed from videotape. Caregivers reported the participants' level of fine and gross motor function. The results show that individuals with Joubert syndrome exhibit a distinct oromotor pattern consistent with verbal and lingual apraxias. Despite significant motor skills deficits and oculomotor apraxia, persons with Joubert syndrome produced gestures when communicating, and those whose speech was less intelligible used a higher rate of gesture compared with those with greater verbal output. These findings suggest a new form of apraxia not previously described in the condition and are consistent with previous research that suggests that persons with Joubert syndrome typically do not exhibit classic symptoms of autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Successful school reentry following traumatic brain injury (TBI) is critical to recovery. Physical, cognitive, behavioral, academic, and social problems can affect a child's school performance after a TBI. However, early intervention has the potential to improve child academic outcomes and promote effective coping with any persistent changes in functioning. The purpose of this article is to review the topic of school reentry after a childhood TBI. The authors describe 4 essential principles to planning a positive reentry to school: assessment, multidisciplinary teaming, facilitation of peer interactions, and planning for the provision and withdrawal of support. The authors delineate a sequence of steps for promoting school reentry and review existing school reentry programs. The authors also discuss barriers to the school reentry process and possible solutions. The article concludes with a case study that highlights some of the challenges of school reentry and the benefits of using interactive videoconferencing to link rehabilitation and community-based treatment teams during the reentry process. [ABSTRACT FROM AUTHOR]

Objective: To examine unmet needs among families of children with chronic health conditions treated in primary care settings and to identify predictors of these needs.Method: Primary care physicians referred 83 caregivers of children with chronic health conditions. Mothers completed the Family Needs Survey, as well as other measures of child and family functioning.Results: Mothers reported a high prevalence and broad range of unmet family needs. The most frequent area of need was for information about services and ways to promote child health and development. Predictors of total number of family needs included demographic characteristics, ratings of social support, and appraisals of family burden. Predictors of specific types of family needs varied according to category of need.Conclusions: Innovative psychosocial intervention programs are needed in primary care settings to reduce family needs and promote child health. More intensive family supports may be indicated for those with minority-group or low socioeconomic status, limited social support, or high perceived burden. [ABSTRACT FROM AUTHOR]

This retrospective study examined predictors of outcome for children with autism following 6 and 12 months of early intensive behavioral intervention. Potential predictor variables included pretreatment functioning, age at onset of treatment, treatment intensity, family involvement, and physical characteristics (e.g., brain abnormalities, dysmorphology). For the 19 study participants, presence of dysmorphic features was the only variable that predicted response to treatment after 6 months (R² = .58). Dysmorphology was associated with worse outcomes. After 12 months, both dysmorphology and a history of regression predicted poorer response to treatment (R² = .67). Children who made the most progress in treatment had pretreatment language skills and normal physical features. Dysmorphic features in children with autism may represent abnormalities in prenatal development that are associated with poorer child outcomes. [ABSTRACT FROM AUTHOR]

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown. [ABSTRACT FROM AUTHOR]

With the goal of identifying a population of children in primary care settings who may benefit from quality improvements in their care, we examined a new method of screening children for chronic health conditions. Parents of children treated in a pediatric clinic (N = 769) completed the screening measure. Approximately 1 in 5 children had a chronic physical, developmental, behavioral, or emotional condition, which is similar to prevalence rates in national surveys. Among children with chronic conditions (n = 162), 79% required prescription medications, 70% had above-average service use, and 28% had functional limitations. The use of the screener in primary care settings has the potential to identify a vulnerable group of children who need comprehensive and coordinated care. [ABSTRACT FROM AUTHOR]

This study examines the memory functioning of 25 children who sustained a traumatic brain injury (TBI) and who had prior learning problems, 48 children with TBI who did not have prior learning problems, and 23 noninjured controls. The children with TBI and prior learning problems displayed significantly worse memory abilities than both the control participants and the children with TBI and no prior learning problems. They differed significantly from these 2 groups on measures of general memory, verbal memory, sound-symbol learning, and attention. The results suggest that children with premorbid learning problems who sustain TBI have less cognitive reserve and a lower threshold for the expression of cognitive impairments in areas that reflect preexisting learning and language problems, compared to children without premorbid learning problems. [ABSTRACT FROM AUTHOR]

Summary: This study identified ways that telehealth systems are used to enhance service delivery for children with special health care needs. Various health professionals utilize telehealth to provide physical and behavioral health care, to conduct developmental evaluations, and to address family/social concerns. Telehealth is used most for follow-up visits after in-person specialty care and for child evaluation with treatment recommendations to local care providers. Telehealth systems have the potential to increase access to specialized services and to enhance community-based services for rural and underserved children. However, inadequate reimbursement poses a significant barrier to the development of these services. Clin Pediatr. 2001;40:93-98 [ABSTRACT FROM AUTHOR]

Galactosemia is an autosomal recessive disorderthat results from a breakdown in the metabolism of galactose, which can befound in milk and milk products. Acute medical complications are controlledby early diagnosis through newborn screening and strict adherence to a galactose-freediet, but there remain physical and neurobehavioral sequelae from treatedgalactosemia. We present a case study of a 7-year-old boy with treated galactosemia.This study describes his history and course over a 41-month period from age6 to 10 years old using repeated neuropsychological assessments. This childexhibited a decline in intellectual functioning, weaknesses in visual-spatialprocessing, fine motor skills, handwriting, math, language, and reading, anda deficit in executive functioning. He also met criteria for Attention DeficitHyperactivity Disorder, Inattentive Type. Following treatment with stimulantmedication, the child reportedly had decreased problems with sustained attentionand increased consistency of responding and motor planning. Recommendationsare made for repeated neuropsychological assessments to chart the course ofchildren with treated galactosemia and to identify potential areas for remediation(e.g., attention). [ABSTRACT FROM AUTHOR]

This study examined specific memory functions in 52 children with mild-moderate or severe traumatic brain injury (TBI) and 29 noninjured controls using the Wide Range Assessment of Memory and Learning (WRAML). Children's recall varied as a function of injury severity and task demands. The participants with severe brain injuries performed worse than controls on global measures of visual memory, learning, and general memory functioning, as well as on specific subtests measuring recall of contextual verbal information. Children with mild-moderate brain injuries performed similarly to controls except for poorer performance on 2 subtests measuring sound-symbol learning and recall of geometric designs. Results suggest that the WRAML provides clinically useful information and that specific aspects of memory processing need to be evaluated following childhood TBI. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the impact of child neuropsychological evaluations from the parent's perspective. Fifty-five parents of children with neurodevelopmental problems completed a 19-item questionnaire, indicating their assessment of the process and outcomes of the evaluation. Respondents reported an increased understanding of the child's impairments and strengths, greater knowledge about treatment strategies and community resources, improved school services, and a high level of overall satisfaction. The strongest predictors of overall satisfaction were (a) perceptions of the professional's concern and technical competence and (b) ratings of the recommendations provided. Child neuropsychological evaluations have the potential to improve child outcomes by influencing multiple systems of care, including family, health care providers, educational programs, and community service agencies. [ABSTRACT FROM AUTHOR]

In this study, an eight-year-old boy received home safety skills training from his mother and demonstrated clear improvements in several aspects of home safety. His five-year-old brother never received formal training from an adult, but was allowed to observe training and received unprompted teaching from his older brother. He, too, showed large improvements in several aspects of home safety skills training. The importance and utility of peer training is described and methods of enhancing this procedure are discussed. [ABSTRACT FROM PUBLISHER]

Summarizes the common consequences of traumatic brain injury (TBI) and reviews a process-oriented approach to assessing children with moderate to severe TBI during rehabilitation. Assessment issues during rehabilitation; Course of recovery; Supporting transition through communication.

New guidelines for training in neuropsychology are needed for several reasons: increased diagnostic accuracy of neuroradiologic techniques: an increasing need for functional neuropsychological evaluations; emergence of other psychological specialities; and managed care/economic factors. Current INS-Division 40 guidelines emphasize neurological and diagnostic areas with minimal suggestions for training in rehabilitation and functional issues. The recent publication of training guidelines for Rehabilitation Psychology (APA Division 22) illustrates weaknesses in Division 40 training. It is proposed that neuropsychological training guidelines (formal guidelines and informal training experiences) incorporate another content area for training and demonstration of competency, defined as Functional Outcomes. Specific training is suggested in: (a) issues in disability; (b) ecological validity of tests; (c) vocational evaluation/training; (d) academic programs for students with disabilities; (e) independent living resources; (f) specific cognitive-behavioral interventions; (g) resources for individuals with disabilities; and (h) government assistance programs for individuals with disabilities. [ABSTRACT FROM PUBLISHER]