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Given the increasing prevalence of autism spectrum disorder (ASD), medical professionals’ understanding of the presentation of ASD is essential to ensuring patients with ASD receive high-quality healthcare. Previous studies have found that individuals with ASD have a lower average bone density and higher fracture risk than those without ASD, increasing the likelihood that these patients will seek orthopaedic care. Early coordination with the patient’s family, identification of stressors and coping strategies, and flexibility during the visit are key to promoting a positive medical encounter. Based on a review of the literature, we present a practical guide for orthopaedic providers to better care for pediatric patients with ASD and their families.

INTRODUCTION Youth with Inflammatory Bowel Disease (IBD) are at significantly increased risk for depression and anxiety, with 25%-40% of youth with IBD reporting internalizing symptoms. These data are based on general measures of anxiety and depression without accounting for the confounds of disease-related processes. Disease-distress, on the other hand, disentangles disease-related processes, including medication sides effects, and the emotional experience of managing a chronic illness. Harris et al. developed a measure of IBD-related distress, the Crohn’s and Colitis Distress Scale (CCDS), to assess the expected worries, concerns, and fears associated with having IBD. This study involved an exploratory factor analysis (EFA) of the CCDS to better categorize IBD distress. METHODS Participants (N=120, ages 12-18, diagnosis of IBD) completed the 27-item CCDS. About half of participants were male (n=66; 55%) and majority were White (n=104; 86.7%). Eighty participants were diagnosed with Crohn’s disease (66.7%) and forty with ulcerative colitis (33.3%). Average length of time since diagnosis was 3.31 years (SD=2.77 years) and average length of time since participants’ last flare was 18.03 months (SD=24.65 months). A subsample of participants reported currently being symptomatic (n=44; 36.7%) and currently flaring (n=27; 22.5%). An EFA with varimax rotation was conducted to assess the factor structure of the CCDS. RESULTS The CCDS yielded a five-factor structure, with three to seven items per factor. Factor loadings ranged from .44 to .83 (see Table). Five factors were extracted from the EFA: emotional burden, physician-related, disease-related interpersonal, regimen-related, and disease-related functional impairment. An item-to-total analysis indicated 23 of 27 total items correlated strongly with the total (r > .5), four items were moderately correlated with the total (r= .43, r= .42, r= .38, and r= .49), and no items were largely uncorrelated with the total. Based on the factor analysis results, only items with an adequate factor loading, or were face valid or unique items for their respective factor domain, were retained. A final 22-item CCDS was supported. CONCLUSIONS The CCDS demonstrated a five-factor structure and the 22-item version was psychometrically sound. The factors that emerged are consistent with the disease-specific distress domains identified in other pediatric health populations (e.g., type 1 diabetes), as well as symptom-related distress as found in adults with IBD. Further validation of the measure is warranted, including assessment of the psychometric soundness of the regimen-related subscale. To our knowledge, the CCDS is the first multifaceted IBD-specific distress instrument to be developed for use with pediatric patients and may allow for further specificity in the identification of IBD-specific distress in this population.

Individuals with diabetes who are of lower socioeconomic status (SES) are more likely to have poorer diabetes-related outcomes (e.g., poorer glycemic control and more avoidable complications). Digital health advancements provide unique opportunities to reduce health inequities for this high-risk group. This chapter addresses digital health interventions, including access to and use of these interventions by people of lower SES (P-LSES). In most cases, as technologies have progressed, they have become increasingly promising in their potential to meet the distinct needs of this high-risk group; however, it is largely unclear at this time whether these technologies are effective tools for P-LSES with diabetes, as research specific to this group has been limited. Future research must focus on digital technologies that are both purposefully designed for and thoughtfully delivered to individuals of lower SES; otherwise, technologies may further increase already existing disparities in diabetes outcomes across socioeconomic groups.

Introduction Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Method Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Results Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. Discussion These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record

There is growing evidence for the feasibility of text-based interventions for pediatric patients with type 1 diabetes (T1D). However, less is known regarding whether the use of personalized text messages with high-risk youth and their caregivers is associated with improvements in youth health. This study examines the use of diabetes-specific texts and associated health outcomes for participants of the Novel Interventions in Children's Healthcare (NICH) program.Text messages sent to youth with T1D and their caregivers during NICH intervention were coded regarding diabetes relevance and adherence-related content. Health outcome data (eg, HbA1c values, hospital admissions) prior to and following NICH program enrollment were collected.Fewer than half (43%) of texts sent to patients and their caregivers were identified as being related to diabetes, and over 95% of diabetes-related texts were identified as adherence-related. Participants in the NICH program demonstrated a significant decrease in HbA1c values, t(23) = 2.78, p ≤ .05, and DKA-related hospital visits, t(24) = 2.78, p ≤ .01, during program involvement. Although no relationships were identified between patient-recipient text characteristics and health outcomes, the frequency and type of text messaging with caregivers was significantly associated with changes in health outcomes.This study represents the most extensive evaluation of diabetes-related SMS use and health outcomes for NICH participants to date. Findings demonstrate improvements in patient health during NICH program involvement. Implications include that sending frequent, personalized, and adherence-reinforcing texts to patients' caregivers may result in improved patient health, decreased utilization, and, potentially, associated reductions in health care costs.

Background: Text message interventions are feasible, preferable, and sometimes effective for youth with diabetes. However, few, if any studies, have examined the personalized use of text messages with youth repeatedly hospitalized for diabetic ketoacidosis (DKA) and their caregivers. This study characterizes the use of personalized text messages in Novel Interventions in Children’s Healthcare (NICH). Methods: Approximately 2 months of text messages sent to youth with repeat DKA and their caregivers were logged regarding the following text characteristics: (1) content, (2) intervention type, (3) timing, and (4) recipient characteristics. Results: NICH interventionists sent 2.3 and 1.5 texts per day to patients and caregivers, respectively. Approximately 59% of outgoing texts occurred outside of typical business hours, and roughly 68% of texts contained some form of support and/or encouragement. The relation between type of intended intervention and day/time of text was significant, χ2(2, N = 5,808) = 266.93, P < .001. Interventionists were more likely to send behavioral intervention text messages outside of business hours, whereas they were more likely to send care coordination and case management text messages during business hours. Conclusions: To our knowledge, this is the first study to specifically categorize and describe the personalized use of text messages with youth repeatedly hospitalized for DKA and their caregivers. Findings indicate that a promising treatment program for these youth frequently used text interventions to deliver praise and encouragement to patients and caregivers alike, often outside of typical business hours, and tailored text content based on patient and caregiver characteristics.

Managing diabetes is known to be invasive, pervasive, and unrelenting, making adherence to the treatment regimen difficult to accomplish. Ongoing clinical and research efforts have attempted to address the struggles faced by youth and adults with diabetes. Recent research supports the integration of behavioral interventions into clinical practice to assist patients and families with the goal of improving health outcomes. Empirically supported and well-documented behavioral learning principles, particularly positive reinforcement, are often underutilized in modern diabetes care. We posit that most diabetes care providers are aware of these principles. However, the constraints of today’s medical systems have become significant barriers to purposefully and consistently applying them to promote improved diabetes care. We provide a brief overview of basic behavioral principles and common barriers to implementation, discuss relevant interventions, and present several examples of applications in clinical settings. We conclude with recommendations to raise awareness regarding the importance of consistently integrating relevant behavioral learning principles and interventions into diabetes care settings.

Diabetic ketoacidosis (DKA) is associated with negative health outcomes and high costs for patients, families, and communities. Interventions developed to effectively reduce DKA and related costs should target the multiple risk factors associated with DKA and adherence difficulties. Certain demographic, psychological, and family factors are associated with increased risk for adherence problems and DKA. Individuals with a combination of risk factors (e.g., mental health problems, low socioeconomic status, high family conflict) may be particularly vulnerable to DKA. Although several different interventions have demonstrated promise in improving adherence and/or decreasing the risk of DKA, the generalizability of treatment results to those individuals most vulnerable to DKA is limited. Approaches which include multiple evidence-based components of care, are flexible in treatment delivery (e.g., home- and community-based, utilize technology), and target the multiple risk factors across relevant systems (e.g., individual, family, school, medical) are warranted to effectively reduce DKA in vulnerable populations.