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Background: Older adults have higher healthcare utilization after liver transplantation (LT), yet objective risk stratification tools in this population are lacking. We evaluated the Liver Frailty Index (LFI) as one potential tool. Methods: Ambulatory LT candidates ≥65 years without hepatocellular carcinoma (HCC) who underwent LT from 1/2012 to 6/2022 at 8 U.S. centers were included. Estimates of the difference in median using quantile regression were used to assess the adjusted association between LFI and hospitalized days within 90 days post‐LT. Results: Of 131 LT recipients, median (interquartile range [IQR]) (1st‐3rd quartiles) age was 68 years (66‐70); median pre‐LT MELD‐Na was 19 (15‐24). Median LFI was 4.1 (3.6‐4.7); 27% were frail (LFI≥4.5). Median hospitalized days within 90 days post‐LT was 11 (7‐20). Compared with non‐frail patients, frail patients were hospitalized for a median of 5 days longer post‐LT (95% CI.30‐9.7, p =.04). Each.5 unit increase in pre‐LT LFI was associated with an increase of 1.16 days (95%CI.42‐2.69, p =.02) in hospitalized days post‐LT. Conclusion: Among older adults undergoing LT, frailty was associated with more hospitalized days within 90 days after LT. The LFI can identify older adults who might benefit from pre‐LT or early post‐LT programs which may reduce post‐LT healthcare utilization, such as early rehabilitation or post‐hospital discharge programs. [ABSTRACT FROM AUTHOR]

Background: Patients with obesity have inferior outcomes after general surgery procedures, but studies evaluating post‐liver transplant (LT) outcomes have been limited by small sample sizes or lack of granularity of outcomes. We evaluated the relationship between obesity and post‐LT outcomes, including those observed in other populations to be obesity‐related. Methods: Included were 1357 LT recipients prospectively enrolled in the ambulatory pre‐LT setting at 8 U.S. centers. Recipient were categorized by body mass index (BMI, kg/m2): non‐obese (BMI < 30), class 1 obesity (BMI 30–<35), and classes 2–3 obesity (BMI ≥ 35). Post‐transplant complications were compared by BMI using Chi‐square and rank‐sum testing, logistic regression, Kaplan‐Meier curves, and Cox regression. Results: Classes 2–3 obesity was associated with higher adjusted odds than non‐obesity of venous thrombosis [adjusted odds ratio (aOR) 2.06, 95% CI 1.01–4.23, p =.047] and wound dehiscence (aOR 2.45, 95% CI 1.19–5.06, p =.02). Compared with non‐obese recipients, post‐LT hospital stay was significantly longer for recipients with classes 2–3 obesity [p =.01; median (Q1–Q3) 9 (6–14) vs. 8 (6–12) days) or class 1 obesity [p =.002; 9 (6–14) vs. 8 (6–11) days]. Likelihood of ICU readmission, infection, discharge to a non‐home facility, rejection, 30‐day readmission, and 1‐year readmission were similar across BMI categories (all p >.05). Conclusion: Compared to non‐obese recipients, obese recipients had similar post‐LT survival but longer hospital stay and higher likelihood of wound dehiscence and venous thrombosis. These findings underscore that obesity alone should not preclude LT, but recipients with obesity should be monitored for obesity‐related complications such as wound dehiscence and venous thrombosis. [ABSTRACT FROM AUTHOR]

Sleep problems are common in autistic children and adversely impact daytime functioning. Knowledge of predictive factors could help with treatment and prevention of these problems. This study aimed to determine predictors of sleep problems among young autistic children. Study cohorts consisted of autistic children aged 2–5 years who did not have sleep problems at a first visit and had sleep measure data available at a subsequent visit. Sleep problems for five study cohorts were defined by different methods: Children's Sleep Habits Questionnaire with two cutoff scores (41 and 48; cohort n = 101 and 204, respectively), Children's Sleep Habits Questionnaire–autism derived cutoff score (35; n = 188), and parent- (n = 205) or clinician- (n = 252) report. Separate predictive models of sleep problems were developed in each cohort using multivariable logistic regression with final model predictors determined by backward elimination selection. Model performance was evaluated. Two of the five models had both adequate discrimination and calibration performance predicting (1) Children's Sleep Habits Questionnaire score ⩾ 48 and (2) Children's Sleep Habits Questionnaire–autism score ⩾ 35. In both models, self-injurious behavior, sensory issues, dental problems, and lower primary caregiver education level were significant risk factors of future sleep problems. These predictors may be useful in helping clinicians provide prevention strategies or early intervention for children who are at a higher risk of developing sleep problems. Sleep problems are common in autistic children and negatively impact daytime functioning. A method for predicting sleep problems could help with treatment and prevention of such problems. This study aimed to determine predictors of sleep problems among young autistic children. Study participants consisted of autistic children aged 2–5 years who did not have sleep problems at a first visit (Autism Treatment Network Registry) and had sleep data available at a subsequent visit (Registry Call-Back Assessment study). Sleep problems for five study cohorts of children were defined by different methods, including parent questionnaires and parent- or clinician-report of sleep problems. We found that self-injurious behavior, sensory issues, dental problems, and lower primary caregiver education level were significant risk factors of future sleep problems. These predictors may help clinicians provide prevention or earlier treatment for children who are at risk of developing sleep problems. [ABSTRACT FROM AUTHOR]

Simple Summary: This was a retrospective single center analysis of 298 consecutive patients with HCC who underwent liver transplant. We sought to understand the impact that the number and type of local regional therapies (LRTs) have on peri-operative outcomes and complications after liver transplantation. The patients who received more than 3 LRTs prior to a liver transplant had a higher risk of biliary leak but otherwise similar outcomes to those who received fewer LRTs. The wait times for patients with hepatocellular carcinoma (HCC) listed for liver transplant are longer than ever, which has led to an increased reliance on the use of pre-operative LRTs. The impact that multiple rounds of LRTs have on peri-operative outcomes following transplant is unknown. This was a retrospective single center analysis of 298 consecutive patients with HCC who underwent liver transplant (January 2017 to May 2021). The data was obtained from two institution-specific databases and the TransQIP database. Of the 298 patients, 27 (9.1%) underwent no LRTs, 156 (52.4%) underwent 1-2 LRTs, and 115 (38.6%) underwent ≥3 LRTs prior to LT. The patients with ≥3 LRTs had a significantly higher rate of bile leak compared to patients who received 1-2 LRTs (7.0 vs. 1.3%, p = 0.014). Unadjusted and adjusted regression analyses demonstrated a significant association between the total number of LRTs administered and bile leak, but not rates of overall biliary complications. The total number of LRTs was not significantly associated with any other peri-operative or post-operative outcome measure. These findings support the aggressive use of LRTs to control HCC in patients awaiting liver transplant, with further evaluation needed to confirm the biliary leak findings. [ABSTRACT FROM AUTHOR]

Elevated caregiver strain is common and linked to poor health in parents of children with autism. Yet, little research has examined caregiver strain longitudinally and in geographically diverse samples of parents whose children have autism. This study aimed to (1) examine change in caregiver strain and (2) determine correlates of improved caregiver strain in North American parents of children with autism. This was a secondary analysis of data from the Autism Treatment Network Registry Call-Back Study, conducted from 2015 to 2017 on a random sample of children with autism spectrum disorder at 12 clinical sites in the United States or Canada. Child assessments and parent-reported questionnaires were completed at two time points 1year apart. Caregiver strain was assessed with the Caregiver Strain Questionnaire. In total, 368 children had caregiver strain data at both times. Mean caregiver strain in parents did not significantly change between Times 1 and 2 (mean difference=0.05, t(360)=0.1, p=0.92). Improved caregiver strain between Times 1 and 2 was associated with improved child adaptive functioning and externalizing problem behaviors. Caregiver strain was persistent and multi-factorial. Parent training to manage challenging child behaviors and adaptively cope may benefit this vulnerable parent population. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common in autistic children and adversely impact daytime functioning. The Children's Sleep Habits Questionnaire (CSHQ) [39] was developed from a community-based sample of children and has validated a cut-off score of 41. Katz et al. [50] developed an abbreviated 23-item four-factor version of the CSHQ, which may be useful when assessing sleep in autistic children. However, a cut-off value has not yet been developed.Objective: Our objective was to develop and validate a cut-off for the CSHQ-autism total score in order to identify sleep problems among autistic children. We hypothesized that the derived cut-off value for the CSHQ-autism would perform better than the original CSHQ cut at 41 on validation in a sample of autistic children.Methods: Age-specific cut-off values were developed and validated using receiver operating characteristic analysis.Results: The derived cut-off values for the CSHQ-autism total score were 34, 35, 33, and 35 for the 2-3, 4-10, 11-17, and 2-17 years age groups, respectively. On validation, all cut-off values performed with moderate to high sensitivity (76.6-82.4%) and moderate specificity (69.1-75.5%), while the original CSHQ cut at 41 had high sensitivity (89.9-93.0%) but low specificity (42.6-57.7%). Using McNemar's tests, the CSHQ-autism had significantly higher specificity but lower sensitivity than the original CSHQ cut at 41 in all age groups.Conclusions: The CSHQ-autism cut-off values performed better overall than the original CSHQ cut at 41 in a sample of autistic children. The CSHQ-autism cut-off can help identify sleep problems among autistic children. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised that scores on standard measures of autism spectrum disorder (ASD) symptoms may differ as a function of sex. However, these findings are hindered by small female samples studied thus far. The current study evaluated if, after accounting for age, IQ, and language level, sex affects ASD severity estimates from diagnostic measures among children with ASD. Methods: Data were obtained from eight sources comprising 27 sites. Linear mixed‐effects models, including a random effect for site, were fit for 10 outcomes (Autism Diagnostic Observation Schedule [ADOS] domain‐level calibrated severity scores, Autism Diagnostic Interview–Revised [ADI‐R] raw scores by age‐based algorithm, and raw scores from the two indices on the Social Responsiveness Scale [SRS]). Sex was added to the models after controlling for age, NVIQ, and an indicator for language level. Results: Sex significantly improved model fit for half of the outcomes, but least square mean differences were generally negligible (effect sizes [ES] < 0.20), increasing to small to moderate in adolescence (ES < 0.40). Boys received more severe RRB scores than girls on both the ADOS and ADI‐R (age 4 + algorithm), and girls received more severe scores than boys on both SRS indices, which emerged in adolescence. Conclusions: This study combined several available databases to create the largest sample of girls with ASD diagnoses. We found minimal differences due to sex beyond other known influences on ASD severity indicators. This may suggest that, among children who ultimately receive a clinical ASD diagnosis, severity estimates do not systematically differ to such an extent that sex‐specific scoring procedures would be necessary. However, given the limitations inherent in clinically ascertained samples, future research must address questions about systematic sex differences among children or adults who do not receive clinical diagnoses of ASD. Moreover, while the current study helps resolve questions about widely used diagnostic instruments, we could not address sex differences in phenotypic aspects outside of these scores. Read the Commentary on this article at doi: 10.1111/jcpp.13284 [ABSTRACT FROM AUTHOR]

Background: Sleep difficulties in children with autism spectrum disorders (ASD) have been well-established.Aims: To develop a model to predict sleep problems in children with ASD.Methods and Procedures: A sample of children in the Autism Speaks-Autism Treatment Network (ATN) registry without parent-reported sleep problems at baseline and with sleep problem (yes/no) data at first annual followup was randomly split into training (n = 527) and test (n = 518) samples. Model predictors were selected using the training sample, and a threshold for classifying children at risk was determined. Comparison of the predicted and true sleep problem status of the test sample yielded model performance measures.Outcomes and Results: In a multivariable model aggressive behavior among children with no sleep problems reported at baseline was associated with having more sleep problems at the first annual follow-up visit. This model performed in the test sample with high sensitivity and accurate prediction of low risk.Conclusions and Implications: Among children with ASD aggressive behavior independently predicts sleep problems. The model's high sensitivity for identifying children at risk and its accurate prediction of low risk can help with treatment and prevention of sleep problems. Further data collection may provide better prediction through methods requiring larger samples. [ABSTRACT FROM AUTHOR]

Background: Anorectal malformations (ARMs) have an incidence of up to 1 in 4000 live births and can require immediate neonatal surgery due to associated intestinal blockage. Due to limited surgical access, Ugandan children present late and undergo three separate staged operations: (1) initial colostomy formation; (2) repair of the ARM (called anoplasty); and (3) colostomy closure. Three operations result in long treatment duration, potential complications with each procedure, delays in care, and stigmata associated with colostomies. By offering primary repair for ARMs in a resource-limited setting, we expect to: reduce healthcare expenditure by families, length of treatment, length of hospital stay, frequency of hospital visits, and social rejection. Materials and methods: A pragmatic clinical trial was performed examining the effectiveness of primary repair (prospective arm) and comparing it with the three-stage repairs (retrospective arm). Results: Of the 241 patients included for analysis—157 patients had a three-stage repair, whereas 84 patients had one- or two-stage repair. The median [IQR age at the last surgery (days) was 730.0 (365.0, 1460.0) vs 180.0 (90.0, 285.0)] in three-stage and one- or two-stage repairs, respectively. There was no difference in postoperative complications compared to patients who had three-stage repair. Patients who had a two-stage repair had less time with colostomy than those with three-stage repair. Non-inferiority analysis demonstrated that the primary repair approach was non-inferior to the three-stage approach. Conclusions: Primary repair for ARM is effective in low-income settings. It allows for less time with colostomy with no difference in post-operative complications. The decision on approach for treatment depends on the surgeon's experience and clinical judgment. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aims Methods Results Conclusions Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking.Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety‐net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD‐7), Patient Health Questionnaire (PHQ‐8), Alcohol Use Disorders Identification Test (AUDIT), COVID‐19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1–10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre‐specified variables' associations with importance and confidence.The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1–Q3) AUDIT score was 16 (12–24), importance was 9 (6–10) and confidence was 8 (5–9). On multivariable analysis, VA site (vs. SN) participants had a 0.97‐point lower importance score (p = 0.02); higher symptoms of depression (PHQ‐8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes.Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology‐based interventions. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to determine the relationship between postoperative weight change and breast cancer–related lymphedema (BCRL). Methods: In this cohort study, 1161 women underwent unilateral breast surgery for breast cancer from 2005 to 2020 and were prospectively screened for BCRL. Arm volume measurements were obtained via an optoelectronic perometer preoperatively, postoperatively, and in the follow‐up setting every 6 to 12 months. Mean follow‐up from preoperative baseline was 49.1 months. The main outcome was BCRL, defined as a relative volume change of the ipsilateral arm of ≥10% at least 3 months after surgery. Results: A total of 92 patients (7.9%) developed BCRL. Net weight loss versus net weight gain from baseline to last follow‐up was not protective against developing BCRL (hazard ratio, 1.38; 95% confidence interval, 0.89‐2.13; P =.152). Conclusions: Although weight loss may be recommended as part of an individualized lifestyle management program for overall health, weight loss alone may not decrease the risk of developing BCRL. Weight loss, when compared to weight gain, does not decrease the risk of breast cancer–related lymphedema (hazard ratio, 1.38; 95% confidence interval, 0.89‐2.13; P =.152). [ABSTRACT FROM AUTHOR]

Lower extremity (LE) vascular disease and adverse cardiovascular events (ACEs) cause significant long‐term morbidity after simultaneous pancreas‐kidney (SPK) transplantation. This study's purpose was to describe the incidence of, and risk factors associated with, LE vascular complications and related ACEs following SPK. All SPKs performed at the authors' institution from 2000 to 2019 were retrospectively analyzed. The primary outcome was any LE vascular event, defined as LE endovascular intervention, open surgery, amputation, or invasive podiatry intervention. Secondary outcomes included post‐SPK ACE. A total of 363 patients were included, of whom 54 (14.9%) required at least one LE vascular intervention following SPK. Only 3 patients received pre‐SPK ankle brachial indices (ABIs). A history of peripheral artery disease (PAD) (HR 2.95, CI 1.4‐6.2) was a risk factor for post‐SPK LE vascular intervention even after adjustment for other factors. Fifty‐nine (16.3%) patients experienced an ACE in follow‐up. Requiring a LE intervention post‐SPK was associated with a subsequent ACE (HR 2.3, CI 1.2‐4.5). LE vascular and cardiovascular complications continue to be significant sources of morbidity for SPK patients, especially for patients with preexisting PAD. The highest risk patients may benefit from more intensive pre‐ and post‐SPK workup with ABIs and follow‐up with a vascular surgeon. [ABSTRACT FROM AUTHOR]

Background: Anorectal malformations (ARMs) have an incidence of up to 1 in 4000 live births and can require immediate neonatal surgery due to associated intestinal blockage. Due to limited surgical access, Ugandan children present late and undergo three separate staged operations: (1) initial colostomy formation; (2) repair of the ARM (called anoplasty); and (3) colostomy closure. Three operations result in long treatment duration, potential complications with each procedure, delays in care, and stigmata associated with colostomies. By offering primary repair for ARMs in a resource-limited setting, we expect to: reduce healthcare expenditure by families, length of treatment, length of hospital stay, frequency of hospital visits, and social rejection. Materials and methods: A pragmatic clinical trial was performed examining the effectiveness of primary repair (prospective arm) and comparing it with the three-stage repairs (retrospective arm). Results: Of the 241 patients included for analysis—157 patients had a three-stage repair, whereas 84 patients had one- or two-stage repair. The median [IQR age at the last surgery (days) was 730.0 (365.0, 1460.0) vs 180.0 (90.0, 285.0)] in three-stage and one- or two-stage repairs, respectively. There was no difference in postoperative complications compared to patients who had three-stage repair. Patients who had a two-stage repair had less time with colostomy than those with three-stage repair. Non-inferiority analysis demonstrated that the primary repair approach was non-inferior to the three-stage approach. Conclusions: Primary repair for ARM is effective in low-income settings. It allows for less time with colostomy with no difference in post-operative complications. The decision on approach for treatment depends on the surgeon's experience and clinical judgment. [ABSTRACT FROM AUTHOR]

Liver transplant (LT) recipients have a high burden of cognitive impairment risk factors identified in other populations, yet little work has explored cognition in the United States LT population. We characterized prevalence of cognitive impairment (CI) in LT recipients pre‐LT and ≥3 months post‐LT. Adult LT recipients with cirrhosis but without active pre‐LT hepatic encephalopathy (HE) were screened for CI using the Montreal Cognitive Assessment (MoCA) for CI (MoCA <24) both pre‐LT and ≥3 months post‐LT. The association between cognitive performance and recipient characteristics was assessed using logistic regression. Of 107 LT recipients, 36% had pre‐LT CI and 27% had post‐LT CI [median (Q1–Q3) MoCA 26 (23–28)]. Each 1‐point increase in pre‐LT MoCA was associated with 26% lower odds of post‐LT cognitive impairment (aOR.74, 95% CI.63–.87, p <.001), after adjusting for recipient age, history of HE, and time since LT. In this study of cirrhosis recipients without active pre‐LT HE, cognitive impairment was prevalent before LT and remained prevalent ≥3 months after LT (27%), long after effects of portal hypertension on cognition would be expected to have resolved. Our data expose an urgent need for more comprehensive neurologic examination of LT recipients to better identify, characterize, and address predictors of post‐LT cognitive impairment. [ABSTRACT FROM AUTHOR]

Alpha-fetoprotein (AFP) predicts hepatocellular carcinoma (HCC) recurrence after liver transplant (LT) but remains an imperfect biomarker. The role of DCP (des-gamma-carboxyprothrombin) and AFP-L3 (AFP bound to Lens culinaris agglutinin) in predicting HCC recurrence remains incompletely characterized. AFP-L3 and DCP could identify patients at high risk of post-transplant HCC recurrence and serve as liver transplant exclusion criteria to defer transplant until patients receive additional risk-reducing pre-transplant locoregional therapy. This prospective cohort study included consecutive patients with HCC who underwent LT (within or down-staged to Milan criteria) between 2017 and 2022. Pre-transplant AFP, AFP-L3, and DCP measurements were obtained. The primary endpoint was the ability of biomarkers to predict HCC recurrence-free survival. This cohort included 285 patients with a median age of 67 (IQR 63-71). At LT, median biomarker values were AFP 5.0 ng/ml (IQR 3.0-12.1), AFP-L3 6.7% (0.5-13.2), and DCP 1.0 ng/ml (0.3-2.8). Most (94.7%) patients received pre-LT locoregional therapy. After a median post-LT follow-up of 3.1 years, HCC recurrence was observed in 18 (6.3%) patients. AFP-L3 and DCP outperformed AFP with C-statistics of 0.81 and 0.86 respectively, compared with 0.74 for AFP. A dual-biomarker combination of AFP-L3 ≥15% and DCP ≥7.5 predicted 61.1% of HCC recurrences, whereas HCC only recurred in 7 of 265 (2.6%) patients not meeting this threshold. The Kaplan-Meier recurrence-free survival rate at 3 years post-LT was 43.7% for patients with dual-positive biomarkers compared to 97.0% for all others (p <0.001). Dual-positivity for AFP-L3 ≥15% and DCP ≥7.5 strongly predicted post-LT HCC recurrence. This model could refine LT selection criteria and identify high-risk patients who require additional locoregional therapy prior to LT. Alpha-fetoprotein (AFP) is used to predict hepatocellular carcinoma (HCC) recurrence after liver transplant, but it remains an imperfect biomarker. In this prospective study, the biomarkers DCP (des-gamma-carboxyprothrombin) and AFP-L3 (AFP bound to Lens culinaris agglutinin) strongly predicted early HCC recurrence and outperformed AFP. A dual-biomarker combination of AFP-L3 ≥15% and DCP ≥7.5 predicted the majority of recurrences and could be used to further refine liver transplant eligibility criteria. [Display omitted] • Even when excluding patients outside Milan criteria with AFP ≥1,000 ng/ml, a subset still experiences post-transplant HCC recurrence. • A dual-positive biomarker model of AFP-L3 ≥15% and DCP ≥7.5 ng/ml strongly predicts the risk of early HCC recurrence. • AFP-L3 and DCP may help further refine liver transplant criteria for patients with HCC. • High-risk patients should receive additional tumor treatment prior to transplant to optimize the use of scarce organs. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder have deficits in adaptive functioning. This study examines the adaptive behavior, its association with cognitive ability, gender, age, and symptom severity in children with autism spectrum disorder. Using data from Autism Treatment Network registry, the adaptive behavior profiles were examined in 2538 school-aged children (between 5 and 17 years, mean: 8.8 years, standard deviation: 3.0) who had an overall intelligence quotient and Vineland Adaptive Behavior Scale scores available. The children were grouped according to their intelligence quotient (low intelligence quotient < 70; borderline intelligence quotient = 70–85; average intelligence quotient > 85), age (5–10 and 11–17 years), and gender for the analyses. Significantly lower Vineland Adaptive Behavior Scale scores were found in borderline and average intelligence quotient groups when compared to mean intelligence quotient, while an opposite pattern was seen in the low intelligence quotient group, with better adaptive behavior scores than mean intelligence quotient. Vineland Adaptive Behavior Scale standard scores were positively correlated with intelligence quotient and poorly associated with autism spectrum disorder severity. Younger children had significantly higher Vineland Adaptive Behavior Scale scores. Adjusted comparisons by gender were not significant. Adaptive behavior profiles in the intelligence quotient categories are discussed. This study confirms a positive relationship between adaptive behavior and intellectual function in autism and indicates that children with higher intelligence quotient and older age are specifically impaired, with lower adaptive behavior, highlighting the need for assessment and targeted intervention in these groups. Future directions for research are discussed. [ABSTRACT FROM AUTHOR]

Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children’s Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 children (age 4-10 years) enrolled in the Autism Treatment Network. A four-factor solution (Sleep Initiation and Duration, Sleep Anxiety/Co-Sleeping, Night Waking/Parasomnias, and Daytime Alertness) with 5-6 items per factor explained 75% of the total variation. Ten items failed to load on any factor. This abbreviated 23-item four-factor version of this measure may be useful when assessing sleep in children with ASD. [ABSTRACT FROM AUTHOR]

Background. Young children with autism spectrum disorder (ASD) often have gross motor delays that may accentuate problem daytime behavior and health- related quality of life (QoL). Objective. The objective of this study was to describe the degree of gross motor delays in young children with ASD and associations of gross motor delays with problem daytime behavior and QoL. The primary hypothesis was that Gross motor delays significantly modifies the associations between internalizing or externalizing problem daytime behavior and QoL. Design. This study used a cross-sectional, retrospective analysis. Methods. Data from 3253 children who were 2 to 6 years old and who had ASD were obtained from the Autism Speaks Autism Treatment Network and analyzed using unadjusted and adjusted linear regression. Measures included the Vineland Adaptive Behavior Scales, 2nd edition, gross motor v-scale score (VABS-GM) (for Gross motor delays), the Child Behavior Checklist (CBCL) (for Problem daytime behavior), and the Pediatric Quality of Life Inventory (PedsQL) (for QoL). Results. The mean VABS-GM was 12.12 (SD = 2.2), representing performance at or below the 16th percentile. After adjustment for covariates, the internalizing CBCL t score decreased with increasing VABS-GM (β = -0.64 SE = 0.12). Total and subscale PedsQL scores increased with increasing VABS-GM (for total score: β = 1.79 SE = 0.17; for subscale score: β = 0.9-2.66 SE = 0.17-0.25). CBCL internalizing and externalizing t scores decreased with increasing PedsQL total score (β = -0.39 SE = 0.01; β = -0.36 SE = 0.01). The associations between CBCL internalizing or externalizing t scores and PedsQL were significantly modified by VABSGM (β = -0.026 SE = 0.005]; β = -0.019 SE = 0.007). Limitations. The study lacked ethnic and socioeconomic diversity. Measures were collected via parent report without accompanying clinical assessment. Conclusions. Gross motor delay was independently associated with Problem daytime behavior and QoL in children with ASD. Gross motor delay modified the association between Problem daytime behavior and QoL. Children with ASD and co- occurring internalizing Problem daytime behavior had greater Gross motor delays than children without internalizing Problem daytime behavior; therefore, these children may be most appropriate for early physical therapist evaluation. [ABSTRACT FROM AUTHOR]

Objective: Differentiated thyroid cancer (DTC) is associated with an excellent prognosis, but patients with distant metastatic DTC have a 10-year disease-specific survival (DSS) of just 50%. The incidence of distant metastatic DTC has steadily increased in the United States since the 1980s. The aim of this study was to examine trends in survival and treatment for patients with distant metastatic DTC. Methods: In this population-based, retrospective cohort study, patients with distant metastatic DTC were identified from the Surveillance, Epidemiology, and End Results-13 cancer registry program. Multivariable logistic and Cox regression analyses were used to examine factors associated with DSS and management. Annual percentage changes in treatment patterns were calculated using log-linear regression. Results: During 1992–2018, 1991 patients (69.7% white, 58.0% female, 47.5% aged ≥65 years) were diagnosed with distant metastatic DTC. Papillary thyroid cancer was the most common histological type (74.5%). While the 10-year DSS for overall DTC increased over time (95.4% for patients diagnosed in 1992–1998, 96.6% in 1999–2008, and 97.3% in 2009–2018; p < 0.01), 10-year DSS for DTC with distant metastases did not change (50.2%, 47.3%, and 52.4%, respectively; p = 0.48). Ten-year DSS rates were reduced for patients aged ≥65 years (28.1%), patients undergoing nonsurgical treatment with external beam radiation therapy and/or systemic therapy (6.0%), and patients undergoing no/unknown treatment (32.8%). On multivariable analysis, oncocytic carcinoma, age 65–79 and ≥80 years, male sex, node-positive disease, larger tumor size, nonsurgical treatment, and no/unknown treatment were associated with increased risk of thyroid cancer death. Between 1992 and 2018, the rate of nonsurgical treatment increased, on average, 1.3% per year (1992–1998: 22.9% vs. 2009–2018: 25.6%; p = 0.03), and the rate of patients receiving no/unknown treatment increased 1.9% per year (1992–1998: 11.3% vs. 2009–2018: 15.6%; p = 0.01). Patients aged 65–79 and ≥80 years were more likely than younger patients to receive nonsurgical management or no/unknown treatment. Conclusion: Patients diagnosed with distant metastatic DTC have experienced no improvement in DSS over the past three decades. An increasing proportion of patients diagnosed with distant metastatic DTC are receiving nonsurgical treatment or no/unknown treatment over time; the proportion was highest among the oldest patients. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Depression is commonly associated with autism spectrum disorder (ASD) across the life span. We sought to identify medical and behavioral problems associated with a history of a parent-reported diagnosis of depression in a large sample of school-aged children and adolescents with ASD. METHODS: A sample of 1272 participants (aged 6-17 years; mean [SD]: 9.56 [2.79] years) from the Autism Speaks Autism Treatment Network consortium were divided into "ever-depressed" (n = 89) and "nondepressed" (n = 1183) groups on the basis of caregiver endorsement of children's current or previous diagnoses of depression. RESULTS: In total, 7.0% of children with ASD (4.8% of those aged 6-12 years and 20.2% of those aged 13-17 years) were reported to have a history of a depression diagnosis. Positive depression history was associated with greater chronoloical age, higher IQ, and Asperger disorder diagnosis. After controlling for age, IQ, and within-spectrum categorical diagnosis, the ever-depressed group exhibited significantly greater rates of seizure disorders (odds ratio = 2.64) and gastrointestinal problems (odds ratio = 2.59) and trend-level differences in aggression, somatic complaints, and social impairments. The groups did not differ in autism severity, repetitive behaviors, sleep problems, eating problems, self-injurious behavior, or current intervention use. CONCLUSIONS: Co-occurring depression is a particularly common problem in higher-functioning older children within the Autism Treatment Network. Our findings indicate that children with ASD and a history of a depression diagnosis are more likely to also have co-occurring medical problems, although the presence and direction of causality is unclear. [ABSTRACT FROM AUTHOR]

Dental care received by children in the Autism Speaks Autism Treatment Network (ATN) was compared to National Survey of Children's Health (NSCH) data for children without special healthcare needs and children with parent-reported ASD. Correlates of obtained preventive dental services were examined within the ATN sample. Participants included 375 families of children ages 4 to 17 enrolled in the ATN. ATN families reported levels of preventive dental care that were similar to, or exceeded, NSCH-reported care. However, disparities in obtained preventive dental services emerged within the ATN sample. Lower intellectual functioning was the most consistent correlate of reduced access to and completion of preventive dental care. Implications for developing system-wide supports and targeted interventions are discussed. [ABSTRACT FROM AUTHOR]

Background: Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance.Methods: We performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty participants who met inclusion criteria and whose insomnia did not respond to sleep education were randomized to 3 mg/kg/day of ferrous sulfate (n = 9) or placebo (n = 11) for three months.Results: Iron supplementation was well tolerated, and no serious adverse events were reported. Iron supplementation improved iron status (+18.4 ng/mL active versus -1.6 ng/mL placebo, P = 0.044) but did not significantly improve the primary outcome measures of sleep onset latency (-11.0 minutes versus placebo, 95% confidence interval -28.4 to 6.4 minutes, P = 0.22) and wake time after sleep onset (-7.7 minutes versus placebo, 95% confidence interval -22.1 to 6.6 min, P = 0.29) as measured by actigraphy. Iron supplementation was associated with improvement in the overall severity score from the Sleep Clinical Global Impression Scale (-1.5 points versus placebo, P = 0.047). Changes in measures of daytime behavior did not differ between groups.Conclusion: This trial demonstrated no improvement in primary outcome measures of insomnia in subjects treated with ferrous sulfate compared with placebo. Interpretation was limited by low enrollment. [ABSTRACT FROM AUTHOR]

The article discusses a study which described early generlized overgrowth in a subgroup of children with autism spectrum disorder (ASD) given the suggestion that overgrowth may be associated with a particular pattern of cognitive and social impairment in ASD. It cites hypothesis that early generalized overgrowth may serve as a biomarker for a distinct subgroup of children with ASD.