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Autism spectrum disorder (ASD) is clinically characterized by social and communication difficulties as well as repetitive behaviors. Many children with ASD also suffer from anxiety, which has been associated with alterations in amygdala structure. In this work, the association between amygdala subnuclei volumes and anxiety was assessed in a cohort of 234 participants (mean age = 11.0 years, SD = 3.9, 95 children with ASD, 139 children were non-autistic). Children underwent magnetic resonance imaging. Amygdala subnuclei volumes were extracted automatically. Anxiety was assessed using the Screen for Child Anxiety Related Disorders, the Child Behavior Checklist, and the Strength and Difficulties Questionnaire. Children with ASD had higher anxiety scores relative to non-autistic children on all anxiety measures (all, p < 0.05). Anxiety levels were significantly predicted in children with ASD by right basal (right: B = 0.235, p = 0.002) and paralaminar (PL) (B = −0.99, p = 0.009) volumes. Basal nuclei receive multisensory information from cortical and subcortical areas and have extensive projections within the limbic system while the PL nuclei are involved in emotional processing. Alterations in basal and PL nuclei in children with ASD and the association with anxiety may reflect morphological changes related to in the neurocircuitry of anxiety in ASD. Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala's subregions in MRI may reveal specific anxiety-related associations in children with ASD. [ABSTRACT FROM AUTHOR]

Background: Recent experience in designing and running clinical trials on new medications for the prevention of migraine in children and adolescents highlighted the need for revision of the 1st edition of the International Headache Society Guidelines for clinical trials of preventive treatment of migraine in children and adolescents which were published in 2019. Methods: The authors of the 1st edition of the guidelines formed an informal focus group with aims of appraising the performance of the guidelines, clarifying any ambiguity and providing improvements, where needed, based on personal experience and expert analysis. Results: This review and the following update were able to address issues related to the classification of migraine, the duration of migraine attacks, the age groups of children and adolescents, the use of electronic diaries, the assessment of outcome measures, the need for an interim analysis and the issues related to placebo response. Conclusions: This update provides necessary clarifications of the guidelines in order to enable better design and running of future clinical trials for the preventive treatment of migraine in children and adolescents. [ABSTRACT FROM AUTHOR]

This study focused on psycho-affective and behavioral problems in children and adolescents with dyslexia. It aims to define clinical psycho-affective and behavioral profiles of dyslexia beyond those found in existing descriptions of the cognitive, neural, and behavioral correlates. The study focused specifically on the understudied population of native Italian-speaking students. Characteristics of anxiety and self-esteem, as psycho-affective factors, and a variety of associated behavioral problems were studied in a sample of children and adolescents with dyslexia (n = 22) and compared to those of a group without learning disabilities (n = 25). The findings suggest the group of participants diagnosed with dyslexia exhibited psycho-affective symptoms, especially anxiety and low self-esteem in social and academic situations more frequently than the control group. These problems were related to reading measures. More research is needed to determine how they are related and their interaction. Overall, these findings are useful in clarifying the profile of psycho-affective symptoms in the development of academic difficulties in children and adolescents with dyslexia. In some cases, school personnel focus their interventions only on the academic difficulties and not the psycho-affective or behavioral problems. These findings could have implications regarding intervention for this population. [ABSTRACT FROM AUTHOR]

In the article the authors detail the lifestyle medicine program launched by Edison Young People, a company that offer therapeutic and residential care and education to vulnerable children and young people (CYP) in Great Britain, aimed at helping CYP in developing healthy daily habits. Topics include the resources utilized in developing the 12 sessions, monitoring of the emotional wellbeing of CYP through various questionnaires, and the learning objectives and outcomes of each session.

Background: Omalizumab is currently approved for the treatment of moderate-to-severe allergic asthma in patients 6 years and older. Objective: To assess the effectiveness and safety of subcutaneous omalizumab as an add-on therapy option for moderate–severe allergic asthma in patients aged 6—20 years old. Methods: The studies published from July, 1970 to May, 2021 were searched from the electronic databases which followed keywords: ("anti-IgE" OR "anti-immunoglobulin E" OR "anti-IgE antibody" OR "omalizumab" OR "rhuMAb-E25" OR "Xolair") AND "asthma" AND ("child" OR "children" OR "adolescents" OR "youth" OR "teenager" OR "kids" OR "pediatric"). Thirteen studies were pooled to determine the effectiveness and safety of omalizumab. Efficacy endpoints were evaluated using a fixed-effects model or a random-effects model depending on heterogeneity. Safety endpoints were evaluated by odds ratio. Results: Thirteen studies were included. In this meta-analysis, our results showed that fractional exhaled nitric oxide and asthma control test scores were significantly improved with omalizumab treatment. Serum immunoglobulin E was also decreased in children with moderate-to-severe asthma after treatment with omalizumab. The analysis found that there was no significant difference between pre-and post-treatment in forced expiratory volume in one second/ forced vital capacity ratio, forced expiratory flow between 25 and 75% of vital capacity, or FEV1. Overall, more adverse events occurred with omalizumab compared to placebo. However, the degree was mild to moderate. Conclusion: This meta-analysis indicates that omalizumab is safe and effective to treat children and adolescents with moderate-to-severe asthma. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). Design: Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). Settings: Multicenter study in two public hospitals. Patients: A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. Main Outcome Measure: Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. Results: A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p =.034), had cleft involving embryonic secondary palate (PSQ-22, p =.009), and history of fixed orthodontic treatment (ESS, p =.002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p =.015). Conclusions: OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques. Materials and methods: A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool. Results: After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3–157.1), suction diathermy (MD, 117.1; 95% CI 37.2–197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01–0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue. Conclusion: There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children. [ABSTRACT FROM AUTHOR]

The term level of care is utilized in mental health care to refer to the different ways in which treatment can be delivered, including qualitative (e.g., modality, approach, setting) and quantitative (e.g., number of sessions, frequency of sessions) variations in services. The concept is often embedded in models of care and measures, yet there is no agreed upon definition or understanding of what it encompasses. A scoping review of level of care conceptualizations in models of care, and triage and service use measures was conducted. Twenty-nine conceptualizations across 63 articles were identified, 12 focused on qualitative components, four on quantitative components, and 13 on a combination of qualitative and quantitative components. A conceptual model to integrate the literature reviewed is proposed. [ABSTRACT FROM AUTHOR]

Background: Despite initiatives to reduce central line–associated bloodstream infection (CLABSI), children and adolescents with hematologic malignancies, as well as those with relapsed disease, remain at the greatest risk for infection. This single-institution project evaluated changes in CLABSI rates following implementation of antibacterial prophylaxis with levofloxacin for patients with high-risk hematologic malignancies. Methods: Positive blood culture events meeting National Health Safety Network surveillance criteria to be classified as CLABSIs from January 1, 2006, to December 31, 2019, were included. Data were organized into four time periods for comparison based on implementation of CLABSI-reduction interventions. Conditional Poisson regression models were used to evaluate the effect of time (intervention period) on CLABSI rates with post hoc Tukey pairwise comparisons between each of the four time periods. Results: From 2006 and 2019, 227 patients experienced 310 CLABSIs. Clinically important decreases in CLABSI rates from baseline (4.84 per 1,000 line days) occurred with implementation of Children's Hospital Association (CHA) bundles (3.29 per 1,000 line days); however, this difference was not significant (p =.16). CLABSI rates decreased from baseline with the addition of formalized supportive cares (2.66 per 1,000 line days; incidence rate ratio [IRR] = 0.60; p <.01), and with the use of antibacterial prophylaxis (1.66 per 1,000 line days; IRR = 0.35; p <.01). Post hoc comparisons indicated decreased CLABSI rates with the use of antibacterial prophylaxis compared with CHA bundles alone (IRR = 0.49; p =.011) and CHA bundles plus formalized supportive cares (IRR = 0.58; p =.046). Discussion: Results demonstrate sustained success using a practice-based evidence approach to guide CLABSI-reduction interventions. Follow-up research, applying machine learning algorithms, may identify additional risk factors and inform future interventions. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a common childhood condition. Up until recent years, the mainstay of long-term control treatment has been inhaled corticosteroids. While inhaled corticosteroids are very effective for most children with asthma, with the introduction of biologic therapies, additional options now exist for children with uncontrolled moderate to severe asthma. Purpose: The purpose of this Practice Update is to provide nursing professionals with a summary of the biologic therapies currently available for the pediatric population and, to describe when they are indicated for inclusion in the plan of care for children with moderate to severe asthma. Conclusion: By properly diagnosing asthma, and, selecting and administering appropriate asthma therapies, nursing professionals can help children with moderate to severe asthma lead healthy and active lives. [ABSTRACT FROM AUTHOR]

The study aimed to explore the development trend of positive mental health and the interaction between adolescents' perceived family support and positive mental health. A 3-year longitudinal survey of perceived family support and positive mental health (resilience and self-efficacy) for four waves was conducted with 564 junior high school students (297 girls, mean age = 11.12 ± 0.38 years at baseline). The Latent Growth Curve Modeling indicated that adolescents' resilience and general self-efficacy showed a curve upward trend, which increased first and then decreased. The development rate decreased each year. The cross-lagged panel model and a random intercept cross-lagged panel model concluded that perceived family support was strongly associated with positive mental health of junior high school students. Family support was important for developing positive mental health in early adolescence. Therefore, attention and interventions targeting positive mental health changes in early adolescence are particularly effective. And, it is important to encourage parents of adolescents to continue to provide support and guidance. [ABSTRACT FROM AUTHOR]

Early adolescents' perception of parenting styles is crucial to their present and future physical and mental well-being. The main aim of the present study was to analyze differences in parenting styles between mothers and fathers and differences on emotional state scales (anxiety, depression, and purpose in life) depending on gender, age, and family structure in 744 girls (54%) and boys (45.7%) aged between 10 and 12 years. The results showed that the early adolescents perceived greater levels of affect than criticism, with mothers being considered more affectionate than fathers. The greater the perceived affect and communication, the greater was the perception of purpose in life and the lower the levels of anxiety and depression in early adolescents. Boys showed higher levels of perceived criticism and rejection. Family affect and communication play a key role in purpose in life and emotional well-being of children, with parenting styles being a determining factor. [ABSTRACT FROM AUTHOR]

The present study investigates factors associated with anxiety, depression, and stress in children being reared by their grandparents in rural Appalachia. Grandparent-headed households, in which grandparents have primary responsibility for care of children, are increasing in number. However, research is needed on child risk for internalizing symptoms in this context. Participants included 35 children aged 5–18 years and one of their custodial grandparents. Interviewers read questionnaires to grandparents and children assessing family functioning and child mental health and participants indicated their answers. Mean scores for child internalizing symptoms and stress were on the higher end of the scale of measurement. Lower grandparent positive parenting, grandparent not having formal custody of children, greater grandparent mental health issues, lower grandparent education, and lower financial status were correlated with greater child anxiety, depression, and stress. Results also indicated that correlates of children's internalizing symptoms differed based on child sex and age. [ABSTRACT FROM AUTHOR]

Autistic children and adolescents are more likely than non-autistic youth to experience mental health problems, such as anxiety or depression, but less likely to receive psychotherapy to address these concerns. Recent research indicates that clinician factors, such as knowledge, attitudes, confidence and beliefs, can impact their decisions to provide care, though this work has primarily focused on adults or within the context of one kind of treatment (cognitive behaviour therapy). The current study examined psychological predictors (e.g. attitudes and confidence) of clinicians' intention to deliver psychotherapy to autistic youth and those with attention-deficit hyperactivity disorder. Participants included 611 clinicians across publicly funded agencies in Ontario, Canada. Multiple mediation analyses revealed that clinician knowledge on mental health-related topics (e.g. core symptoms, developing treatment plans and identifying progress towards treatment goals) was associated with intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, and normative pressures and attitudes partially mediated this association. Clinicians felt less likely to treat autistic clients than clients with attention-deficit hyperactivity disorder, partly because of differences in attitudes, normative pressures and knowledge. This research suggests that targeted training around autism and mental health care may be a useful initiative for agency staff. Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners. [ABSTRACT FROM AUTHOR]

Increased food selectivity among children with autism spectrum disorder may lead to nutritional inadequacy. We designed this study to examine the prospective relationship between autistic traits in children and subsequent nutrient intake in later childhood and whether this relationship changes over time. We utilized longitudinal data obtained at two time points from the Shika study, an ongoing population-based study conducted in a rural area of Japan. Participants were 759 Japanese children aged between 7 and 12 years at baseline and between 10 and 15 years in the follow-up. The results obtained showed relatively lower intakes of sodium, calcium, magnesium, iron, vitamin D, vitamin B2, and vitamin B12 among children with than without autistic traits. Interactions were observed among autistic traits and time points for iron, vitamin B2, folic acid, and pantothenic acid. The results of this study suggest the importance of screening the nutrient intake of children with autistic traits across childhood in order to reduce the risk of restricted intake. It is known about food selectivity among children with autism spectrum disorder. However, the nutritional inadequacy among children with ASD is not clear. Especially, long-term evaluation has not been studied. We examined the prospective relationship between autistic traits in children and subsequent nutrient intake in later childhood. We utilized data obtained at two time points from a study conducted in Japan. Participants were 759 Japanese children aged between 7 and 12 years at baseline and between 10 and 15 years in the follow-up. The results showed relatively lower intakes of sodium, calcium, magnesium, iron, vitamin D, vitamin B2, and vitamin B12 among children with than without autistic traits. Relatively lower intake of minerals and vitamins in children with autistic traits is more evident in later childhood. The results suggest the importance of screening the nutrient intake of children with autistic traits across childhood. [ABSTRACT FROM AUTHOR]

Our aims in this study were to examine the construct/concurrent validity and internal/test-re-test reliabilities of both the self-report and parent-report questionnaires of a Turkish version of the KIDSCREEN-27 for adolescents with cerebral palsy (CP). We used a convenience sample of 135 children and adolescents with CP aged 8–18 years (65 males, 70 females; M age = 12.39, SD = 3.57) and their parents/caregivers (123 mothers, seven fathers, and five grandmothers). We explored structural construct validity via confirmatory factor analysis (CFA). Concurrent validity was examined via Spearman's correlations between the KIDSCREEN-27 questionnaires and the self-report and primary caregiver report forms of the Cerebral Palsy Quality of Life for Children (CP QOL-Child) and adolescents (CP QOL-Teen). We explored test-retest and internal consistency reliabilities utilizing intraclass correlation coefficients (ICC) and Cronbach's alpha (α), respectively. CFA goodness-of fit indices verified that the predefined model of the KIDSCREEN-27 was a good fit for data from the CP population (X2/df<5, GFI >0.90, AGFI >0.90, RMSEA<0.80). Results showed the subdomains of both KIDSCREEN-27 forms to be significantly correlated with the matched subdomains of the CP QOL-Child and CP QOL-Teen questionnaires (ranges of r = 0.62–0.94). Overall, α and ICC coefficients for all subdomains of both KIDSCREEN-27 versions were acceptable (α and ICC >0.70). Both versions of the KIDSCREEN-27 have satisfactory psychometric properties for use in evaluating health-related quality of life (HRQOL) outcomes in children and adolescents with CP. [ABSTRACT FROM AUTHOR]

We investigated factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome (DS). Our assessment of participants followed the biopsychosocial model. Body function and structure were represented by muscle strength and postural sway during sit-to-stand movement, which were assessed by manual muscle testing and kinetics analysis, respectively. The Gross Motor Function Measure and Pediatric Balance Scale depicted the activity component. In addition, we included these relevant contextual factors: age, Home Observation for Measurement of the Environment, family income, and maternal schooling. A correlation analysis verified a suspected association between biopsychosocial and postural sway variables. There were significant separated correlations between postural sway in the three phases of the sit-to-stand movement, and age, GMFM-88 dimension D, and muscle strength. Thus, postural control in sit-to-stand movement was related to biopsychosocial factors involving different life aspects of children and adolescents with DS, and these factors should be addressed in rehabilitation therapy intended to improve postural control among these individuals. [ABSTRACT FROM AUTHOR]

Duchenne Muscular Dystrophy (DMD), the most common form of muscular dystrophies, is characterized by progressive and generalized muscle weakness. The weakness of the trunk and other muscle groups leads these patients to perform motor compensation strategies to maintain their lower limb functionality for gait quality and for tasks such as getting up from a sitting position. In this cross-sectional observational study, we described and quantified trunk, gait, and sit-to-stand motor compensation strategie s in different stages of this disease. Thirty-one ambulatory 5–18-year-old children and adolescents with a diagnosis of DMD, underwent cognitive assessment with the Mental Mini-Examination (MMSE) and motor assessment with the Vignos scale, Segmental Assessment of Trunk Control (SATCo-BR), Timed Up and Go test (TUG Test), and 10-m walk test. We found strong correlations between trunk and gait compensations, and identified motor compensation strategies characteristic of certain DMD classifications. Also, these lower limb and trunk compensations related to disease staging (Vignos) such that compensations were fewer for patients at relatively better disease staging. [ABSTRACT FROM AUTHOR]

To establish the factor structure of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) in Chinese and American adolescent samples; to assess measurement invariance of the ERQ-CA in Chinese and American adolescent samples and latent means across early adolescents from two diverse cultural settings. The ERQ-CA was administered to 1221 Chinese adolescents (49.3% males) and 1148 American adolescents (50.1% males), and multi-group confirmatory factor analysis was performed to evaluate measurement invariance.(1) Multi-group confirmatory factor analysis of the ERQ-CA demonstrated full configural invariance, full metric invariance, partial scalar invariance, and partial strict invariance. (2) The latent variable mean comparisons revealed significant differences between the two samples; specifically, Chinese adolescents' mean scores on the latent variables of cognitive reappraisal (CR) and expressive suppression (ES) were significantly higher than American adolescents' scores. The findings demonstrated that the ERQ-CA displays appropriate measurement invariance across Chinese and America adolescents and that Chinese adolescents reported higher scores on CR and ES. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among adolescents in the age group of 15 to 19 years. As per the National Crime Record Bureau, India loses 1 student to suicide every hour. The COVID pandemic saw an alarming rise in the number of children/adolescents attempting suicide. The state of Kerala lost 173 children in the age group of 10 to 18 years, during the first wave of the pandemic (March-October 2020). This review article has been written with the aim of exploring causes of aggression, suicide, and self-harm in children and adolescents. It also strives to bring forth the various interventions which can be taken in order to reduce the rate of suicide and self-harm in children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic–pituitary–adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children. Methods: Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3−16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6–17.7 years). Saliva samples were collected using a Salivette sampling device at two time points – upon awakening and 30 minutes after awakening. Results: Patients with functional neurological disorder showed a decrease in cortisol awakening response (–4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t (55) = –.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r (58) = –0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r (58) = –0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r (56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses. Discussion: The results suggest dysregulation of the hypothalamic–pituitary–adrenal axis in children with functional neurological disorder. Hypothalamic–pituitary–adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic–pituitary–adrenal dysregulation – and changes in glucocorticoid (cortisol) signalling at the molecular level – may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder. [ABSTRACT FROM AUTHOR]

There is some indication that discrimination as well as low levels of life satisfaction render young people at risk of cyberhate victimization. Adopting a socio-ecological perspective, this paper examines whether supportive family, peer and school environments may buffer against the effects of perceived discrimination and low life satisfaction on cyberhate victimization. Data from four countries (N = 3396) of the EU Kids Online IV survey on children aged 11–17 (51% girls) revealed a positive association between perceived discrimination and cyberhate victimization, but this impact was moderated by supportive family and peer environments. A negative association between life satisfaction and cyberhate victimization was mitigated by peer support. However, no associations with the school context were found. The current study provides new insights on how social support on different levels of the social environment may buffer against potential risk factors for cyberhate victimization and can inform decision-makers towards intervention and prevention strategies. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare the prevalence of bullying victimization and perpetration between a sample of gifted students and a sample of nongifted students, and their relationship in both groups with depression, stress, anxiety, and health-related quality of life (HRQoL). A cross-sectional design was performed with two comparison groups: 449 Spanish adolescents identified as gifted (M age = 11.72, S D = 1.89) and 950 nongifted Spanish students (M age = 12.72, SD =0.79). Results reveal that 41.1%, 1.1%, and 9.5% of the gifted sample were pure-victims, pure-bullies, and bully-victims, respectively, compared to 21.8%, 2.4%, and 5.8% of the nongifted students. It is observed that gifted students are more likely to be victims (OR = 3.20[2.40, 4.28]). Gifted pure-victims have significantly higher stress scores than nongifted pure-victims (p <. 001). In general, pure-victims and bully-victims of gifted and nongifted students both have higher stress, anxiety, and depression scores and lower HRQoL scores than other profiles. [ABSTRACT FROM AUTHOR]

This retrospective single-center study included children aged 2 months to 18 years who were prescribed an oral antibiotic for microbiologically confirmed urinary tract infection (UTI). The primary outcomes were re-encounter to the hospital, emergency department, or urgent care within 30 days and modification of the antibiotic regimen within 14 days. Development of Clostridioides difficile (C difficile) infection or new allergic reaction to the antibiotic prescribed was the secondary outcome. The sample included 2685 children. Rates of re-encounter were similar regardless of the initial antibiotic prescribed (P =.88), and patients who received cefdinir had a lower rate of medication changes (5%) compared with both cephalexin (14%) and sulfamethoxazole-trimethoprim (15%) (P ≤.001). The most common reason for medication change was susceptibility interpretation. Given its low side-effect profile and narrow spectrum compared with the alternatives, cephalexin appears to be a reasonable choice as first-line therapy for the treatment of uncomplicated pediatric UTI. [ABSTRACT FROM AUTHOR]

Autistic children and adolescents and their parents are likely to have been disproportionally affected during the COVID-19 pandemic. There has been little focus on how the mental health of these vulnerable families developed during the pandemic and how it compared to those with other special educational needs and disabilities. Questionnaires were completed by a maximum of 527 parents/carers about their own and their child's mental health at one or more time points between 23 March 2020 (at the onset of the first lockdown) and 10 October 2020 (when schools fully reopened for face-to-face teaching). Multi-level regression models were fitted to the data. Autistic young people had more depression and anxiety symptoms compared to young people with other special educational needs and disabilities throughout the study period. As lockdown progressed and schools subsequently reopened for face-to-face teaching, anxiety levels decreased for young people with special educational needs and disabilities but not for autistic young people, whose anxiety levels remained stable throughout. Depression symptoms, however, remained stable for both groups during this period as did parents'/carers' psychological distress and well-being. These findings shed new light on the likely disproportionate effect of the COVID-19 pandemic on anxiety levels in autistic young people. Autistic children and adolescents, and their parents/carers, tend to experience more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. The rapid change in society as a result of the COVID-19 pandemic is likely to have disproportionately affected autistic young people and their parents/carers. We investigated how the mental health of autistic young people, and their parents/carers, developed during the first lockdown in the United Kingdom and how it changed once schools fully reopened for face-to-face teaching approximately 6 months later. Parents/carers completed online standardised questionnaires about their own and their child's mental health at four time points between March 2020 and October 2020. We found that, throughout this period, autistic young people experienced more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. Anxiety levels decreased as lockdown progressed and schools reopened for face-to-face teaching but only for those with other special educational needs and disabilities. For autistic young people, both anxiety and depression symptoms remained high throughout. There were no differences in the mental health of parents/carers of autistic children compared to those with other special educational needs and disabilities. These findings suggest that the mental health of autistic children and adolescents is likely to have been disproportionately affected during and after the first lockdown in the United Kingdom. In the second part of this article (Asbury & Toseeb, 2022), we attempt to explain these trends using qualitative data provided by parents during the same period. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has resulted in many changes to the lives of children and young people. Our aim is to explore the impact of the pandemic on the mental health of children and young people (ages 5–21). Methods: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was used to report the findings of this rapid review. Results: Children and young people are potentially very vulnerable to the emotional impact of traumatic events that disrupt their daily lives. Key areas of concern include: Death Anxiety and Fear of Infection; lack of social interaction and loss of routine. Conclusions: Despite some early and responsive studies, the evidence base for pandemic impact on children and young people is very limited. Such evidence is urgently needed if adequate and responsive services, that can mitigate the long-term impact of the pandemic for children and young people can be established. [ABSTRACT FROM AUTHOR]

This study aimed to understand the postoperative nutritional experiences of parents of children who had undergone gastric transposition surgery after corrosive esophageal injury. The study had a descriptive qualitative research design, and used a structured interview form as a result of the COVID-19 pandemic. The population of the study consisted of the parents of 12 children who had undergone gastric transposition surgery at the pediatric surgery clinic of a university hospital in an urban area in Turkey. Thematic analysis was conducted on the transcripts using the MAXQDA program. Four main themes emerged and five supporting sub-themes were identified. The main themes were what we experienced in the postoperative nutrition process, coping with how we live, what we want to know, and our recommendations to healthcare professionals. Family-centered care should be a main focus when caring children who have had gastric transposition surgery, and children and their parents should be supported by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Introduction: A paediatric cancer ward is a setting where pharmacists participate in direct patient care, acting as coordinators between the patient, caregivers and healthcare professionals. The aim of the study was to develop a Gap Finding Tool to support the setting up of a pharmaceutical care model at a Paediatric-Adolescent Cancer Ward. Methods: The Standards of Practice for Clinical Pharmacy Services by the Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy (2013), the American College of Clinical Pharmacy (2014) and the European Association of Hospital Pharmacists (2014) were used to compile the Gap Finding Tool. The developed Tool was tested for content validity by a panel of experts and subsequently implemented over 2 months. Results: The Gap Finding Tool comprised of nine sections with an average of eight statements each about pharmacy services that should be provided at ward level. For each statement, the rater indicates whether these contributions are provided. When the Tool was implemented at the Paediatric-Adolescent Cancer Ward, four major gaps were identified, namely, absence of a clinical pharmacist, lack of medicines information, vetting of chemotherapy prescriptions by pharmacist with limited access to patient data and lack of pharmacist-input on medicines availability. Processes requiring optimisation included discharge medication advice and documentation processes. Conclusion: The developed Gap Finding Tool is an innovative tool which is versatile and can be used in ward or ambulatory clinical settings to identify gaps in pharmaceutical processes and services and compare national or regional practices to international standards. [ABSTRACT FROM AUTHOR]

Objective: This study aimed at describing routine electroencephalogram (EEG) findings among children and adolescents with a clinical diagnosis of epilepsy and determines how interictal EEG abnormalities vary with the psychiatric comorbidities. Methods: We conducted a cross-sectional study among children and adolescents with epilepsy aged 5–18 years receiving care from a regional referral hospital in Southwestern Uganda. Psychiatric comorbidities were assessed using an adapted parent version of Child and Adolescent Symptom Inventory-5. Thirty-minute EEG samples were taken from routine EEG recordings that were locally performed and remotely interpreted for all participants. Results: Of the 140 participants, 71 (50.7%) had normal EEG findings and 51 (36.4%) had epileptiform abnormalities while 18 (12.9%) had non-epileptiform. Of those who had epileptiform abnormalities on EEG, 23 (45.1%) were focal, 26 (51.0%) were generalized, and 2 (3.9%) were focal with bilateral spread. There was no significant association between the different psychiatric comorbidities and the interictal EEG abnormalities. Conclusions: Among children and adolescents with a clinical diagnosis of epilepsy in Southwestern Uganda, only 36% showed epileptiform abnormalities on their EEG recordings. There was no association between the interictal EEG abnormalities and psychiatric comorbidities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic created a major transformation in the delivery of music therapy services worldwide as they moved online. Telehealth research is in its infancy and online work with children and adolescents with visual impairment has yet to be investigated. This survey-based study explored the experiences and perceptions of parents of children and adolescents with visual impairment (n = 11) who engaged in online music therapy. Video playlists were accessed regularly and almost all parents reported positive (2/11) or very positive (8/11) responses and perceived them as beneficial in engaging with their child. Ninety-five percent (10/11) of parents perceived the teleheath programme to be a positive experience for their child, 73% (8/11) observed positive behaviours directly after the sessions, and 82% (9/11) indicated that the programme was a valuable family resource that supported bonding and interaction. Inductive reflexive thematic analysis generated four themes from the qualitative data: (a) positive impacts, (b) interactive family resource, (c) connection to school, and (d) challenges. A discussion of the findings is followed by implications for practice. [ABSTRACT FROM AUTHOR]

Sluggish Cognitive Tempo (SCT) has been less frequently studied in adolescents compared with school-aged youth, few studies have examined youth self-report of SCT, and no study has examined SCT in Italy. The present study examined the reliability and validity of the Child Concentration Inventory–Version 2 (CCI-2), a youth self-report measure of SCT, in 452 Italian adolescent high school students (37.8% female; mean age = 15.92 years). Adolescents were administered Italian translations of the CCI-2 and the attention deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS). School performance variables (i.e., teacher-rated grades and teachers' disciplinary ratings) were also collected. A random subsample (n = 88) of participants was also administered the Mackworth Clock Test, a short version of the Attention Network Test, and the Stop-Signal Task. In our study, all CCI-2 items showed adequate convergent–discriminant validity, and the CCI-2 scale score showed adequate internal consistency reliability. Confirmatory factor analysis results suggested the adequacy of a one-factor model of the CCI-2 items, which showed to be invariant across sex. Confirmatory factor analyses supported the dissociability of SCT from ADHD-Inattention and ADHD-Impulsivity. SCT was significantly and negatively associated with adolescents' average school grades, whereas ADHD was also significantly and negatively associated with adolescents' disciplinary ratings. In the random subsample, the CCI-2 total score was positively, significantly, and uniquely associated with overall reaction time on the Attention Network Task, but not other neurocognitive variables. This study provides further support for the reliability and validity of self-reported SCT in adolescence. [ABSTRACT FROM AUTHOR]

Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is an evidence-based indicated depression prevention program that has been shown to reduce depression symptoms. Research is needed to identify moderators of IPT-AST's effects. Although trauma history has emerged as a moderator of depression treatment outcomes, the impact of trauma on short- and long-term outcomes in the context of preventive interventions for adolescent depression is unknown. This study examines the impact of trauma on prevention outcomes in a school-based randomized controlled trial (RCT) in which 186 adolescents (mean age = 14.01 years, SD = 1.22; 67% female) were randomly assigned to IPT-AST delivered by research staff or to group counseling (GC) provided by school counselors. Trauma history significantly moderated intervention outcomes during the active phase of the intervention but not during long-term follow-up. During the active phase, youth in IPT-AST with low or no trauma exposure experienced significantly greater reductions in depression symptoms than youth in GC with low or no trauma exposure, but there were no significant differences in rates of change between the two interventions for youth with high or any trauma exposure. These findings highlight the importance of assessing trauma and investigating whether these interventions can be tailored or supplemented to enhance the effects for youth with trauma exposure. [ABSTRACT FROM AUTHOR]

Background: The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) has demonstrated normally distributed scores in children aged 10 to 18 years. It has been used to evaluate knee injuries; however, there is limited information regarding its use in evaluating other injury types. Purpose: To (1) assess the validity and utility of HSS Pedi-FABS in youth athletes with injuries to different parts of the body and (2) evaluate the association between the HSS Pedi-FABS and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health 7 (PGH), as well as PROMIS–Pain Interference (PGH-PI) and PROMIS-Fatigue (PGH-F) components. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors performed a retrospective review of youth athletes aged 10 to 18 years who completed the HSS Pedi-FABS as part of their previsit intake questionnaire between April 2016 and July 2020. HSS Pedi-FABS score distributions were compared and evaluated for ceiling effects in cohorts determined by demographic, injury characteristic, and sports participation variables; a ceiling effect was determined to be present if >15% of respondents received the highest possible score. HSS Pedi-FABS scores were analyzed for a correlation with PGH, PGH-PI, and PGH-F components. Results: Included were 2274 patients (mean age, 14.6 ± 2.1 years; 53.0% female) participating in 21 distinct primary sports for 9.6 ± 7.9 hours per week. The mean HSS Pedi-FABS scores by injury group were as follows: elbow (22.7 ± 6.7), shoulder (21.0 ± 8.7), ankle (20.2 ± 8.8), knee (19.5 ± 9.1), and hip (15.4 ± 10.4) (P <.001). Broad distribution was seen in each cohort, with no floor or ceiling effects. The HSS Pedi-FABS score correlated with patient-reported hours per week (r = 0.33), days per week (r = 0.33), and years of participation (r = 0.21) (P <.001 for all). All 3 PROMIS components correlated with HSS Pedi-FABS: PGH (r = 0.28), PGH-PI (r = –0.11), and PGH-F (r = –0.15) (P <.001). Conclusion: Study findings indicated that the HSS Pedi-FABS is a valid tool for measuring physical activity level in most injured youth athletes, not just those with knee injuries. The correlation of HSS Pedi-FABS with the PGH suggests a positive relationship of childhood physical activity with general health. [ABSTRACT FROM AUTHOR]

Background: Concussion is a common injury among children and adolescents, with a growing body of literature supporting a variety of diagnostic and treatment modalities. Recovery is variable and depends on multiple factors that can be evaluated through a clinic visit: a thorough history, physical examination, and use of the Post-concussion Symptom Scale (PCSS). Purpose/Hypothesis: The purpose of this study was to evaluate factors associated with overall recovery from concussion in children and adolescents in the clinical setting. It was hypothesized that the presence of 1 of a number of pre- or postinjury characteristics will be associated with poor concussion recovery. Study Design: Case-control study; Level of evidence, 3. Methods: We conducted a retrospective chart review of adolescents and children aged 6 to 17 years with a diagnosis of concussion who were evaluated at a single sports medicine center between January 2015 and December 2019. Cases were categorized into recovered (PCSS <7) and poorly recovered (PCSS ≥7) cohorts based on the last PCSS scores during clinical follow-ups for concussion management. Results: Of the 162 charts reviewed, 110 cases met inclusion criteria. Significant statistical differences were found between the recovered and poorly recovered cohorts regarding mean days from injury to last clinic visit, previous migraine diagnosis, and emergency room (ER) visit before the first clinic visit (P <.01 for all). Binary logistic regression analysis revealed that the most predictive factors associated with poorer recovery were having an ER visit before the first clinic evaluation (P =.01) and previous migraine diagnosis (P =.04). Conclusion: While many factors may contribute to overall recovery from concussion in pediatric populations, our study suggested that a history of migraine and an ER visit before clinic evaluation may be associated with poor recovery of concussive symptoms. [ABSTRACT FROM AUTHOR]

Background: Patellar dislocation is a common injury in children and adolescents. There is a lack of information about concomitant osteochondral lesions in these patients. Hypothesis: We hypothesized that the likelihood of chondral or osteochondral lesions would increase with each prior patellar dislocation and that the appearance of lesions in surgically treated children and adolescents would be influenced by age, sex, injury mechanism, and body mass index (BMI). Study Design: Case-control study; Level of evidence, 3. Methods: Inclusion criteria were (1) age <18 years, (2) surgical treatment with diagnostic arthroscopy of the knee including description of chondral and osteochondral lesions, and (3) maximum time period between the last patellar dislocation and presentation in our department of 6 weeks and maximum of 4 weeks between presentation and surgery. A total of 153 children (173 knees) with a mean age of 13.0 ± 2.1 years were included. All surgical reports and intraoperative arthroscopic imaging were analyzed retrospectively for the location and severity of lesions. The likelihood of lesions was calculated with multiple stepwise regression models regarding injury mechanism, number of dislocations, sex, age, physeal closure, and BMI. Results: The regression model to predict femoral lesions was statistically significant (χ2[5] = 26.55; P <.001) and identified male sex, BMI ≥25, traumatic injury mechanism, and physeal closure as independent factors associated with the appearance of femoral lesions. The second regression model predicting the appearance of patellar lesions was also statistically significant (χ2[4] = 26.07; P <.001) and identified the traumatic injury mechanism as a single independent predictor for patellar lesions. Conclusion: BMI ≥25, male sex, and physeal closure were factors significantly associated with femoral chondral and osteochondral lesions in our cohort. In case of traumatic lateral patellar dislocation (LPD), the likelihood of patellar and femoral chondral and osteochondral lesions is significantly higher than in nontraumatic LPD. Early magnetic resonance imaging and surgical treatment should be considered in obese patients, male patients, and patients with physeal closure and after traumatic LPD. [ABSTRACT FROM AUTHOR]

Simple mean differences summarized in meta-analyses do not always adequately describe sex similarities and differences. We investigated sex similarities and differences in academic achievement test scores during childhood and adolescence multiple ways based on composite and subtest scores from the Kaufman Test of Educational Achievement (Third edition) norming sample. Sex differences in means were investigated across achievement domains and ability levels. Test score variance and percentages of scores at different parts of score distributions were also compared across sex. The largest and most consistent sex differences were female advantages in writing tests: Larger advantages were found in more complex writing tasks. Females also showed consistent advantages in silent reading fluency. Males demonstrated advantages in math problem solving that emerged at the average ability level. Females were more likely to be high achievers in reading fluency and written expression, whereas males were more likely to be low achievers in reading fluency and aspects of writing, and very low achievers in word recognition, word recognition fluency, and reading vocabulary. Males were more likely to be high achievers in math problem solving. Analysis that goes beyond simple mean differences reveals important sex differences regarding academic achievement, and theories should account for overall patterns of academic achievement similarities and differences. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to analyze the rate and type of complications and subsequent procedures encountered with soft tissue quadriceps tendon autograft (QTA) for anterior cruciate ligament reconstruction (ACLR) in pediatric patients ≤ 18 years old. Methods: After institutional review board approval, operative records of all pediatric patients ≤ 18 years old who underwent ACLR from June 2015 to December 2021 were retrospectively reviewed. A consecutive series of patients who underwent ACLR with a QTA with minimum 6 month-follow up were included in the study. Skeletally immature patients underwent an all-epiphyseal (AE) technique while patients nearing skeletal maturity or that were skeletally mature underwent a complete transphyseal (CT) procedure. All patients underwent ACLR by utilizing a full thickness soft tissue QTA without a bone plug. Additionally, patients who were determined to be at high risk of re-tear underwent a concomitant a lateral extra-articular tenodesis (LET) with a modified Lemaire technique. Preoperative demographic information, surgical details, associated diagnosis, and subsequent injuries and complications were collected. Complications associated with the quadriceps tendon harvest site and use of QTA including removal of non-absorbable sutures from the autograft donor site, quadriceps tendon rupture, and the subsequent development of a superior patellar osteochondritis dissecans lesions (OCD) were reported. Results: A total of 143 pediatric patients ≤ 18 years old underwent an ACLR with a soft tissue QTA during the study period. Of the 143 eligible patients, 137 patients had minimum 6-month follow-up and were included in the study. After 3 attempted contacts, six patients (4%) were deemed lost to follow-up and excluded from the study. The mean age was 14.8±1.6 (range 11-18 years) and 60% were male. The average follow-up time was of 2.0 ± 1.1 years (range 0.5-4.9 years). Of the 137 patients included in the study, 11 (8%) had a subsequent complication associated with the use a of a QTA. Baseline demographic characteristics of this cohort are summarized in (Table 1). Of the 11 patients with QTA related complications, 8 (6%) had a subsequent procedure to remove non- absorbable sutures used for the donor site closure. When we first began to perform QTA ACLR, non- absorbable sutures were used to close the donor site defect. We encountered a subset of patients that developed persistent donor site irritation and pain associated to the use of such sutures, and consequently changed our technique to use absorbable sutures. Interestingly, 2 (1%) patients developed OCD-like lesions in the superior aspect of the patella 1.2 ± 0.8 years on average following surgery (Fig 1). We speculate that the QTA harvest could have compromised the vasculature of the patella, thus resulting in the development of OCD and subsequent chondromalacia. Finally, 2 (1%) patients had quadriceps tendon ruptures following QTA ACLR. The first patient aged 16, slipped and fell onto a hyperflexed left knee 6 weeks after QTA ACLR and sustained a small boney avulsion injury of the superior pole of the patella. During repair, cultures were taken, and rare Staphylococcus aureus were identified. The patient was placed on Keflex for 4 weeks, however 2 weeks after finishing treatment they presented with sudden limited range of motion, increased pain, and a yellow appearing scab. An ultrasound guided aspirated was positive for Staphylococcus aureus, and the patient subsequently underwent an infection and debridement procedure. The second patient, aged 14, sustained a non-contact injury while playing football 7 months post- operatively prior to being cleared to return to sports. They sustained a complete tear of the distal quadriceps tendon, adjacent to the donor site. Of note, 1 patient underwent a concomitant removal of non-absorbable sutures and patellar chondromalacia debridement and is thus represented twice. In addition, 5 (4%) patients had a graft failure and underwent subsequent revision ACLR, 6 (4%) had a second meniscus related surgery, 8 (6%) had a subsequent lysis of adhesions procedure and 13 (9%) underwent ACLR for injuries sustained on the contralateral knee. Conclusions: In this study, we report complications encountered with soft tissue QTA for ACLR. The complication rate for quadriceps tendon graft harvest was 8%. However, given that the removal of non- absorbable sutures from the donor site was caused by the surgical technique used, the revised complication rate for quadriceps tendon graft harvest was 3%. To the authors' knowledge, this is the first study to raise the suspicion that quadriceps tendon graft harvest could lead to the development of super patellar OCD as this occurred in two patients from this cohort. Although the use of a QTA has recently gained popularity due to its high return to sports and low graft failure rate, surgeons must be aware of the complications and risk associated with quadriceps tendon graft harvest. [ABSTRACT FROM AUTHOR]

Background: Despite the well-established diagnostic and therapeutic applications of endoscopic ultrasound (EUS) in adults, data about its use in children are limited. In this study, we tried to assess the feasibility, safety, and clinical impact of EUS in pediatric patients. Methods: Data of pediatric patients (<18 years) referred for EUS over a 3-year period to the endoscopy units of four Egyptian tertiary centers were retrospectively analyzed. Significant impact was defined as a new diagnosis or treatment attributed to the EUS procedure. Results: Twenty-four diagnostic and five therapeutic EUS procedures were conducted in 29 children with a median age of 9 years. Indications for EUS included assessment of solid pancreatic mass (n = 3), pancreatic cyst (n = 2), suspected chronic pancreatitis (n = 9), pancreatic pseudocyst (PPC) (n = 5), recurrent hypoglycemia (n = 1), bile duct mass (n = 1), subepithelial lesion (esophageal, duodenal or anorectal) (n = 4), mediastinal mass (n = 1), pelvic mass (n = 3), and mass at splenic hilum (n = 1). Therapeutically, five patients underwent cystogastrostomy for symptomatic PPC with 100% technical and clinical success. EUS was able to diagnose 21 out of the other 24 patients. EUS-guided tissue acquisition was performed in 11 patients with definitive histopathological diagnosis in 10 patients (91%). There was no procedure-related major complication, while minor complications occurred in two cases (transient pain in one case, temporary fever, and vomiting in two cases). Conclusion: Standard linear EUS equipment and accessories can be used safely and effectively in selected pediatric patients for diagnostic and therapeutic purposes. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in prescribing psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018. Method: A retrospective cohort study examined prescriptions written by general practitioners using MedicineInsight, a large Australian primary care database, covering approximately 9% of all general practitioner practices. Numbers of patients receiving prescriptions for five main classes of psychotropics (antipsychotics, antidepressants, attention deficit hyperactivity disorder medications, anxiolytics, and hypnotics/sedatives [including benzodiazepines and Z-drugs, but excluding melatonin]) were examined annually by age-group (0–4, 5–9, 10–14, 15–18 years). Melatonin was analysed separately. Results: The number of patients prescribed any psychotropic increased from 25.6 to 36.2 per 1000 individuals from 2011 to 2018 (average annual increase +4.5%, 95% confidence interval [4.1%, 4.9%]; overall +41.4%). Among the five main classes, the largest annual increase was for attention deficit hyperactivity disorder medications (+9.6%, 95% confidence interval [8.8%, 10.5%]; overall +95.8%), followed by antipsychotics (+6.2%, 95% confidence interval [5.0%, 7.3%]; overall +62.8%) and antidepressants (+4.5%, 95% confidence interval [4.0%, 5.0%]; overall +42.8%). Hypnotic/sedative prescribing decreased on average 6.5% per year (95% confidence interval [–8.0%, –5.0%]; overall −40.2%). Anxiolytic prescribing remained steady. Melatonin prescriptions showed the highest increase of all (+24.7%, 95% confidence interval [23.7%, 25.8%]; overall +606.7%). The largest annual increase in antipsychotic, antidepressant or attention deficit hyperactivity disorder medication prescribing occurred in 10- to 14-year-olds (+7.5%, +6.5% and +10.4%, respectively). The largest point prevalence occurred in 2018 among 15- to 18-year-olds, with 98.5 per 1000 prescribed antidepressants. Antidepressants were more frequently prescribed to females; antipsychotics, attention deficit hyperactivity disorder medications and melatonin more often to males. The most prescribed antipsychotics were risperidone (<15 years) and quetiapine (15- to 18-year-olds). Fluoxetine was the most prescribed antidepressant in those aged 5+ years and amitriptyline in 0- to 4-year-olds. Conclusion: General practitioner prescribing of melatonin, antipsychotics, antidepressants and attention deficit hyperactivity disorder medications to under-19-year-olds increased markedly from 2011 to 2018. Although benzodiazepine and Z-drug prescriptions declined, this was offset by a substantial increase in melatonin prescribing. [ABSTRACT FROM AUTHOR]

Objective: Cognitive-behavioural therapy is recommended as the first-line treatment for children and adolescents with anxiety. Despite its efficacy, a recent United Kingdom study indicated that few children with anxiety disorders receive cognitive-behavioural therapy. The primary aim of this study was to examine the receipt of cognitive-behavioural therapy for children and adolescents with elevated anxiety symptoms in Australia. Second, this study also examined whether there was a difference in the type of treatment received based on socioeconomic status and geographical location. Method: Using self-reported questionnaires, parents of children aged 4–18 years and children aged 12–18 years (N = 784; elevated anxiety symptom sample n = 169) were recruited from four samples: community (n = 164), school (n = 177), clinic (n = 16) and online panel provider (n = 427). Participants reported on the child's anxiety symptoms and the type of treatment (if any) the child received for their anxiety symptoms. Results: Results indicated that 19.5% of children and adolescents with elevated anxiety symptoms received evidence-based treatment (e.g. cognitive-behavioural therapy). Of those families who did seek help for anxiety in Australia, the majority (66.3%) did not receive cognitive-behavioural therapy. In addition, neither socioeconomic status (which was based on the Australian Index of Community Socio-Educational Advantage [ICSEA]) nor location (metropolitan vs regional/remote) affected whether individuals received evidence-based care or non-evidence-based care. Conclusion: Overall, children and adolescents in this study seeking support for their anxiety symptoms were not receiving adequate evidence-based care, regardless of socioeconomic status and location. These findings indicate there is a need to increase the receipt of cognitive-behavioural therapy for children and adolescents with anxiety symptoms. The findings should tentatively be interpreted, given data were collected during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Summary: A high percentage of homeless youth have a history of foster care placement; this population faces high rates of behavioral health problems. No research has focused on the predictors of service use among homeless former foster youth. This analysis seeks to determine what foster care and homeless experiences are associated with service use among this population. Data were collected via convenience sample from 184 homeless former foster youth at a drop-in center in Hollywood, California. A series of logistic regressions were conducted for network engagement behaviors that may be impacted by foster care experiences. Knowledge from prior empirical results form the basis for this analysis. Findings: Number of foster care placements and age at first foster care placement, overall time spent homeless, age at first homelessness, and being kicked out of housing as a cause of homelessness were associated with decreased service use. Time spent in foster care and homeless experiences during foster care were associated with increased service use. Application: Results can be used to aid in understanding which foster care and homeless experiences aid or hinder service use. From a policy level, findings from this study can aid child welfare agencies in further understanding which foster care experiences present as risk factors after transition from care. [ABSTRACT FROM AUTHOR]

As the research and treatment of childhood cancer steadily progresses, so has the interest in children's needs, not only throughout such treatment but also following completion. Whilst there is increased literature focussing on the long-term psychosocial impact of treatment completion, little is currently known about how children and young people (CYP) experience the more immediate end of their cancer treatment. The current review seeks to examine CYP's experiences of the end of their cancer treatment. Sixteen studies were retrieved using a systematic search strategy across five databases, all of which used qualitative methodology. Thematic synthesis was chosen to analyse the data. Four overarching themes were generated, which encompassed ' the continuity of cancer ', ' ambivalence of needs ', ' making sense of the cancer experience ' and ' sense of self following the ending '. The end of treatment is a time of complexity for CYP, yet it is currently largely overlooked. In order to scaffold these endings for CYP, increased emphasis and thought needs to be placed on the end of treatment and the support that is provided within it. [ABSTRACT FROM AUTHOR]

Introduction: It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment. In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. Material and method: 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. Results: All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). Conclusions: Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement. [ABSTRACT FROM AUTHOR]

Introduction: Dogs may elicit positive therapy outcomes for children/adolescents with autism spectrum disorder (ASD). However, little is known about the parent perspectives of the use of dogs as part of an occupational therapy program for ASD. This study aimed to explore parent perspectives about the Animal Assisted Therapy (AAT) component of the occupational therapy intervention their child/adolescent received across five weekly sessions. Method: Using a phenomenological approach, 16 semi-structured interviews were conducted with parents (13 mothers and four fathers) following an AAT occupational therapy program. Thematic analysis was conducted. Results: Three themes were identified relating to the value parents attributed to the AAT occupational therapy program with dogs for their child/adolescent: 1. Stress and anxiety management; 2. Participation and engagement and 3. Social communication. Positive outcomes identified by parents included the dogs being a calming influence and facilitating the participation of their child/adolescent in life-skill activities. Conclusion: Parents valued AAT occupational therapy involving dogs. Future studies should investigate how to best target this occupational therapy approach for autistic children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: To provide state-level estimates of diagnosed ADHD and associated treatment among children in the United States in 2016 to 2019. Method: This study used the National Survey of Children's Health to produce national and state-level estimates of lifetime diagnosis and current ADHD among all children aged 3 to 17 years (n =114,476), and national and state-level estimates of medication and behavioral treatment use among children with current ADHD. Results: The state-level estimates of diagnosed ADHD ranged from 6.1% to 16.3%. Among children with current ADHD, state-level estimates of ADHD medication usage ranged from 37.8% to 81.4%, and state-level estimates of behavioral treatment ranged from 38.8% to 61.8%. Conclusion: There was substantial state-level variation for indicators of ADHD diagnosis and associated treatment. These state-level results can be used by policymakers, public health practitioners, health care providers, and other stakeholders to help address the service needs of children with ADHD in their states. [ABSTRACT FROM AUTHOR]

Background: Acupressure is known to be a nursing intervention used to prevent chemotherapy-induced nausea and vomiting in children. Methods: This study was conducted to evaluate and compare the effectiveness of manual and wristband acupressure in the prevention of chemotherapy-induced nausea and vomiting in children. This double-blinded and placebo-controlled study was conducted with 44 children aged between 5 and 18 years receiving chemotherapy in a university hospital's pediatric oncology clinic. Children were randomized into groups using a 2 × 2 factorial design: (a) The child who was given manual acupressure before the first chemotherapy was given placebo manual acupressure before the next chemotherapy; (b) the same child who was administered wristband acupressure before the first chemotherapy was administered placebo wristband acupressure before the next chemotherapy. After all interventions, the severity and number of episodes of nausea and vomiting and additional antiemetic needs in the children were monitored for 24 h. Results: In both groups, the severity and number of nausea and vomiting were lower according to their own placebo groups. Manual and wristband acupressure were effective in reducing the severity and number of nausea and vomiting, but manual acupressure was more effective in reducing the severity and number of nausea and vomiting in comparison to wristband acupressure (p <.05). No statistically significant difference was found between the groups regarding additional antiemetic drug use. Discussion: In this study, manual and wristband acupressure were determined to be effective in reducing the severity and number of nausea and vomiting related to chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p <.05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome. [ABSTRACT FROM AUTHOR]

Background: There is little information on facemask use during the COVID-19 pandemic in the pediatric population. This became the main purpose of the present study to investigate demographic data of facemask wearing in children, types, and length of facemask, as well as the benefits, drawbacks, and negative consequences of facemask wearing in this population. Methods: A cross-sectional study was conducted using a structured questionnaire sent via Google Forms. Caregivers for consecutive convenience were asked in the survey (parents of children under the age of 18). Results: A total number of 706 children were enrolled. There were 320 boys (45.33%), and 386 girls (54.67%). The children's ages range between 4 months and 18 years, with a median age of 9 years. A surgical mask (549, 77.76%) was the most frequent type of facemask in the study population, followed by a cloth mask (86, 12.18%). Facemasks have been shown to be beneficial in the pediatric population. When compared to a former time when facemasks were not used routinely, there were considerably fewer respiratory infections, reduced diarrhea symptoms, and a drop in hospital admissions. In 317 cases (44.9%), children were shown to have negative consequences from wearing facemasks. The most prevalent adverse effect observed in the study population was non-cutaneous (respiratory discomfort/breathing difficulty) which were found in 240 cases (33.99%). Double masking method (surgical + surgical) and wearing a facemask oversize revealed a higher risk in the presence of facemask adverse effects, whereas wearing a proper size facemask reduces the risk of adverse effects from facemask use in children (Adjusted OR [95% CI] = 0.55 [0.38-0.78], P.0003). Conclusions: Wearing a proper-size facemask reduces the risk of adverse effects from facemask use in children. The future suggestion of an appropriate facemask size for a certain age will aid in the avoidance of facemask adverse effects in the pediatric population. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate psychiatric disorders, bullying/victimization, and quality of life in children and adolescents with idiopathic growth hormone deficiency (GHD). Sixty-one children and adolescents who were diagnosed as having idiopathic GHD were evaluated using a semistructured interview by a child and adolescent psychiatrist. Some 45.9% of the subjects with GHD were diagnosed with at least 1 psychiatric disorder. The most common psychiatric diagnosis was social anxiety disorder (18.3%). Twenty-eight percent of the subjects reported being bullied by their peers. Victimization rates were less frequent in those treated for more than 1 year. Children aged between 6 and 12 years had poorer quality of life and higher anxiety levels than adolescents aged between 13 and 18 years. Due to the higher rates of existing psychiatric disorders, the clinical management of patients with GHD should be conducted with a multidisciplinary approach, in which pediatric endocrinologists and mental health professionals work in coordination. [ABSTRACT FROM AUTHOR]

The Social and Emotional Assets and Resilience Scale (SEARS) is a promising instrument for prediction of resilience in youth; however, there is limited data to support its use. The purpose of the current study was to examine the factor structure, measurement invariance, internal consistency, and validity of the SEARS-Adolescent Report in youth 8 to 20 years of age. Two hundred and twenty-five childhood cancer survivors (M age = 15.9, SD = 4.2; 51.4% male; 74.5% White) and 122 student controls without history of significant health problems (M age = 14.2, SD = 3.5; 54.1% female; 79.5% White) 8 to 20 years of age completed the SEARS-A. The SEARS-A was found to have an adequate factor structure and model fit (χ2 = 1215.5, p <.001; root mean square error of approximation =.057; comparative fit index =.95; standardized root mean square residual =.06) and demonstrated invariance across domains of age, health status, gender, race, and socioeconomic status (Δ comparative fit index < −0.01). It also demonstrated excellent internal reliability, criterion validity, and current validity when compared with another well-established measure of psychological adjustment. As such, the SEARS-A has potential to be a useful, valid, and psychometrically sound tool for predicting social–emotional adjustment outcomes among at-risk youth 8 to 20 years of age. [ABSTRACT FROM AUTHOR]