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The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period. Children had more than 30 medical diagnoses including chronic pain, dysautonomia, neurologic disorders, and diabetes. Complete utilization data were available for 118 patients, and demonstrated decreased hospitalizations and increased behavioral health visits during the 12 months post program compared with 12 months prior. Private insurance and female sex were associated with reduced utilization costs after program participation. Estimated avoided cost for the 118 children was $1 111 485. Patients reported significant improvements in somatic symptoms, sleep problems, inattention, depression, anger, and anxiety. Limited data indicated improvements in school attendance. Additional research addressing other outcomes, such as school-related symptoms, would be helpful. [ABSTRACT FROM AUTHOR]

Children's behavioral problems, screen time, and sleep problems' association with negative and positive parenting strategies during the COVID-19 outbreak in Brazil. Cognitive studies have cautioned against allocating screen time for young children, because clinical research shows that a lot of screen time can delay children's cognitive development. Keywords: digital addiction; screen; children; screen time; WHO EN digital addiction screen children screen time WHO 469 472 4 10/12/22 20221001 NES 221001 Among the most frequent family conflicts in homes with small children are those associated with adults struggling to tear children and teenagers away from the captivating screens of smartphones and tablets. [Extracted from the article]

To examine the relationship between relative deprivation and social anxiety, which affects mental health, and investigate the mediating role of perceived control and the moderating role of belief in a just world (BJW) in an understudied population in Asia, we surveyed 1573 rural-to-urban migrant children (48% female; 푀age = 12.3, SD = 1.7) in southeast China. Relative deprivation was positively correlated with social anxiety; perceived control partially mediated this connection. Moreover, BJW moderated the indirect effect, which was stronger for male migrant children with lower levels of BJW. The limitations and practical implications of this study are discussed. [ABSTRACT FROM AUTHOR]

Executive functions (EFs) refer to a set of cognitive skills used to achieve goals and adapt to novelty and social situations. These cognitive skills strongly impact people's daily lives. Hence, assessing these skills is important for an early intervention to address their lack if need be. Nevertheless, relevant scientific literature reports difficulties in assessing EFs, as they are a set of processes that involve many dimensions. Further, there are differences between everyday situations wherein EFs are employed and the context of a typical performance-based task, involving the use of EFs. Questionnaires are an excellent way to address these difficulties. The objective of this study is to test SENA's convergent validity in terms of EFs' assessment. The SENA is the first Spanish standardized questionnaire based on DSM-5 (2013), it assesses emotional and behavioral problems in children aged 3-18 years. This experiment involved students from regular schools (N = 140; M age = 6.97 SD = 1.02). Statistical analysis was conducted that compared a validated EFs test (BRIEF-2) and the SENA test. The results of this study suggested the presence of convergent validity between SENA and BRIEF-2 vis-a-vis EFs. Thus, SENA is a valid assessment for EFs that are called for in school and family environments for those who speak Spanish. That said SENA is more comprehensive than BRIEF-2, as it not only assesses EFs but also identifies the problems currently associated with the failure in employing EFs, psychological vulnerabilities, and personal resources that are lacking. SENA provides a complete picture of children's and adolescents' behaviors and emotions. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals report challenges in supporting dying patients who have dependent children. These parents are often uncertain how to meet the needs of their children and require appropriate support from professionals. There is limited evidence based guidance for professionals around this issue, which is informed by the views and experiences of children themselves. Aim: To develop an understanding of the perspective of children on living with parental life-limiting illness and inform recommendations for healthcare professionals. Design: Qualitative semi-structured interviews were conducted, with thematic analysis of the data. Setting/participants: A diverse sample of 32 children aged 6–17, whose parent was living with life-limiting illness, were recruited from across the United Kingdom. Results: Despite the challenges of living with a parent with a life-limiting illness, the children display agency in their response. The children: feel a responsibility to look after their family; negotiate a relationship with healthcare; employ strategies to maintain some normality; and ensure that the inevitable sadness does not become overwhelming. Conclusions: Five recommendations for healthcare professionals were developed from the findings. Clinicians should encourage dying parents to: (1) acknowledge the agency of children; (2) recognise children's caregiving roles; (3) engender children's trust in healthcare; (4) maintain some normality; and (5) discuss emotions with their children. Implementing these recommendations will assist parents with a life-limiting illness to provide evidence-based support to their dependent children. [ABSTRACT FROM AUTHOR]

The article discusses the issue on whether it is ethical to conduct neuropsychological screening of children with visual impairments and how clinicians should handle visually impaired children. Also cited are the differences between neuropsychological testing and educational assessment, and how cortical visual impairment is caused by traumatic injury, brain tumors, and hydrocephalus.

Background: The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment. Hypothesis: Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. Results: A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P <.05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P <.05). There were no associations detected between income bracket and the outcomes in this study. Conclusion: This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair. [ABSTRACT FROM AUTHOR]

This article reviews conceptual and empirical issues on the developmental prevention of prejudice in childhood and adolescence. Developmental prejudice prevention is defined as interventions that intentionally change and promote intergroup attitudes and behavior by systematically recognizing theories and empirical results on the development of prejudice in young people. After presenting a general conception of designing evidence-based interventions, we will discuss the application of this model in the field of developmental prejudice prevention. This includes the legitimation, a developmental concept of change, and the derivation of intervention content and implementation. Finally, we summarized recent evaluations results by reviewing meta-analytical evidence of programs and discuss important issues of future research and practice. [ABSTRACT FROM AUTHOR]

Background: The pathologic features and potential predictive biomarkers for recurrence of antrochoanal polyps (ACPs) in children are not fully understood. Objectives: To identify the pathologic differences between recurrent and nonrecurrent group and to explore potential clinical markers which predict recurrence of ACPs in children. Material and Methods: A total of 11 recurrent and 21 nonrecurrent ACPs children were enrolled into this retrospect study. Clinical basic information was collected before the first surgery. The counts of vessels were evaluated by hematoxylin–eosin (HE) staining, and CD34 was detected by immunohistochemistry. Meanwhile, the percentage of each tissue inflammatory cells (eosinophils, neutrophils, lymphocytes, and plasma cells) was assessed by HE staining. Results: No statistical significance was observed between the 2 groups in the basic clinical features. Moreover, both the counts of blood vessels and the tissue neutrophils percentage were enhanced significantly in group with ACPs recurrence (P <.05). According to the receiver operating characteristic curves, the area under the curve for the counts of blood vessels and tissue neutrophils percentage in the prediction of ACPs' recurrence was 0.779 (P =.0105) and 0.989 (P <.0001) respectively. Conclusions and Significance: It was concluded that the counts of blood vessels and the percentage of tissue neutrophils appeared to be potential excellent predictors of ACPs recurrence in children. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of short bouts of ergometric exercises on the number of days in the burn intensive care unit (ICU), body mass, and functional ambulation. Design: Multi-center, randomized controlled trial. Setting: Burn intensive care unit. Participants: Children ages 7–17 with severe burns covering over 30% total body surface area (TBSA). Intervention: All patients received standard of care (Control) with the experimental group receiving additional exercise with a cycle ergometer (Exercise). Main measures: The number of days in the ICU, total weight, lean body mass (LBM), and functional ambulation were taken shortly after randomization and again within one week of the scheduled hospital discharge. Results of outcomes are expressed as median ± interquartile range (IQR), unless otherwise noted (e.g. demographics). Results: Fifty-four severely burned children (n = 18 Control, n = 36 Exercise) were included. The average ± standard deviation for age was 12 ± 3 years and TBSA was 48 ± 16%. The median ± IQR ICU days for Control was 46 ± 51 days vs 31 ± 29 days for Exercise. The median total weight loss for Control was 2.2 ± 1.2 kg vs 1.8 ± 1.4 kg in Exercise. Control lost 0.75 ± 0.8 kg of LBM vs 0.46 ± 0.43 kg in Exercise. Both groups showed significant improvement in functional ambulation (p < 0.01). However, exercise did not add additional benefits. Conclusion: Short bouts of ergometric exercises are feasible for severely burned patients while receiving care in the ICU but did not add additional benefits. [ABSTRACT FROM AUTHOR]

Functional analyses are often conducted by behavior analysts to understand the environmental variables contributing to an individual's problem behavior to better inform treatment implementation. While functional analyses are integral for designing function-based interventions, they often arrange contingencies to evoke and reinforce dangerous problem behavior. In Study 1 we reviewed 22 functional analyses with open-contingency classes including non-dangerous topographies of problem behavior and we found that participants were more likely to exhibit the non-dangerous behavior in 82% of the applications. We then conducted a single-subject comparison of closed and open-contingency classes with four additional participants in Study 2. Our results suggest that the functional analyses with the open-contingency class reduced the likelihood of observing dangerous problem behavior. [ABSTRACT FROM AUTHOR]

Cyberbullying has been pervading worldwide with negative implications for victims. Therefore, there is an urgent need to better understand this phenomenon and the factors that predict it, as the basis for effective prevention and intervention efforts. The current research aims to examine routine activity theory (RAT) as a theoretical framework predictive of cyberbullying victimization (CV) among children and youth. It was hypothesized that each of the RAT measures and the convergence of all measures predict CV. Data were collected from 5,719 primary, middle, and high school Israeli students (51.9% females) during the 2019–2020 school year via online questionnaires. Regression and moderation analyses were conducted to assess the predictability of CV from RAT measures, separately and converged. All RAT measures, separately and converged, predict CV. While off-line trust negatively predicts CV, other control variables, that is, online trust, educational institution phase, and gender, do not. Implications for school programs and guidelines for parents address the risk and protective factors of CV found. This study provides support for the predictability of CV from RAT and expands the knowledge of risk and protective factors predictive of CV. [ABSTRACT FROM AUTHOR]

It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health—the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11–15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of "connections to self" (i.e., a sense of meaning/purpose or joy and happiness in one's life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26–2.12] and 1.25 [1.06–1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered. [ABSTRACT FROM AUTHOR]

As of 2018, over 25.4 million people worldwide meet the criteria to be considered refugees, the highest number on record. Over half of these individuals are under 18 years old, leaving approximately 12 million children to cope with the trauma and stress typically encountered by refugees. Increased rates of depression in this population are well-documented in the literature. This article reviews the ecological determinants of depression for displaced children and current empirical methods for alleviating depression across contexts. PubMed and PsycINFO databases were reviewed for articles that met the following criteria for inclusion: published between January 1, 2000, and April 16, 2020; peer-reviewed empirical article; in English; reviewed an intervention targeting depression; and included a sample of refugees 18 years of age or younger. Sixteen interventions met inclusion criteria and were assessed using an ecological framework. The programs were analyzed for several methodological and outcome factors including intervention type, retention rate, participant demographics, participant country of origin and host country, ecological framework, and effectiveness. Major findings suggest that interventions including caregivers, involving the child's community, addressing multiple contexts, and that are culturally informed may improve outcomes. This article presents research surrounding risk and protective factors for depression within each context to inform existing interventions and presents additional avenues for services to meet the needs of refugee youth across contexts. [ABSTRACT FROM AUTHOR]

Objective: Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children. Methods: A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications. Results: Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported. Conclusions: Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children. [ABSTRACT FROM AUTHOR]

Background: Awareness of psychotropic medication and its adverse drug reactions (ADRs) can promote safe and rational use of medications, particularly in children and adolescents with mental problems. This study examined the prescription of psychotropic drugs and actual drug-drug interaction (DDI) and ADR for children with mental disorders under 18 years of age in a tertiary hospital in Vietnam. Methods: A cross-sectional descriptive study was performed on 257 psychiatric inpatients under 18 years of age at the National Mental Health Institute—Bach Mai Hospital in 2017. Information about the course of treatment included prescribed medications, drug interactions, side effects, drug combination, and modifications to the regimen was collected. Results: 14.8% and 59.5% of patients received a single-drug regimen and a 2-drug combination regimen upon admission, respectively. The most used regimen was antipsychotics + tranquilizers, accounting for 38.1%. Haloperidol was the most commonly prescribed drug (40.5%). Most patients were given the recommended dosage of the drug (>90%). There were 20.6% of patients having drug interactions with the largest proportion of the combination of diazepam and olanzapine (62.3%). ADRs of psychotropic drugs were detected in 46.3% of patients, with the highest rate of ADRs from antipsychotic drugs. Antipsychotics had the highest rate of replacement (91.3%), mostly replaced from a first-generation antipsychotic (FGA) to a second-generation antipsychotic (SGA). Conclusion: The appointment of psychotropic drugs to patients under 18 years of age has to comply with the recommendations, and carefully balance the benefits and risks of ADRs as well as the risk of DDI in case of the drug combination. [ABSTRACT FROM AUTHOR]

Background: Despite increasing participation rates in youth gymnastics, the majority of epidemiologic literature focuses on older elite athletes or stratifies athletes by level of competition. Hypothesis: The authors hypothesized that sex- and age-based patterns in youth gymnastics–related injuries exist, which are otherwise overlooked in an unstratified population. Study Design: Descriptive epidemiology study. Methods: Publicly available injury data from the National Electronic Injury Surveillance System were collected on pediatric gymnastics injuries presenting to emergency departments in the United States. Participation data from the National Sporting Goods Association were used to calculate national injury incidence rates in 7- to 11-year-olds (childhood) and 12- to 17-year-olds (adolescence) from January 1, 2012, to December 31, 2018. Z tests were conducted for the comparison of injury rates between girls and boys within each age group and for overall injury rate across age groups. Results: Girls participated in gymnastics at a frequency 6.5 times that of boys in childhood and 13.5 times that of boys in adolescence. An estimated 72,542 youth gymnastics–related injuries were reported in US emergency departments each year. A large proportion (61.3%) occurred in childhood, with female predominance in both age groups. Overall, there was no difference in weighted annual injury rate (injuries per 100,000 athlete-days per year) by age group (6.9 [childhood] vs 8.8 [adolescence]; P =.19) or sex (7.4 [girls] vs 8.1 [boys]; P =.65). In adolescence, boys were more likely than girls to experience injury (16.47 vs 8.2; P =.003). Wrist and lower arm fractures were more common in childhood than adolescence (1.07 vs 0.43; P =.002) and specifically in girls (childhood vs adolescence, 1.06 vs 0.37; P =.001). Ankle injuries and concussions were more common in adolescence vs childhood (P =.01 and.0002). Conclusion: Upper extremity injuries predominated among childhood gymnasts, particularly girls. In adolescence, girls and boys experienced increases in concussions and foot and ankle injuries. Although representing a lower overall number of training gymnasts as compared with girls, adolescent boys experience a higher rate of injuries overall. [ABSTRACT FROM AUTHOR]

Research on adults indicates other-oriented perfectionism (requiring perfection from others) is associated with various consequential outcomes independent of self-oriented perfectionism (requiring perfection of the self) and socially prescribed perfectionism (believing others require perfection of the self). However, historically, the most widely used and researched measure of trait perfectionism in children, the Child-Adolescent Perfectionism Scale (CAPS), has omitted other-oriented perfectionism. In the present study, we address this by reporting on the multisource development and validation of the first self-report measure of other-oriented perfectionism specifically intended for youths: the Other-Oriented Perfectionism Subscale-Junior Form (OOPjr). Children (N = 107; Mage = 11.5, SD = 1.7) completed the OOPjr, CAPS, and measures of perfectionistic self-presentation, narcissism, social disconnection, depressive symptoms, and parental psychological control. Parents provided ratings of children's self-oriented, socially prescribed, and other-oriented perfectionism. Psychometric analyses indicated the OOPjr is a homogenous and internally reliable scale that, when factor analyzed alongside the CAPS, displays measurement invariance across gender and replicates the three-factor solution found in adults. Furthermore, parent ratings of other-oriented perfectionism showed unique positive relationships with OOPjr scores, but not CAPS scores. Likewise, other-oriented perfectionism had independent positive relationships with narcissistic superiority and achievement-oriented parental psychological control, after controlling for self-oriented and socially prescribed perfectionism. Overall, our findings provide preliminary support for the use of the OOPjr as a measure of other-oriented perfectionism in youths. [ABSTRACT FROM AUTHOR]

The article focuses on the prevalence and challenges of diagnosing Long Covid Syndrome in children and adolescents, highlighting the varied symptoms, the scarcity of literature on the subject, and the potential risk factors, including age, gender, allergies, and persistent symptoms.

Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0–17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution's forensic registry. Descriptive statistics (mean, median), chi-square and Mann–Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp(β) = 2.3 [ p =.02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death. [ABSTRACT FROM AUTHOR]

There have been significant efforts to develop, adapt, and test interventions targeting the co-occurring mental health conditions common among autistic youth, with several extant narrative and systematic reviews demonstrating the efficacy of these interventions. Yet, a methodological analysis of the literature testing these interventions, particularly the characteristics of the participant samples comprising this evidence base, is needed to contextualize our current understanding of treatment effects and highlight current gaps in the current evidence base to inform future research. This systematic quantitative methodology review characterized participants included in the mental health treatment research for autistic youth. One hundred and thirty-one articles testing mental health interventions for autism spectrum disorder were coded for youth, caregiver, and provider participant demographics. Findings indicated limited representation of females, transition age youth, racial/ethnic minority groups, and youth diverse in cognitive functioning and co-occurring mental health symptoms or conditions. Limited inclusion of providers' representative of the clinical workforce was also noted. These results illuminate several critical gaps in the current evidence base for mental health interventions for autistic youth and provide recommendations for future research directions. Previous research has highlighted the importance of mental health treatment for autistic youth. In that research base, most studies focus on demonstrating the efficacy of a particular intervention with a sample of autistic youth. However, understanding the characteristics of samples used within these studies (i.e. demographics) is an important avenue for expanding this research to a more diverse, representative sample of autistic youth in community settings. As such, the current review examined and characterized participants included within mental health treatment research. We coded studies for various demographics among the youth sample, caregivers, and providers participants. Results indicated that while efforts have been made to increase diversity in research, very few studies including transition-aged youth, those identifying as female, and/or those identifying as non-Caucasian. Clinically, a few studies included youth with lower cognitive abilities and/or those with specific mental health problems (e.g. trauma and depression) or more than one co-occurring mental health conditions. Overall, our results highlight several critical gaps in our current evidence base regarding mental health treatment for autistic youth, including the limited clinical representativeness of both provider and child participants. [ABSTRACT FROM AUTHOR]

There is considerable variability in the extent to which young people with developmental language disorder (DLD) experience mental health difficulties. What drives these individual differences remains unclear. In the current article, data from the Twin Early Development Study were used to investigate the genetic and environmental influences on psychopathology in children and adolescents with DLD (n = 325) and those without DLD (n = 865). Trivariate models were fitted to investigate etiological influences on DLD and psychopathology, and bivariate heterogeneity and homogeneity models were fitted and compared to investigate quantitative differences in etiological influences on psychopathology between those with and without DLD. The genetic correlation between DLD and internalizing problems in childhood was significant, suggesting that their co-occurrence is due to common genetic influences. Similar, but nonsignificant effects were observed for externalizing problems. In addition, genetic influences on internalizing problems, but not externalizing problems, appeared to be higher in young people with DLD than those without DLD, suggesting that the presence of DLD may exacerbate genetic risk for internalizing problems. These findings indicate that genetic influences on internalizing problems may also confer susceptibility to DLD (or vice versa) and that DLD serves as an additional risk factor for those with a genetic predisposition for internalizing problems. [ABSTRACT FROM AUTHOR]

Background: Health care disparities have been highlighted in pediatric sports medicine, but the association between insurance status and delayed care for patients undergoing surgery for patellar instability has not been defined. Purpose: To determine whether there is an association between insurance status and delays in care in pediatric and adolescent patients undergoing surgery for patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective case series at a safety-net tertiary referral center of pediatric and adolescent patients undergoing surgical treatment for patellar instability. Insurance status was classified as public or private. We calculated the times from injury to clinical evaluation, injury to magnetic resonance imaging (MRI), injury to surgery, clinical evaluation to MRI, and clinical evaluation to surgery. Comparisons were made between insurance groups. Results: Included were 78 patients (38 public, 40 private insurance) who underwent surgery for patellar instability. The public insurance group was older (P =.019), with a lower proportion of White patients (15.8% vs 52.5%; P =.0005), higher proportion with Hispanic ethnicity (55.3% vs 15.0%; P =.0001), and higher proportion of Spanish-speaking patients (21.1% vs 2.5%; P =.007). Publicly insured patients had longer times from initial injury to clinical evaluation (466 vs 77 days; P =.002), MRI (466 vs 82 days; P =.003), and surgery (695 vs 153 days; P =.0003), as well as a longer time from clinical evaluation to surgery (226 vs 73 days; P =.002). Multivariable models confirmed insurance status as an independent predictor in each of the identified delays. Conclusion: Significant delays were seen for pediatric and adolescent patients with patellar instability and public insurance (approximately 6 times longer to clinical evaluation, more than 5.5 times longer to obtain MRI, and 4.5 times longer to surgery) relative to injured patients with private insurance. Even after adjusting for delays to clinical evaluation, publicly insured patients had a delay from clinic to surgery that was triple that of privately insured patients. [ABSTRACT FROM AUTHOR]

Introduction: Home mechanical ventilation is an established method to support children suffering from chronic respiratory insufficiency, still more research is needed regarding mechanically ventilated children's and adolescents' quality of life (QoL). Therefore, the aim of this scoping review was to explore research regarding QoL and lived experience of children and adolescents with home mechanical ventilation. Methods: A scoping review with systematic searches for research studies published between year 2000–2020 was performed in Cinahl, Medline, and PubMed. Studies that met the inclusion criteria were quality assessed and a thematic analysis was performed. Results: In total, ten articles were quality assessed and included in the results. Four themes emerged: Children's self-reported QoL, Parents' perception and parent-proxy report, Differences between the child's and parent's perception, and challenges in daily life. Children with home mechanical ventilation reported a lower QoL than healthy children and children with other chronic diseases. Generally, parents rate their child's QoL lower than the children themselves. Conclusion: This is the first literature review focusing on HMV in the paediatric population. It is clear that HMV does not only affect the treated child or adolescent but also the whole family. It is important to regularly measure and evaluate QoL in children and adolescents with HMV to provide person-centered care. More research is needed to improve these children's and adolescents' QoL. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the factor structure and degree of measurement invariance of a Spanish adaptation of the Abbreviated Math Anxiety Scale (AMAS) in primary and secondary school students (N = 1,504 students, 46.08% males, 7-19 years of age). The results of confirmatory factor analysis corroborated the original two-factor structure, although a modified two-factor model with one item loading simultaneously on both factors was better supported. Full measurement invariance was observed across gender, and partial measurement invariance was achieved across educational levels (primary and secondary education). The AMAS showed reasonable internal consistency, test–retest reliability, and convergent validity. These results highlight the utility of the AMAS as a measure of math anxiety in primary and secondary school students whose scores can be compared by gender and educational level. [ABSTRACT FROM AUTHOR]

The goal of this study was to expand current attachment models by validating a three-component model of the supervision partnership conceptualization of attachment (accessibility and availability of attachment figures, willingness to communicate, and mutual recognition of other's rights in decision-making). The model was tested by examining associations with parenting, friendship quality, other attachment measures, temperament, and IQ. In a sample of 92 10- to 14-year-olds, the three components of the supervision partnership were significantly related to each other, other attachment measures and child reports of parenting and friendship, and demonstrated some discriminant validity with temperament and IQ. This study provides support for the supervision partnership as a phase of attachment in late middle childhood and early adolescence. [ABSTRACT FROM AUTHOR]

In the current article we examined the extent to which parents and caregivers engage in violence prevention and related discussions with their youth and the correlates (i.e., demographics, confidence, modeling of emotion regulation) of these experiences. We also examined the ways in which parents access prevention-related information to aid in these discussions with their youth. Participants were 142 parents/caregivers of a middle or high school-aged youth. Results suggested that adults reported speaking with youth about less sensitive prevention topics (e.g., bullying) more often than more sensitive topics (e.g., sexual violence). Whereas there were no demographic correlates for the level of confidence in discussing prevention topics with youth, emotion regulation modeling was positively correlated with confidence discussing prevention with youth. Also, parents who identified as White were less likely to discuss more sensitive topics with youth while parents who identified as American Indian were more likely to discuss more sensitive topics with youth and model emotion regulation. Having more confidence discussing prevention with youth positively correlated to discussing more sensitive and less sensitive topics with youth. These results underscore the need for engaging parents in prevention programming. More specifically, these data suggest that programs that builds parents' confidence and comfort in having prevention-related conversations with their youth, especially about more sensitive topics is needed in addition to programming that enhances parents' ability to model emotion regulation skills for their children. [ABSTRACT FROM AUTHOR]

Emotion dysregulation (ED) underlies psychiatric symptoms and impedes adaptive responses in autistic individuals. The Emotion Awareness and Skills Enhancement (EASE) program was the first mindfulness-based intervention designed to target emotion dysregulation in autistic adolescents (12–17 years old). This project partnered with stakeholders to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups who often benefit from caregiver support in treatment. Over three adaptation phases, we: (1) elicited stakeholder and expert feedback to adapt the original EASE program for autistic individuals with intellectual disability; (2) redesigned the adapted manual and expanded the target age range following a small "micro-trial" with a sample of autistic adolescents and adults with intellectual disability (n = 6); and (3) demonstrated feasibility and acceptability of a caregiver-client team-based approach (EASE-Teams) in a sample of 10 autistic individuals with and without intellectual disability (ages 7–25) and their caregivers. EASE-Teams was both acceptable and helpful to families. Significant improvements were noted in participant emotion dysregulation, psychiatric symptoms, and caregiver stress from their child's dysregulation. Findings suggest that EASE-Teams may be appropriate for heterogeneous developmental and cognitive needs. Future research to establish efficacy and refine EASE-Teams with community providers is warranted. Emotion dysregulation (ED) impacts mental health symptoms and well-being in autistic individuals. In prior work, we developed the Emotion Awareness and Skills Enhancement (EASE) to improve emotion dysregulation with autistic adolescents (aged 12–17). The study team partnered with autistic individuals, their caregivers, and expert clinicians to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups that often benefit from caregiver support in treatment. In three phases, we (1) gathered caregiver and expert feedback to adapt the original EASE program for autistic adults with intellectual disability, (2) revised the treatment after using it with six autistic adults with intellectual disability, and (3) tested the newly developed caregiver–client team-based treatment, called EASE-Teams, in a small group of 10 autistic individuals with and without intellectual disability (aged 7–25). Families found EASE-Teams to be acceptable and helpful. We found improvements in emotion dysregulation and mental health symptoms for autistic participants. Caregivers reported less stress from their child's dysregulation after participating. These results show that EASE-Teams can be appropriate for different developmental and cognitive needs. Future studies will need to test the benefits of the treatment in community clinics. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that suture tape-reinforced anterior cruciate ligament (ACL) grafts may have higher ultimate failure loads without stress-shielding. In patients at high risk for graft failure, such as adolescents, the addition of suture tape could have beneficial outcomes. Hypothesis: Suture tape reinforcement (STR) of ACL grafts in adolescent patients would lead to fewer graft ruptures during early recovery, without hindering subjective outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on adolescent patients with a minimum 2-year follow-up after hamstring tendon autograft ACL reconstruction; enrolled were patients from both before (n = 40) and after (n = 40) a shift in surgical technique that added STR. Both the no-STR and the STR cohorts were contacted yearly to obtain patient-reported outcome data for visual analog scale (VAS; range, 0-10) for pain score, Single Assessment Numeric Evaluation, Lysholm score, Tegner activity score, patient satisfaction score (range, 0-100), and return to previous level of sport (yes/no). The cohorts were then matched based on follow-up duration, excluding those with follow-up of <2 years and >3 years to maintain consistency in duration of follow-up. Graft failure was defined as either graft rupture or recurrent instability symptoms, and failures occurring from index procedure to the 3-year mark were recorded for calculations of failure rate. Results: There were no differences between cohorts in mean age [STR, 15.7 years (range, 9.5-18.7 years); no STR, 14.9 years (range, 9.3-18.8 years)], follow-up duration, laterality, or graft size. While not statistically significant, 2 (5%) patients in the STR cohort experienced graft rupture compared with 7 (17.5%) patients in the no-STR cohort. The Tegner score was significantly higher in the STR cohort (P = .017); no between-group differences were seen on the other outcome scores. A subanalysis of the STR cohort comparing small-diameter grafts (<8 mm) with grafts -8 mm also demonstrated no difference in outcome measures, with 1 graft failure in each cohort. Conclusion: Study outcomes indicated that patients treated with ACL reconstruction and STR experienced a significant improvement in Tegner scores while at the same time maintaining the other subjective outcomes. [ABSTRACT FROM AUTHOR]

The majority of childhood cancer patients survive well into adulthood, but remain at risk for psychological late effects that can impact overall health and quality of life. The current narrative review summarizes the literature on psychological late effects, including anxiety, depression, psychological distress, post-traumatic stress disorder, suicidality, psychoactive medication use, and post-traumatic growth in survivors of childhood cancers. While results were mixed, many studies demonstrated that psychological symptoms occurred at levels higher than would be expected in the general population. Treatment, environmental, and behavioral risk factors, as well as symptom onset and trajectory merit further investigation. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the efficacy of sleep endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy in patients with sleep disordered breathing (SDB), including polysomnography (PSG) and swallowing outcomes. Methods: A retrospective review was performed of all patients undergoing simultaneous lingual tonsillectomy and epiglottopexy over the study period. PSG objective measures were recorded pre- and postoperatively, along with demographic data, comorbidities, and descriptive data of swallowing dysfunction in the postoperative setting. Results: A total of 24 patients met inclusion criteria for consideration, with 13 having valid pre- and postoperative PSG data. Successful surgery was achieved in 84.6% of patients, with no difference based on presence of medical comorbidities including Trisomy 21. Median reduction in obstructive apnea–hypopnea index (oAHI) with the procedure was 69.9%. Four patients (16.7%) had postoperative concern for dysphagia, but all objective swallowing evaluations were normal and no dietary modifications were necessary. Conclusion: Combination lingual tonsillectomy and epiglottopexy in indicated patients has a high rate of success in this single-institutional study without new dysphagia in this population. These procedures are amenable to a combination surgery in appropriately selected patients determined by sleep state endoscopy in the setting of SDB evaluated with drug-induced sleep endoscopy. [ABSTRACT FROM AUTHOR]

Sixty-one children and adolescents with traumatic brain injury completed the Child and Adolescent Memory Profile (ChAMP; Sherman & Brooks, 2015) within 1 to 12 months post injury. Most of the ChAMP index scores demonstrated statistically significant negative correlations with time to follow commands following traumatic brain injury. Compared with demographically matched neurologically healthy controls, selected from the ChAMP standardization sample, participants with traumatic brain injury had statistically significantly lower scores on all ChAMP index scores but sensitivity and specificity were suboptimal. We conclude that the ChAMP has modest clinical utility as part of a more comprehensive evaluation of sequelae of traumatic brain injury in children and adolescents. [ABSTRACT FROM AUTHOR]

We examined US parent and youth perceptions of how life events, both positive and negative, associated with COVID-19 resulted in changes in family and youth functioning. Families (n = 105, 80% white, 48% male, and 87% mothers) completed surveys during the pandemic (May to July 2020) and 3 years prior (for youth ages M = 10.6, SD = 1.17 and M = 13.6, SD = 1.19). Declines in youth, though not parent, report of open family communication, parental support, and family satisfaction were found. Declines were associated with various domains of pandemic-related stress in parent report, though positive life events served as buffers. Pre-pandemic family functioning also predicted pandemic stress. Spillover effects in turn impacted youth functioning. The current findings shed light on how experiences of the pandemic are linked with family functioning and have implications for how to support families during this time. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of trunk training on trunk control, arm, and pulmonary function in children with Duchenne muscular dystrophy. Design: A randomised controlled trial. Settings: Neuromuscular diseases clinic of university hospital. Subjects: Twenty-six children with Duchenne muscular dystrophy aged 5–16 were included in the study. Intervention: Participants were randomly allocated into two groups. The study group (N = 13) exercised with the trunk-oriented exercise program and the conventional exercise program, whereas the control group (N = 13) underwent the conventional exercise program for eight weeks. Main measures: The primary outcomes were trunk control was assessed using the Trunk Control Measurement Scale, the arm function was assessed using Performance of Upper Limb, and respiratory function using the pulmonary function test. Data collection was conducted at baseline, and eighth week. The differences in trunk control scores, arm function scores, and respiratory function values before and after the training were calculated for the intergroup comparison. Results: The mean age of the participants was 11.6 (2.6) in the study group and 10.6 (3.4) in the control group. The changes between trunk control score, arm function score (total and distal level score), and respiratory function value (Forced Vital Capacity, Forced Expiratory Volume in one second, and Peak Expiratory Flow Volume percentage values) were compared and significant differences were found after eight week periods in the study and control groups. Conclusions: Trunk-oriented exercise program in Duchenne muscular dystrophy might be effective for trunk control, arm, and respiratory function. [ABSTRACT FROM AUTHOR]

Background: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. Methods: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. Results: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. Conclusions: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered. [ABSTRACT FROM AUTHOR]

Background: Evaluation of intra-articular osteochondral fractures in children with acute traumatic lateral patellar dislocation (LPD) is important for determining treatment options. Purpose: To (1) compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for evaluating intra-articular osteochondral fractures; (2) compare the interpretation of CT and MRI images between radiologists and pediatric orthopaedic surgeons (POS); and (3) investigate any clinical factors influencing the accuracy of CT and MRI evaluations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We reviewed 35 knees in 35 patients (mean age, 12.2 ± 1.2 years; 12 boys and 23 girls) who were treated arthroscopically for acute traumatic LPD; 71% of the patients had patellar fractures, 54% had femoral fractures, and 60% had free osteochondral fracture fragments. All presurgical MRI and CT images were reviewed by POS who were blinded to both the reports of the radiologists and surgical records. We compared the accuracy of CT and MRI in diagnosing intra-articular osteochondral fractures against the arthroscopic findings and compared the interpretation of the images by the POS (MRI-O, CT-O) with those of the radiologists (MRI-R, CT-R). Results: There was no significant difference in diagnostic accuracy between CT and MRI for overall intra-articular osteochondral fractures by the POS or the radiologists; however, the CT-O images had a higher diagnostic specificity (84.2% vs 69.6%; P <.001) and sensitivity (88.1% vs 70.1%; P <.001) versus the MRI-R images. Regarding free fracture fragments, the CT-R images had a higher diagnostic accuracy than the MRI-R images (73.5% vs 47.1%; P =.026). When backed by clinical data, the MRI-O images had greater diagnostic accuracy (78.7% vs 60.3%; P =.001) and sensitivity (88.1% vs 30.7%; P =.021) but lower specificity compared with the MRI-R images, and the CT-O images had similar diagnostic accuracy but greater sensitivity than the CT-R images (70.1% vs 52.2%; P <.001). The diagnostic accuracy of MRI-O images was lower for children under 12 years versus children 12 years and over (67.5% vs 83.3%; P =.040). Conclusion: Compared with MRI, CT scans had better diagnostic performance in the evaluation of intra-articular osteochondral fractures in pediatric patients with acute traumatic LPD. Clinical data enhanced the diagnostic sensitivity of MRI and CT but decreased the specificity of MRI. MRI evaluations remain challenging for both POS and radiologists. [ABSTRACT FROM AUTHOR]

Background: Preoperative diagnosis of concomitant meniscal tears in pediatric and adolescent patients with acute anterior cruciate ligament (ACL) deficiency is challenging. Purpose: To investigate the diagnostic performance of magnetic resonance imaging (MRI) in detecting meniscal injuries for pediatric and adolescent patients with acute ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The authors retrospectively identified patients aged ≤18 years who underwent acute ACL reconstruction between 2006 and 2018 at 2 tertiary academic hospitals. The primary outcomes were arthroscopically confirmed medial, lateral, or any (defined as medial and/or lateral) meniscal tears. To control for chronically deficient knees, patients must have received their MRI study within 4 weeks of injury and must have undergone surgery no more than 8 weeks after their MRI study. Preoperative MRI reports were compared with the gold standard of arthroscopically confirmed tears to calculate sensitivity, specificity, positive predictive value, and negative predictive value. In a secondary analysis, patients were stratified by age into 2 groups (≤13 or ≥14 years), body mass index-for-age data from the Centers for Disease Control were used to classify patients as obese or nonobese, and differences between sensitivity and specificity proportions were analyzed using chi-square test for homogeneity. Results: Overall, 406 patients with a mean age of 15.4 years (range, 10-18 years) were identified. The sensitivity, specificity, positive predictive value, and negative predictive value were as follows: for lateral meniscal (LM) tears, 51.0%, 86.5%, 78.3%, and 65.0%; for medial meniscal tears, 83.2%, 80.6%, 62.3%, and 92.5%; and for any meniscal tear, 75.0%, 72.1%, 81.5%, and 63.8%, respectively. In the stratified analysis, MRI was less specific for the following diagnoses: any meniscal tear in patients aged ≤13 years (P =.048) and LM tears in obese patients (P =.020). Conclusion: The diagnostic ability of MRI to predict meniscal injuries present at acute ACL reconstruction was moderate. Performance was poorest at the lateral meniscus, where MRI failed to detect 97 tears that were found arthroscopically. Specificity was significantly lower in younger patients for any meniscal tear and in obese patients for LM tears. [ABSTRACT FROM AUTHOR]

Assessment of psychological and emotional disorders is an important indicator of well-being among children and adolescents with cancer. This review aimed to determine the prevalence rates of three major psychological disorders in this population, including anxiety, depression, and post-traumatic stress disorder (PTSD). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various databases were searched to identify cross-sectional studies assessing anxiety, depression, and PTSD among children and adolescents with cancer. The Joanna Briggs Institute checklist was used to assess research quality. Of the 40 studies included in the literature review, 33 measured anxiety, 28 focused on depression, and nine assessed PTSD. A total of 18 studies were incorporated into the meta-analysis, with pooled prevalence rates of anxiety, depression and PTSD found to be 13.92% (n = 1,971; 95% confidence interval [CI] = 10.23–18.07%), 20.43% (n = 1,990, 95% CI = 13.85–27.93%), and 20.90% (n = 755, 95% CI = 13.28–29.73%), respectively. Mental health and psychological interventions are essential for children and adolescents diagnosed with cancer. Future work should be undertaken in different regions, such as the Middle East or Africa, or South America when assessing the prevalence of psychological disorders in children and adolescents diagnosed with cancer. [ABSTRACT FROM AUTHOR]

Research evidence suggests that heterogeneity in emotion processing difficulties in autistic individuals may reflect co-occurring alexithymia. Elevated levels of alexithymia is a robust finding in the adult autistic population but there is a relative poverty regarding the corresponding research in younger populations. The aim of this review is to investigate associations between autism and alexithymia in children and adolescents, so that we can better understand the nature and impact of alexithymia in autistic individuals early on in their lives. Online scientific databases were systematically reviewed for studies on autistic children and adolescents and co-occurring alexithymia. A total of eight studies were identified. Evidence indicated that alexithymia prevalence in autistic individuals is higher compared to their typically developing peers and is closely related to the emotional and social deficits involved in autism but not to the associated cognitive deficits. Main concerns associated with these results are related to the alexithymia assessment measures implemented in each study, their limitations, and potential effects on the validity of findings. This review sheds light on the topic of alexithymia in children and adolescents and underscores the difficulties in conducting this research, while providing insights for research with autistic children and adolescents. In this study, we aim to explore the ability of autistic children to process emotions and respond to a range of feelings in relation to a triad of difficulties known as alexithymia, namely children's difficulties to recognize, describe, and distinguish emotions. Alexithymia is common in autistic adults but we know very little about children. To understand this condition better, within a large group of studies, first we study the extent to which alexithymia difficulties are present in autistic children. In reviewing the literature, we also present the assessment measures implemented in each study, their limitations, and potential effects on our understanding of findings. This knowledge will help us understand the extent to which alexithymia is present in autistic children and how it may be related to their emotional difficulties. Also, it will allow us to further detect challenges early on in children's lives so that we recommend interventions that teach autistic children how to recognize, describe, and distinguish emotions in themselves and in others. Such interventions may include family members of autistic children to assist interactions with their child. Supporting children from an early age will help them develop skills that will ready them for school and life and it will enhance their ability to build supportive relationships and meet their fullest potential. [ABSTRACT FROM AUTHOR]

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children's hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance (P <.001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P =.003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

School nurses are the most accessible health care providers for many young people including adolescents and young adults. Early identification of depression results in improved outcomes, but little information is available comprehensively describing depressive symptoms specific to this population. The aim of this study was to develop a taxonomy of depressive symptoms that were manifested and described by young people based on a scoping review and content analysis. Twenty-five journal articles that included narrative descriptions of depressive symptoms in young people were included. A total of 60 depressive symptoms were identified and categorized into five dimensions: behavioral (n = 8), cognitive (n = 14), emotional (n = 15), interpersonal (n = 13), and somatic (n = 10). This comprehensive depression symptom taxonomy can help school nurses to identify young people who may experience depression and will support future research to better screen for depression. [ABSTRACT FROM AUTHOR]

This study examined typologies of childhood polyvictimization and the associations of profiles with demographic characteristics at the levels of child, household, and primary caregiver. This study evaluated a sample of children aged 4 to 17 years residing in San Juan de Lurigancho District, an urban setting on the edge of Lima, Peru (n = 384). An in-person interview of the primary caregiver of each child was conducted in June 2018, assessing the victimization of the child, the caregiver's exposure to trauma and abuse, and general socioeconomic and demographic characteristics of the household. Latent class analysis was used to identify typologies of child victimization. Follow-up analysis was conducted to quantify differences between the classes which emerged, in terms of the child, caregiver, and household. Five classes emerged: High Peer victimization, Moderate Community victimization; High Community victimization; Verbal Abuse; High victimization across domains; and Low victimization across domains. Caregiver exposure to trauma was positively associated with membership in the high-exposure classes. This study offers a unique opportunity to more deeply understand childhood exposure to violence in Latin America, specifically in an urban setting in Peru, and to further understand how childhood victimization is associated with various characteristics of the child, caregiver, and household. These findings could inform interventions supporting children and families at risk of exposure to violence in Peru or globally. [ABSTRACT FROM AUTHOR]

It is common knowledge that bullying victimization and coping strategies significantly affect the psychological well-being of children. However, which coping strategies are more effective at a particular level of bullying victimization is underexplored. Using survey data from 1,634 children from 10 schools in Wuhan, China, this study aims to investigate the abovementioned research gap. The results of factor analysis suggest that coping strategies of children in China can be divided into three types: help-seeking, avoidance, and self-defense. The results of multilevel modeling suggest that children adopting different coping strategies have distinct levels of depression. Help seekers show a significantly lower level of depression than self-defenders and avoiders. However, with increased bullying victimization, the effectiveness of the help-seeking strategy gradually decreases to offset the negative effect of bullying victimization on psychological well-being. Instead, those who adopt the self-defense strategy display a lower level of depression. The findings of this study suggest that there is no single coping strategy that is best for children, and the more effective strategy largely relies on the level of bullying victimization. The findings also imply that without external support, it is almost impossible for children to completely overcome the negative consequences of bullying on their own. [ABSTRACT FROM AUTHOR]

Prevalence rates of depression are higher in autistic youth than neurotypical peers, yet the effects of autism spectrum disorder diagnosis and sex on depressive symptom severity remain incompletely understood, particularly in specific age groups. Using the Children's Depression Inventory, Second Edition, this study explored diagnostic- and sex-based differences in depressive symptom severity in a sample of 212 autistic and neurotypical early adolescents (10:0–13:5 years). Significant group differences were found according to autism spectrum disorder diagnosis [ d = 0.587, 95% confidence interval (0.308, 0.867)] and sex [ d = 0.365, 95% confidence interval (0.089, 0.641)], with more depressive symptoms endorsed in the autism spectrum disorder and female groups. However, the interaction of diagnosis and sex was not significant, suggesting an additive risk of autism spectrum disorder status and female sex. Item-level analyses showed diagnostic differences on nearly half of the CDI-2 items with higher severity in the autism spectrum disorder group (Probability of Superiority range = 0.42–0.65), differences within the sexes, and differences by diagnosis, which persisted when limiting analyses to children with high levels of depressive symptoms. A more nuanced understanding of symptom endorsement and the roles of diagnosis and sex may uncover salient intervention targets for depression in the unique context of autism spectrum disorder. Depression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children's Depression Inventory, Second Edition, Total T -score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents. [ABSTRACT FROM AUTHOR]

Objectives: Turner syndrome (TS) is a rare sex chromosome aneuploidy, with an incidence of four in 10,000 new-born girls. TS is often associated with impaired social communication skills, but the extent to which these are attributable to Autism Spectrum Disorders (ASD) is uncertain. We made standardized assessments of the mental health and associated neurodevelopmental disorders in children and adolescents with TS and report on the prevalence of concurrent conditions. Methods: Our sample comprised 127 girls with TS, 5–19 years of age. We obtained reports of their mental health from a combination of diagnostic interview (the Development and Wellbeing Assessment (DAWBA)), from the Strengths and Difficulties Questionnaire (SDQ) and from the Social Responsiveness Scale (SRS-2). Sources of information included parents, teachers and self-reports. The prevalence of mental health disorders in this sample was compared with age/sex matched national English data from typical controls. Results: Most individuals with TS (83%) had experienced significant social communication difficulties and nearly one in four (23%) met diagnostic criteria for ASD on the DAWBA. One-third (34%) had at least one mental health or neurodevelopmental condition, and those girls with an ASD were at a greater risk of a co-occurring emotional disorder and/or attention deficit hyperactivity disorder (ADHD). Conclusion: Children and adolescents with TS are substantially more likely to meet criteria for ASD than their typically developing peers. Our finding has clinical implications for appropriate behavioural management from preschool through to adolescence. [ABSTRACT FROM AUTHOR]

Limitations in hand function are common among children with cerebral palsy (CP), with almost 50% presenting an arm–hand dysfunction. However, there is no standardized assessment tool available in Italian for evaluating bimanual performance for this population. Our objective in this study was to evaluate the psychometric properties of an Italian translation of the ABILHAND-Kids (ABILHAND-Kids-IT) among children with CP. We examined internal consistency using Cronbach's Alpha and Omega coefficients, and we investigated test-retest reliability with intraclass correlation coefficients (ICC). We performed explorative factor analysis (EFA) to investigate structural validity. We calculated Pearson's correlation coefficients between the ABILAND-Kids IT and the Manual Ability Classification System (MACS) to assess criterion validity; and, to demonstrate the score variability of the ABILHAND-Kids-IT, we used analyses of variance (ANOVAs) to compare the 181 children with CP in this sample with their levels on the MACS. We enrolled 181 children with CP in the study. EFA confirmed a uni-dimensional scale. We obtained internal consistency on both Cronbach's Alpha and Omega coefficient of 0.98, and a one-week test-retest reliability analysis revealed an ICC with 95% of confidence interval of.992. The ANOVA revealed significant score variability (p < 0.01) and the Pearson correlation coefficient comparing the ABILHAND-Kids-It score with the MACS was –0.929 (p < 0.01). We conclude that the ABILHAND-Kids-IT is valid and reliable for use with Italian children with CP. [ABSTRACT FROM AUTHOR]

Background: Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries. Purpose/Hypothesis: The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non–English language manuscripts, multiligamentous injuries, and nonclinical studies. Results: A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; P =.006) and irreparable meniscal tear (odds ratio, 0.31; P =.001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences (P =.413) or proportion with difference ≥3 mm (P =.181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%. Conclusion: Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports. [ABSTRACT FROM AUTHOR]

Background: Medial patellofemoral ligament reconstruction in skeletally immature patients who experience lateral patellar dislocation has been reported to yield good results. Whether bony abnormalities such as patellar height and trochlear dysplasia should be addressed additionally is a topic of discussion. Purpose: To evaluate patient-reported outcomes and redislocation rates after isolated medial patellofemoral ligament reconstruction as first-line surgical treatment for lateral patellar dislocation in skeletally immature patients. Further, to analyze epidemiological, intraoperative, and radiographical factors influencing redislocation and clinical outcome. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were retrospectively analyzed for adolescent patients younger than 16 years who underwent medial patellofemoral ligament reconstruction between 2014 and 2018. Inclusion criteria were isolated medial patellofemoral ligament reconstruction with gracilis tendon and availability of accurate pre- and postoperative radiographs with the presence of open physes. The patients were questioned regarding further surgery, redislocation, and clinical outcomes using the Tegner Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Form, Lysholm score, and Kujala score. The influence of diverse epidemiological, intraoperative, and radiographical parameters on the redislocation rates and clinical outcome was analyzed. Results: A total of 54 medial patellofemoral ligament reconstructions (49 patients) met the inclusion criteria. After 4.3 ± 1.7 years (range, 2.0-7.3 years), 45 reconstructions (83.3%) in 41 patients were available for follow-up. The distribution of trochlear dysplasia was as follows: type A and B, 19 cases (42.2%) each; type C, 6 cases (13.3%); and type D, 1 case (2.2%). Patellar redislocation occurred in 3 patients (6.7%). The mean Tegner, subjective IKDC, Lysholm, and Kujala scores at follow-up were 6.3 ± 1.6 (range, 3-9), 93.6 ± 8.8, 95.9 ± 7.4, and 97.9 ± 7.1, respectively. Patellar height and trochlear dysplasia had no influence on redislocation or clinical scores. The Lysholm score was lower in knees with intraoperative retropatellar chondral lesion grade ≥III versus grade