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Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication. [ABSTRACT FROM AUTHOR]

The article discusses the Adolescent Brain Cognitive Development and the HEALthy Brain and Child Development studies related to child and adolescent neurodevelopment. Highlights include the effects of adolescent alcohol and marijuana use on the adolescent brain, increased availability of marijuana and its possible increased use by adolescents, and factors that may mitigate the negative effects of stressful environments or environmental chemicals on brain development.

Using a cross-sectional survey of 673 multidisciplinary autism spectrum disorder providers recruited from five different sites in the United States, we examined the frequency with which community-based providers inquire about, screen, and treat trauma-related symptoms in their patients/students and assessed their perceptions regarding the need for and barriers to providing these services. Univariate and bivariate frequencies of self-reported trauma service provision, training needs, and barriers were estimated. Multivariable logistic regressions identified provider and patient-related factors associated with trauma-related symptoms screening and treatment. Over 50% of providers reported some screening and treatment of trauma-related symptoms in youth with autism spectrum disorder. Over 70% informally inquired about trauma-related symptoms; only 10% universally screened. Screening and treatment varied by provider discipline, setting, amount of interaction, and years of experience with autism spectrum disorder, as well as by patient/student sex, ethnicity, and socioeconomic status. Most providers agreed that trauma screening is a needed service impeded by inadequate provider training in trauma identification and treatment. The findings indicate that community providers in the United States of varied disciplines are assessing and treating trauma-related symptoms in youth with autism spectrum disorder, and that evidence-based approaches are needed to inform and maximize these efforts. [ABSTRACT FROM AUTHOR]

Undertaking research with young people presents an array of methodological challenges. We report the findings from a qualitative study that took place alongside a fetal alcohol spectrum disorder (FASD) prevalence study among detainees in Australia. Of 38 participants, 27 were Aboriginal youth. Interviews were conducted using "social yarning" and "research topic yarning," an Indigenous research method which allows for data collection in an exploratory, culturally safe way. A complex interplay emerged between social yarning and research topic yarning which provided a space to explore responsively with participants their experiences of FASD assessments. Flexibility, including language adaptation and visual descriptions about assessments, was utilized to assist participants recall and retell their experiences. There were, however, challenges in gathering data on the assessment experiences of some participants. We describe how employing a "yarning" method for collecting data could benefit children and young people undergoing neurodevelopmental assessments in the future. [ABSTRACT FROM AUTHOR]

Background: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. Methods: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. Results: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents (P =.4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants' group (P =.01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms (P <.05), location of the FB (P <.001), and witnessed aspiration (P <.001) were independent prognostic factors for the length of hospitalization. Conclusion: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate a cognitive-behavioral treatment for children and adolescents with tic disorder including habit reversal training (HRT) in a sample of children and adolescents (n = 27). Multiple outcome measures were used to assess the effects of the treatment on tic symptoms. In addition, impairment/subjective burden ratings and the self-efficacy to control tics were assessed. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (MLM). During the treatment phase, significant improvements in tic symptoms, impairment, and self-efficacy to control tics were found on most outcome measures. Treatment effects were found on the clinical rating of tic symptoms (Yale Global Tic Severity Scale [YGTSS]), the self-efficacy to control tics, and the video-observed motor tic frequency by comparing the improvements during treatment with the course of the outcome measures during the preceding diagnostic phase. [ABSTRACT FROM AUTHOR]

This study investigated children <18 years old treated for burns in United States (US) emergency departments from 1990 to 2014 using data from the National Electronic Injury Surveillance System. There were 2 548 971 children treated for burns during the study period, averaging 101 959 annually. The number and rate of burns decreased by 30.0% and 38.9%, respectively, (both P <.001) during the study. Most patients (58.4%) were boys, 64.0% were <6 years old, and 7.4% were admitted to the hospital. Thermal burns accounted for 60.2% of injuries. The hand/fingers were most commonly injured (37.1%), followed by head/neck (19.6%). The most common specified mechanism of injury was grabbing/touching (18.4%), followed by spilling/splashing (16.4%). Although the number of children treated for burns has decreased, it remains an important source of pediatric injury, demonstrating the need to increase prevention efforts, especially among young children. This is the first study to use a nationally representative sample to investigate burn mechanisms. [ABSTRACT FROM AUTHOR]

Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA. [ABSTRACT FROM AUTHOR]

The prevalence of coronary intimal thickening (IT) was assessed in fetuses and pediatric population. We studied the coronary arteries of 63 hearts obtained from fetuses, infants, children, and adolescents, deceased from noncardiac disease or trauma. Histomorphometric analysis, planimetry, and immunohistochemical studies were conducted. Intimal thickening consisted of proliferation of smooth muscle cells and scarce monocytes embedded in amorphous deposits within the internal elastic membrane (IEM). Intermingled lesions of intimal hyperplasia and parietal nonstenotic plaques were also observed. Intimal thickening was found in 10% of 20 fetuses, in 33.3% of 18 infants, 73.3% of 15 children, and 100% of 10 adolescents. A significant correlation (r = 0.671, P < 0.001) was found between the extent of IT and age. The IEM was duplicated or interrupted in 43% of patients, showing a positive correlation with the degree of IT (P = 0.01). Intimal thickening was predominantly found near bifurcation sites in the left anterior descending coronary artery (55.6%) and in zones free of bifurcation in the right coronary artery (75%). In conclusion, the prevalence and extension of IT lesions are higher at older ages within a young population. Intimal thickening may be regarded as the first event occurring in coronary preatherosclerosis, preceding lipid deposition. [ABSTRACT FROM AUTHOR]

In the article, we propose a comprehensive model, which aims to enhance understanding of the contribution of sense of fear as a major response to continuous traumatic stress situations, and which addresses contextual factors as potential moderators of psychological distress and aggressive behavior. The research sample consisted of 1,290 children and adolescents living near a war zone, who filled out questionnaires relating to negative psychological consequences, as well as to the role of sense of fear, resilience resources, and sense of belonging to the school in mediating or moderating those consequences. The findings revealed that the direct effect of fear reactions on negative psychological consequences may vary with different levels of these moderators. The study highlights the role of the school as a substantial source of support for children and adolescents, which can lead to reduced levels of psychological distress and aggressive behavior. [ABSTRACT FROM AUTHOR]

Introduction: The use of debating as an educational tool is increasing in popularity. Students who take part in debates can develop a range of skills such as confidence and communication as well as gaining a greater understanding of the topic discussed. Within this study we have evaluated an antibiotic-resistant debate kit, assessing the ability of the debate lesson to improve student knowledge and awareness around antibiotics. Methods: The debate lesson was delivered in seven schools across South West England to 235 students aged 13-16 years. Change in student knowledge was measured using before and after knowledge questionnaires. Student and teacher feedback and suggestions for improvements for the lesson were also collected through questionnaires and interviews. Results: Quantitative questionnaires found a significant improvement in knowledge for most areas covered in the debate, particularly around the use of antibiotics to treat colds and bacteria developing resistance. Teachers felt their students engaged well with the debate session and made suggestions for minor modifications that could improve the lesson. Conclusions: The results suggest that the e-Bug antibiotic resistant debate kit is able to improve knowledge in young people around antibiotics and antibiotic resistance. Furthermore, the lesson was enjoyed by students and therefore this resource should be promoted more widely to teachers and schools. [ABSTRACT FROM AUTHOR]

Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind–body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects. [ABSTRACT FROM AUTHOR]

Traditional bullying and cyberbullying have become serious worldwide issues. The meta-analysis in this article took a cross-cultural perspective to explore whether there were any differences between the effects of cyber victimization and traditional victimization on the presence of depression and anxiety in children and adolescents and to examine the effects of moderators in explaining these differences/similarities. Fifty-six empirical studies (generating 148 independent samples) were included with a total sample size of 214,819 participants. The results indicated that the effects of cyber victimization and the subtypes of traditional victimization on anxiety were significantly different, and there was a marginally significant difference for depression. The moderating effects of country of origin were found to be significant for depression, with the mean effect size in North America being significantly higher than in China and Europe, which suggested that culture was an important factor. The moderating effects of age were also found to be significant for the relationships between traditional victimization and depression, traditional victimization and anxiety, cyber victimization and depression, and cyber victimization and anxiety. In addition, the effect size for cyber victimization and depression has increased in more recent publication years. [ABSTRACT FROM AUTHOR]

Background. Literature on childhood conversion disorder (CD) is sparse and is mostly limited to the outpatient population. Method. Our study retrospectively examines the characteristics of childhood CD in 42 children and adolescents seen by the psychiatric consultation-liaison service in an urban academic medical center with a large minority population. Results. CD accounted for 11% of our consultations. The majority of patients were female adolescents, but in the younger cohort, the male-to-female ratio equalized. Other somatic symptoms and additional psychiatric diagnoses were common, anxiety disorders in particular. Antecedent stressors were identified in 95% of patients, most commonly related to family stressors. Recent or remote history of abuse was rare. Neurological presentations were complex, with almost half of the patients presenting with multiple distinct neurological symptoms. Hyperkinetic symptoms were more common than hypokinetic symptoms, and paroxysmal symptoms were more common than non-paroxysmal. No distress (la belle indifference) was found in only 25% of patients and about half of patients had no socio-academic impairment. High resource utilization was noted based on multiple specialist consultants, diagnostic studies, and length of stay. Conclusion. Much of our data confirms previous findings and contributes to what is becoming a more robust characterization of this population. [ABSTRACT FROM AUTHOR]

The recently developed short form of the Experiences in Close Relationships Scale-Revised Child version (ECR-RC) is a promising tool to assess anxious and avoidant attachment in children and adolescents. Yet, evidence concerning its validity in middle childhood is limited. This study aimed to test the psychometric properties of the 12-item ECR-RC for both mother and father forms in a sample of 448 Italian children (50.2% girls) aged between 8 and 13 years. The scale was adapted by changing the response format to make it more understandable for young children. Psychometric proprieties of the brief ECR-RC were investigated by testing its factor structure and internal consistency, invariance across middle childhood and early adolescence, and concurrent and convergent validity. A series of confirmatory factor analyses provided support for the two-factor structure (i.e., anxiety and avoidance) of the ECR-RC, and multi-group confirmatory factor analyses supported its invariance across middle childhood and early adolescence. Older children reported significantly higher latent mean values in avoidant attachment to both parents compared to their younger counterparts. Furthermore, the questionnaire showed evidence of concurrent and convergent validity. Our results indicate that the 12-item version of the ECR-RC is a psychometrically robust instrument to assess avoidance and anxiety toward mother and father among Italian children and early adolescents. [ABSTRACT FROM AUTHOR]

Persistent pain is a global health care issue affecting more than 30% of children and young people. mHealth applications delivered using smartphones, are an innovative method to engage children in pain self-management. This article outlines the evidence concerning the development, implementation, and evaluation of mHealth apps for these children in terms of feasibility, acceptability, and impact on important pain outcomes such as quality of life and health care utilization. [ABSTRACT FROM AUTHOR]

Deficits in executive function (EFDs) are thought to be the mechanisms that underlie a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). However, prior research has indicated that EFDs are not uniform throughout the ADHD population and it is not clear what factors lead to individual variability in EF abilities. The current study was conducted to (a) elucidate the possible presence of unique patterns in EFDs and (b) identify potential risk factors for clinically significant EFDs. A sample of 256 young adolescents were comprehensively assessed and diagnosed with ADHD, and parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Latent profile analysis (LPA) was conducted to elicit individual-level patterns of ratings across the eight clinical scales of the BRIEF. Chi-square analyses and regression models were also conducted to determine whether ADHD presentation, gender, or comorbid psychopathology was associated with the profiles elicited in the LPA. LPA results demonstrated a consistent trend in relative EF strengths and weaknesses, with patterns differing primarily in the intensity of deficits. Females with ADHD and adolescents with ADHD Combined Presentation or comorbid Oppositional Defiant Disorder exhibited more severe patterns of EFDs based upon group comparisons and regression models. ADHD may be associated with a consistent pattern of relative strengths and weaknesses in EF, although several important factors appear associated with an increased risk of more severe EFDs. These findings carry important clinical implications for the assessment of ADHD in adolescence. [ABSTRACT FROM AUTHOR]

Objective: Suicide is a leading cause of death among American Indian/Alaska Native (AI/AN) young people aged 10-19 years in the United States, but data collection and reporting in this population are lacking. We examined results of an oversample project in New Mexico to determine the association between resiliency factors and suicide-related behaviors among AI/AN middle school students. Methods: We conducted analyses using data from the 2019 New Mexico Youth Risk and Resiliency Survey for students in grades 6 through 8. An oversampling method was used to increase the sample size of AI/AN students. We used logistic regression to determine the association between resiliency factors and suicide indicators among AI/AN students, stratified by sex. Results: Among female AI/AN students, community support had the strongest protective effect against having seriously thought about suicide (adjusted odds ratio [aOR] = 0.23; 95% CI, 0.14-0.38), while family support was significantly associated with the lowest odds of having made a suicide plan (aOR = 0.15; 95% CI, 0.08-0.28) and having attempted suicide (aOR = 0.21; 95% CI, 0.13-0.34) (P <.001 for all). Among male AI/AN students, school support had the strongest protective effect against all 3 outcomes: seriously thought about suicide (aOR = 0.34; 95% CI, 0.19-0.62; P <.001), having made a suicide plan (aOR = 0.19; 95% CI, 0.09-0.39; P <.001), and having attempted suicide (aOR = 0.27; 95% CI, 0.12-0.65; P =.003). Conclusions: Oversampling AI/AN young people can help accurately quantify and understand health risk behaviors and strengths of this population, leading to improved health and wellness. Family, community, and school-based support should be considered in interventions geared toward suicide prevention among AI/AN young people. [ABSTRACT FROM AUTHOR]

Background: Segond fractures (avulsion fractures of the proximal lateral tibia) are considered to be pathognomonic for anterior cruciate ligament (ACL) tears in adult patients. Purpose: To describe the largest case series of pediatric Segond fractures and associated intra-articular injuries of the knee to determine if these fractures are pathognomonic for ACL tears in young patients. Methods: IRB-approved retrospective study of patients under 20 years who presented with Segond fracture to a tertiary children’s hospital between 2009-2019. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected. Results: 55 patients (46 males, 9 females) with mean age 15.2 years (11.8-19.1) with Segond fractures of the proximal tibia on radiology imaging were identified (Fig.1.2). Diagnosis of associated injuries was established based on clinical examination, radiology report and findings during arthroscopy. Average Segond fracture size was 2.7 x 9.5mm as measured on standard knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/55(89%) patients. Associated injuries included anterior cruciate ligament (ACL) tears (39 patients, 70.9%), tibial eminence fractures (9, 16.4%), and all other injuries (7, 12.7%) (Table 1.1). Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. When age was compared between the patient group with ACL tears (mean 15.7 years) to the ones with tibial spine fractures ( mean 13.9 years), there was a statistically significant difference(p=0.007). 12/55 (21.8%) had associated articular cartilaginous injuries, 3 of which required surgical intervention. 37/55 (67.3%) patients had meniscal injury. 3 (5.5%) patients suffered multi-ligament injuries. Overall, 87.2% of the patients required surgical management for associated intra-articular injuries of the knee. Conclusion: The Segond (tibial avulsion) fracture is associated with intra-articular injuries the pediatric population, most commonly ACL tears and meniscus tears. However, the largest case series in the pediatric population suggests that they are not pathognomonic for ACL tears as a notable proportion of patients, especially the ones who are younger in age, have tibial eminence fractures or no ACL tears. [ABSTRACT FROM AUTHOR]

Background: Migraine in children and adolescents is associated with significant disability and a high risk of persistence into adulthood.Objective: Data on migraine incidence in children and adolescents are few and relatively coarse. To tailor interventions starting shortly after disease onset, detailed information on age- and sex-specific incidence of migraine in children and adolescents is needed.Methods: We used health care data prospectively collected by the BARMER statutory health insurance, representing ∼11% of the German population. The incidence of migraine diagnoses (International Classification of Diseases (ICD)-10 code G43) in the year 2016 was assessed in subjects aged 0-19 years, who had been continuously insured with the BARMER between 2005 and 2016 or during their entire lifespan.Results: Data from ∼1.2 million children and adolescents were available. The incidence of migraine diagnoses steadily increased with age, reaching ∼1% per year around the age of 10 for both sexes, and 3.49% per year in females and 1.72% per year in males at the age of 19. Incidences in males and females were similar up to the age of 13 and higher in females from there on. The proportion of incident migraine diagnoses specified as "definite" versus "probable" migraine increased with age.Conclusion: The present study provides a representative estimation of the first documented health care use for migraine in children and adolescents in Germany within 1-year age bins, separately for boys and girls. These data will be helpful for tailoring early healthcare interventions to reduce disability and prevent migraine chronification. [ABSTRACT FROM AUTHOR]

Neuromyelitis optica spectrum disorder is a severe and disabling disease that manifests with severe relapses of optic neuritis, longitudinally extensive myelitis, and/or brainstem syndromes. The disease is complex and, although onset typically occurs in middle age, children and adolescents may be affected. The present study adds to the literature through detailed clinical data from 36 Brazilian patients with neuromyelitis optica spectrum disorder starting before age 21. This was a retrospective assessment of medical records from 14 specialized units in Brazil. The results showed that the course of neuromyelitis optica spectrum disorder was worse in patients with disease onset before the age of 12 years. Gender and ethnic background did not influence disability accumulation. Over a median period of 8 years, 14% of the patients who presented the initial symptoms of neuromyelitis optica spectrum disorder before the age of 21 years died. In conclusion, the present study adds to the reports from other authors examining the severity of early-onset neuromyelitis optica spectrum disorder. [ABSTRACT FROM AUTHOR]

Background: Pediatric-onset SLE (pSLE) is a multisystem autoimmune disease. Recently, the ficolin-2 (FCN2) gene has emerged as a potential candidate gene for susceptibility to SLE. Objectives: The objective of this study was to evaluate the association of the FCN2 gene polymorphisms at positions −986 (G/A), −602 (G/A), −4 (A/G) and SNP C/T (rs3124954) located in intron 1, with susceptibility to pSLE in Egyptian children and adolescents. Methods: This was a multicenter study of 280 patients diagnosed with pSLE, and 280 well-matched healthy controls. The FCN2 promoter polymorphisms at –986 G/A (rs3124952), −602 G/A (rs3124953), −4 A/G (rs17514136) and SNP C/T (rs3124954) located in intron 1 were genotyped by polymerase chain reaction, while serum ficolin-2 levels were assessed using enzyme-linked immunosorbent assay. Results: The frequencies of the FCN2 GG genotype and G allele at −986 and −602 positions were significantly more represented in patients with pSLE than in controls (p < 0.001). Conversely, the FCN2 AA genotype and A allele at position −4 were more common in patients than in controls (p < 0.001). Moreover, patients carrying the FCN2 GG genotype in −986 position were more likely to develop lupus nephritis (odds ratio: 2.6 (95% confidence interval: 1.4–4.78); p = 0.006). The FCN2 AA genotype at position −4 was also identified as a possible risk factor for lupus nephritis (odds ratio: 3.12 (95% confidence interval: 1.25–7.84); p = 0.024). Conclusion: The FCN2 promoter polymorphisms may contribute to susceptibility to pSLE in Egyptian children and adolescents. Moreover, the FCN2 GG genotype at position −986 and AA genotype at position −4 were associated with low serum ficolin-2 levels and may constitute risk factors for lupus nephritis in pSLE. [ABSTRACT FROM AUTHOR]

Sentiment analysis is a computational method that automatically analyzes the valence of massive quantities of text. Basic sentiment analysis involves extracting and counting emotionally-laden keywords from passages of text (e.g., hate, love, happy, sad). This study describes using sentiment analysis to explore changes in emotion expression in a developmental context. A sample of n = 8,688 poems published online by children and adolescents from Grade 4 to Grade 12 was analyzed. Sentiment analysis coded words as positive or negative and these were averaged within each poem to obtain its relative percentage of positive and negative sentiment. Polynomial regressions explored linear and nonlinear trends in sentiment scores by grade. Among the results, negative sentiment demonstrated an upward curvilinear trend, increasing sharply from Grade 6 to Grade 11 and then decreasing afterward. Positive sentiment demonstrated a sinusoidal pattern throughout development. Overall, these findings are consistent with previous research on the progressions of emotion expression in childhood and adolescence. Despite some limitations, sentiment analysis presents an opportunity for researchers in developmental psychology to explore basic questions in emotional development using large quantities of data. [ABSTRACT FROM AUTHOR]

The present study explores the longitudinal development between Grade 3 word level reading skills and higher level semantic skills to Grade 10 reading comprehension for 3,157 students. In particular, this work focused on how the developmental relations varied for subsamples of students who are English learners (EL; N = 308), students identified as specific learning disability (SLD; N = 133), and general education (Gen Ed; N = 2,716) students who have no formal classification or diagnoses. Multiple group structural equation modeling showed that the relation between Grade 3 vocabulary and Grade 10 reading comprehension did not vary across three student subgroups when accounting for Grade 3 fluency and that when controlling for students' vocabulary, the unique effect of oral reading fluency ranged from a standardized effect of γ =.22 to γ =.39 across the three subgroups. Quantile regression using estimated factor scores revealed heterogeneous relations of component skills to reading comprehension across each subgroup. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the efficacy of cycling to improve function and reduce activity limitations in children with cerebral palsy; the optimal training parameters for improved function; and whether improvements in function can be retained. Method: Six databases were searched (until February 2019) and articles were screened in duplicate. Randomized or quasi-randomized controlled trials and pre–post studies were included. Methodological quality was assessed using the Downs and Black scale. Outcomes were reported under the International Classification of Functioning, Disability and Health domains of body functions and activity limitations. Quantitative analyses were completed using RevMan V5.3. Results: A total of 533 articles were identified and 9 studies containing data on 282 participants met full inclusion criteria. Methodological quality ranged from low (14 of 32) to high (28 of 32). Significant improvements were reported for hamstring strength (effect size = 0.77–0.93), cardiorespiratory fitness (effect size = 1.13–1.77), balance (effect size = 1.03–1.29), 3-minute walk test distance (effect size = 1.14) and gross motor function (effect size = 0.91). Meta-analysis suggested that cycling can improve gross motor function (standardized mean difference = 0.35; 95% confidence interval = (−0.01, 0.70); P = 0.05); however, the effect was insignificant when a poor-quality study was omitted. Conclusion: Cycling can improve muscle strength, balance and gross motor function in children with cerebral palsy; however, optimal training doses are yet to be determined. There was insufficient data to determine whether functional improvements can be retained. Conclusions were limited by small sample sizes, inconsistent outcome measures and a lack of follow-up testing. [ABSTRACT FROM AUTHOR]

Attribution of importance and satisfaction with performance are key dimensions contributing to engagement in occupations. This study explored caregiver satisfaction with and importance attributed to the participation of their children and adolescents in household tasks. Participants included 109 caregivers of children and adolescents of both sexes, aged 6 to 14 years, from various socioeconomic levels. They were interviewed with two questions of the Children Helping Out: Responsibilities, Expectations and Supports (CHORES), with ratings of importance and satisfaction on Likert-type scales, and asked to explain their ratings. We examined the association between the two dimensions. Results showed no correlation between caregivers' ratings of satisfaction and importance (rs =.04; p =.699). The majority of caregivers evaluated their children's participation in domestic care as very important, explaining in terms of the need for children's autonomy in adulthood. Caregivers' satisfaction was attributed to children's attitudes. The expressed ideal of children's future autonomy by caregivers is not converted to current engagement in household task. [ABSTRACT FROM AUTHOR]

In Germany, there are no self-report questionnaires assessing emotion awareness in youth under the age of 16 years or simultaneously with emotion suppression. The "Emotion Expression Scale for Children" (EESC) measuring lack of emotion awareness and reluctance to express emotions in 10- to 15-year-olds can fill this gap. Goal of this study was to evaluate the factorial structure of the German version of the 16-item EESC in a test and a validation sample of overall 588 adolescents (314 boys; M age = 11.6 years; SD =.74). The original structure comprised of the factors "Poor Awareness" and "Expressive Reluctance" could not be confirmed in the test sample using confirmatory factor analysis. An exploratory factor analysis yield a one-factor structure. Modification process led to an adjusted one-factor model with 13 items, which fitted the data best in the validation sample. The factor was named "Low Emotion Awareness/Suppression." Results indicated that the EESC structure is not measurement invariant. Reasons for missing fit of the two-factor model are discussed. [ABSTRACT FROM AUTHOR]

Clinical and empirical research have consistently distinguished two dimensions of narcissism: grandiose narcissism and vulnerable narcissism. However, to date there is no psychometrically validated measure of grandiose and vulnerable narcissism for children. A measure that assesses both expressions of narcissism in children and adolescents is necessary to understand the causes and consequences of narcissistic self-views prior to adulthood. In this article, four studies are presented documenting the construction and psychometric properties of a 15-item Narcissism Scale for Children, adapted from the (adult) Narcissism Scale. Partial confirmatory factor analysis supported two dimensions of narcissism in children (Study 1) and adolescents (Study 4), with evidence for good validity and reliability (Studies 1-4). As in adults, trait narcissism in children and adolescents consists of both grandiose and vulnerable dimensions. Enabling the measurement of multidimensional narcissism prior to adulthood has important implications for narcissism theory and future research. [ABSTRACT FROM AUTHOR]

Research on the association between complicated grief (CG), hope, and posttraumatic growth (PTG) among bereaved youth is limited. Measures of CG, depression, hope, and PTG were completed by 85 youth (aged 7–18 years). Results indicated a strong positive relationship between CG and depressive symptoms, an inverse relationship between hope and depressive symptoms, and a moderate positive relationship between hope and PTG. There was no significant association between CG and hope or between CG and PTG. Higher levels of CG and lower levels of hope independently predicted greater depressive symptoms, but PTG did not. Results have implications for assessing positive outcomes in bereaved youth. [ABSTRACT FROM AUTHOR]

Background: Gliomatosis cerebri is a rare but fatal widespread infiltrating central nervous system tumor. We aimed to describe diagnostic and prognostic features of gliomatosis cerebri among children and adolescents. Methods: We conducted a systematic literature review for published case reports and case series on patients with histologically confirmed gliomatosis cerebri and extracted data on an individual patient level for those aged 0-18 years. Multivariable Cox proportional hazard models were fit for overall survival. Results: Following screening of 274 published studies, 182 gliomatosis cerebri patients (63% males) aged 0-18 years with individual-level data available were identified. The most common presenting symptoms were seizures (52%), focal motor deficits (36%), and headache (30%). Imaging showed bilateral hemisphere involvement in 60%, infratentorial infiltration in 39%, and a focal contrast-enhanced mass (type II gliomatosis cerebri) in 27% of cases. Anaplastic astrocytoma was the most common histologic subtype of pediatric gliomatosis cerebri, whereas MGMT promoter methylation, IDH1 mutations, and codeletion of 1p/19q were less common molecular aberrations, as compared to adult gliomatosis cerebri. In the multivariable analyses, age at diagnosis >4 years, extended central nervous system infiltration, coordination abnormalities, and cognitive decline were predictors of worse outcome. Conversely, IDH1 mutations were associated with prolonged overall survival. Chemotherapy and extended surgical resection were associated with improved outcome, whereas radiotherapy was not associated with overall survival and was inferior to chemotherapy alone. Conclusion: Gliomatosis cerebri among children and adolescents presents distinct histopathologic and molecular features compared to adults. However, similar associations of chemotherapy, and, when feasible, extended surgical resection, with favorable outcomes were noted among the 2 age groups. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study are (1) to characterize factors influencing self-management behaviors and quality of life in adolescent and young adult (AYA) patients with childhood-onset systemic lupus erythematosus (cSLE) and (2) to identify barriers and facilitators of treatment adherence via focus groups. Methods: AYAs with cSLE ages 12–24 years and primary caregivers of the adolescents participated in this study. Recruitment occurred during pediatric rheumatology clinic visits at a Midwestern children's hospital or the hospital's cSLE active clinic registry. Information about disease severity was obtained from patient health records. Pain and fatigue questionnaires were administered. Descriptive statistics were used to analyze data. Results: Thirty-one AYA patients and caregivers participated in six focus groups. Ten major themes emerged from sessions; four were expressed both by the AYA and caregiver groups: knowledge deficits about cSLE, symptoms limiting daily function, specifically mood and cognition/learning, barriers and facilitators of adherence, and worry about the future. Themes unique to AYA participants included symptoms limiting daily functioning—pain/fatigue, self-care and management, impact on personal relationships, and health care provider communication/relationship. For caregiver groups unique themes included need for school advocacy, disruption of family schedule, and sense of normalcy for their adolescent. Conclusion: AYAs with cSLE face a lifelong disease characterized by pervasive pain, fatigue, organ damage, isolation—social and/or physical—and psycho-socioeducational challenges. This study confirmed that continued psychosocial support, health information education, adherence interventions, and personalized treatment plans are necessary to increase self-management and autonomy in AYAs with cSLE. [ABSTRACT FROM AUTHOR]

Objective: Mood disorders are more common among girls and typically emerge during adolescence. The precise reasons for this are unknown, but among the many mechanisms implicated are stress-induced hippocampal structural changes during this developmental stage. The hippocampus is a complex structure comprised of subfields that develop differentially and respond variably to stress and childhood adversity, both of which are risk factors for mood disorders. To better understand vulnerability to mood disorders, we investigated a cohort of adolescent girls and determined volumetric changes in their hippocampal subfields to elucidate the potential effects of childhood trauma. Methods: Of the 229 participants, 201 girls (aged 12–17 years) fulfilled our analysis inclusion criteria. Of these, 76 had been exposed to higher emotional trauma (emotional abuse or neglect). The girls underwent high-resolution structural magnetic resonance imaging scans, and hippocampal subfield volumes were measured using FreeSurfer. We compared hippocampal subfield volumes in those exposed to higher emotional trauma and those exposed to minimal emotional trauma, at three time-points of adolescent development: early (12–13 years), mid (14–15 years) and late (16–17 years). Results: Mid-adolescent girls exposed to higher emotional trauma had significantly smaller left CA3 volumes than minimal emotional trauma girls (p = 0.028). Within the minimal emotional trauma group, mid-adolescents had significantly larger left CA3 volumes than early (p = 0.034) and late (p = 0.036) adolescents. Within the higher emotional trauma group, early adolescents had significantly larger left CA3 volumes than late adolescents (p = 0.036). Conclusion: In our exploratory study, we observed higher emotional trauma–induced volume changes in the left CA3 hippocampal subfield, which varied depending on age, and may ultimately produce deficits in behavioural, cognitive and emotional processes. We propose that these changes (1) may provide a mechanism through which vulnerability to mood disorders may be increased in adolescent girls, and (2) may signal the best times to implement targeted prevention interventions. [ABSTRACT FROM AUTHOR]

Background: The number of migrant workers in Indonesia has been increasing over the years. Most of the migrant workers are females with children, creating a huge number of left-behind children (LBC). The issue of LBC has become important to discuss because LBC tends to experience more emotional and behavioral problems than non-LBC. The aim of this study was to assess and compare emotional and behavioral problems between LBC and non-LBC in Indonesia. This paper analyzes data from a project by the Community Mental Health Research Group from the Faculty of Psychology, Universitas Indonesia, held in 2015 − 2016. Materials and Methods: Participants were 629 adolescents: 359 LBC and 270 non-LBC. The data were acquired in a cross-sectional study conducted in rural Indonesia. Data on emotional and behavioral problems were assessed with Strength and Difficulties Questionnaire, while data related to risk factor variables were collected using multidimensional scale of perceived social support, the 6-item De Jong Gierveld Loneliness Scale, and Inventory of Parent and Peer Attachment. The data were analyzed with descriptive statistics and multiple regression analysis. Results: The prevalence of emotional and behavioral problems in LBC was 28.4% compared to 21% among non-LBC. Peer attachment, communication, social support, and loneliness were identified as factors that impact the emotional and behavioral problems among LBC. Conclusions: LBC has more emotional and behavioral problems than non-LBC. Comprehensive understanding of various protective and risk factors is needed to provide impactful interventions for LBC. [ABSTRACT FROM AUTHOR]

Background: Anxiety spectrum disorders are the most prevalent psychopathology among children and adolescents. Qualitative research in childhood anxiety disorders can provide valuable insights regarding interventions. The objectives of this study were to examine the child's perspectives on the subjective experience of concerns, the impact of the symptoms on socioacademic functioning, and the process of recovery with interventions. Methods: Children and adolescents aged 6–16 years, presenting with any subtype of anxiety spectrum disorder as per International Classification of Diseases and Related Health problems, 10th Revision (ICD-10) Diagnostic Criteria for Research, were included. Convenience sampling was used, and 30 children fulfilling inclusion and exclusion criteria were selected. An interview guide with simple questions to facilitate response was used, at the baseline and 12th week of follow-up, to generate a written narrative account of the experience of concerns, the impact of symptoms, and the treatment process. Children received treatment as usual, which included a workbook-based cognitive behavioral intervention. Results: Content analysis was done using 30 baseline and 20 follow-up narratives. Clustering of themes were done. Themes related to the recovery process reflected perceived improvement in academic performance and competence, apart from the improvement in symptoms. There were more themes in favor of cognitive interventions. Conclusion: Children's narratives highlight the importance of cognitive interventions for anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Depression is a common mental disorder seen across all age groups, including children and adolescents. Depression is often associated with significant disability in children and adolescents. Aim: This review aims to evaluate the Indian research on depression in children and adolescents. Results: Available data suggest that the point prevalence of depression/affective disorders ranges from 1.2% to 21% in the clinic-based studies; 3%–68% in school-based studies and 0.1%–6.94% in community studies. There has been only one incidence study from India which estimated the incidence to be 1.6%. With respect to the risk factors for depression, studies have reported various education-related difficulties, relationship issues with parents or at home, family-related issues, economic difficulties, and other factors. A limited number of studies have evaluated the symptom profile, and the commonly reported symptoms include depressed mood, diminished interest in play activities, concentration difficulties, behavior problems in the form of anger and aggression, pessimism, decreased appetite, decreased sleep, anhedonia, and somatic symptoms. None of the studies from India has evaluated the efficacy/effectiveness of various antidepressants in children and adolescents with depression. Conclusion: There is a wide variation in the point prevalence reported across different studies, which is mainly due to methodological differences across studies. Limited data are available with respect to symptom profile and factors associated with depression in children and adolescents. [ABSTRACT FROM AUTHOR]

Firearm violence in the United States knows no age limit. This study compares the survival of children younger than five years to children and adolescents of age 5-19 years who presented to an ED for gunshot wounds (GSWs) in the United States to test the hypothesis of higher GSW mortality in very young children. A study of GSW patients aged 19 years and younger who survived to reach medical care was performed using the Nationwide ED Sample for 2010-2015. Hospital survival and incidence of fatal and nonfatal GSWs in the United States were the study outcomes. A multilevel logistic regression model estimated the strength of association among predictors of hospital mortality. The incidence of ED presentation for GSW is as high as 19 per 100,000 population per year. Children younger than five years were 2.7 times as likely to die compared with older children (15.3% vs 5.6%). Children younger than one year had the highest hospital mortality, 33.1 per cent. The mortality from GSW is highest among the youngest children compared with older children. This information may help policy makers and the public better understand the impact of gun violence on the youngest and most vulnerable Americans. [ABSTRACT FROM AUTHOR]

Children with a visual impairment are less active than their sighted peers. Yet, they are born with the potential to match their sighted peers' motor skill competency and levels of physical fitness. Environmental barriers are one of the main causes of inequities. This article provides insight on these issues, drawing upon a physical activity intervention called 'First Steps', a British Blind Sport initiative that aimed to get more children with a visual impairment more active. Physical activity packs were delivered to 53 children, aged 5–15 years, with a visual impairment. Of these participants, 62% had additional impairments or medical conditions. A mixed-methods approach was used to gather participants' experiences of physical activity prior to receiving this pack and canvas opinion on how the pack changed their activity levels. The findings revealed inequitable experiences of physical activity. The First Steps pack made considerable progress in developing children's physical activity levels. Participants' motor skills, social interactions, and confidence improved. Organisations working with this population might look to adopt a similar concept. Recommendations for those wishing to do so are provided. [ABSTRACT FROM AUTHOR]

Objective: Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6–17 year olds with mental disorders in the 2013–2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. Method: Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. Results: Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders (n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help (n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. Conclusion: During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders. [ABSTRACT FROM AUTHOR]

Our objective was to identify factors associated with trouble falling asleep postconcussion. Patients seen for care after sport-related concussion were assessed ≤10 days postinjury and were between 6 and 19 years of age. Outcomes included symptoms (Post-Concussion Symptom Scale), postural steadiness, missed school, and medical history. There were 261 patients (49% female; mean age=14.8±2.5 years): 45% reported trouble falling asleep. A greater proportion of patients who reported trouble falling asleep missed ≥2 days of school (64% vs 49%; P = .02). Patients who reported trouble falling asleep endorsed more severe symptom severity than those who did not (median=38 vs 18; P < .001). After covariate adjustment, confusion (aOR = 1.95, 95% CI = 1.131-3.375), missing ≥2 days of school (aOR = 4.52, 95% CI = 1.553-13.16), and noise sensitivity (aOR = 1.48, 95% CI = 1.1.042-2.010) were independently associated with trouble falling asleep. Sleep disturbances are associated with poorer clinical outcomes after concussion. Inclusion of sleep assessments may help to provide early therapeutic pathways for pediatric concussion patients. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair is desirable over resection to prevent postmeniscectomy arthritis, especially among young and active patients. However, long-term data are currently lacking following isolated meniscal repair, particularly in the pediatric population. Purpose/Hypothesis: To report long-term follow-up of isolated meniscal tears treated by meniscal repair in a pediatric and adolescent population and to compare those results with previous midterm follow-up data reported. The authors hypothesized that these patients would have satisfactory function and reoperation rates at long-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: Forty-four patients aged ≤18 years undergoing repair of an isolated meniscal tear (without concomitant anterior cruciate ligament injury) between 1990 and 2005 were included. At the time of final follow-up, recurrent tear, reoperations, and International Knee Documentation Committee (IKDC) and Tegner scores were determined. With logistic regression, the overall failure among tear types was calculated. Wilcoxon rank sum analysis were performed to calculate the differences in clinical outcome for different time points, and Spearman coefficients were calculated for Tegner and IKDC with different variables. Results: At a mean follow-up of 17.6 years (range, 13.1-25.9 years), 32 patients with 33 isolated meniscal repairs (29 male, 3 female) with a mean age of 16.1 years (range, 9.9-18.7 years) at surgery were included in this study. At early follow-up, the overall failure rate was 14 of 33 (42%); complex tears (80%) and bucket-handle tears (47%) had higher overall failure rates when compared with simple tears (18.2%), although only complex tears had a significantly higher failure rate. However, no further failures occurred since midterm follow-up with any tear type. At final follow-up, the mean IKDC score was 92.3, which was significantly increased when compared with preoperative (65.3, P < .0001) and midterm (90.2, P = .01) scores. The mean Tegner score (6.5) was significantly lower than both preoperative (8.3, P < .0001) and midterm (8.4, P < .0001) scores. There was no difference in Tegner or IKDC score for patients with successful versus failed repair. Conclusion: In conclusion, while there was a high early failure rate, this study demonstrated overall good to excellent long-term clinical outcomes after isolated meniscal repair in an adolescent population, even for those requiring reoperation. Early failure and reoperation rates were variable, depending on tear type, with complex multiplanar tears having more failures at short-term follow-up. However, at long-term follow-up, IKDC and Tegner scores were not significantly different for those with complex tears as compared with other tear types. [ABSTRACT FROM AUTHOR]

We examined how two different definitions of cross-ethnic friendships, namely reciprocal peer nominations for shared activities and mutual trust, predict attitudes towards immigrant students among non-immigrant Swiss children and early adolescents (N = 309). Among both Swiss children and early adolescents, only the number of mutually trusting peer nominations with immigrant students, but not the number of mutual nominations for shared activities, positively predicted inclusive intergroup attitudes. In addition, the perception of cooperation on a common goal in the classroom positively correlated with the number of cross-ethnic—but not same-ethnic—friends whom students trusted. We discuss the implications of our findings in relation to developmental research on the antecedents of intergroup attitudes and positive cross-ethnic relationships among children and early adolescents. [ABSTRACT FROM AUTHOR]

With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963–2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic. [ABSTRACT FROM AUTHOR]

Learning problems (LP) can have wider implications than the academic deficits per se. The goal of the present series of studies was to develop a reliable and valid quality-of-life measure targeted to children and adolescents with LP. In Study 1, using a 35-item questionnaire, we surveyed 151 parents/guardians of children referred for assessment of learning disorders. Exploratory factor analysis identified a three-factor model: Academic Performance, School Understanding, and Child/Family Psychological. These factors were validated against standardized measures of academic achievement and psychosocial functioning. The questionnaire was then reduced to 15 items—the LD/QOL15 —and administered to a community sample of 325 parents/guardians of children in Grades 1 to 8 (Study 2). The three-factor model was verified with confirmatory factor analysis. Comparison of general education (n = 232) and LP (n = 93) groups within the community sample documented substantial group differences (p < .0001), with the LP group having higher mean scores. These differences were larger for older students (Grades 5–8) than younger students (Grades 1–4; p < .01). The LD/QOL15 is a brief and reliable measure that is valid to assess quality of life and, potentially, outcomes in children and adolescents with LP. [ABSTRACT FROM AUTHOR]

Objective: To examine pediatric neuroblastoma survival and management in the head and neck compared to other body sites. Study Design: Retrospective analysis of a large population database. Methods: Patients in the Surveillance, Epidemiology, and End Results (SEER) database with neuroblastoma, NOS; ganglioneuroblastoma; or olfactory neuroblastoma diagnosed from birth to 18 years between 1973 and 2014 were included. These patients were classified into 1 of 3 categories based on primary tumor site: head and neck, adrenal, and "other." Results: Four thousand five hundred neuroblastoma cases were identified. One hundred seventy-five (3.9%) occurred in the head and neck, 1,934 (43.0%) occurred in the adrenal gland, and 2,391 (53.1%) occurred in "other" sites. The mean age at diagnosis was 4.21 years in the head and neck, 2.23 years in the adrenal gland, and 2.47 years in the "other" cohorts (P < .001). Two- and 5-year disease-specific survival rates were 89% and 84% in the head and neck versus 77% and 65% in the adrenal and 84% and 77% in the "other" cohorts (P < .001). The risk of disease-specific death (DSD) was higher in the adrenal cohort (adjusted hazard ratio [aHR] = 2.85; 95% CI, 1.54-5.27) compared to the head and neck cohort. Patients treated with surgery only had the lowest risk of DSD (aHR = 0.22; 95% CI, 0.13-0.35) compared to all other studied treatments. Conclusion: Our results demonstrate that primary neuroblastoma of the head and neck has a better prognosis than primary neuroblastoma of the adrenal gland. [ABSTRACT FROM AUTHOR]

Background: The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. Purpose: To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon–patellar bone autograft (QPA). Study Design: Cohort study; Level of evidence, 3. Methods: Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. Results: The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. Conclusion: The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury. [ABSTRACT FROM AUTHOR]

Introduction This article examines the effect of age and gender on somatosensory capacity for children and adolescents, and provides preliminary normative data and reliability for the SenScreen© Kids, a new standardised measure of touch, wrist position sense and haptic object recognition. Method A cross-sectional study of 88 typically developing children aged 6–15 years (mean 10.3 years; SD 2.6 years) was used to determine the developmental effects of age and gender on somatosensory capacity. Intra-rater reliability was assessed in 22 of the 88 participants at two time points (mean 8.8 years; SD 2.6 years). Results Statistically significant differences were observed between age groups for tactile discrimination, wrist position sense and haptic object recognition, but not for touch registration for which all except one participant achieved a maximum score. There was no effect of gender. Three of four SenScreen Kids subtests demonstrated good intra-rater agreement between time points. Conclusions Somatosensory capacity increased with age for typically developing children aged 6–15 years. Three subtests of the SenScreen Kids demonstrated good intra-rater reliability with typically developing children. Further investigation of reliability is required, and all subtests require psychometric testing with clinical populations. [ABSTRACT FROM AUTHOR]

This study examines differences in psychological adjustment in a sample of rural adolescents who have been exposed to family violence. Self-report questionnaires were administered to 580 adolescents and their primary caregivers. The results revealed that over two thirds of the study participants (68.8%) had been exposed to violence in their families. As hypothesized, cluster analysis identified several profiles among adolescents, distinguished by their psychological and emotional functioning: well adjusted (46.2%), moderately adjusted (44.3%), and struggling (9.5%). Discriminant function analysis confirmed the groupings and revealed that family functioning was among the most influential factors explaining adjustment differences. Multivariate analyses of variance (MANOVAs) further showed that adolescents from each of the three adjustment profiles reported significantly different levels of family social support, parental involvement, and perceived neighborhood safety. Overall, the results confirm heterogeneity of adolescent adaptation in the aftermath of family violence and provide insights into family and neighborhood factors that account for variability in adolescents' reactions to violence. Implications for future research and practical interventions are discussed. [ABSTRACT FROM AUTHOR]

This study explored the association between parental fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes. A total of 120 mothers and 79 fathers participated. Mothers' and fathers' fear of hypoglycemia was significantly associated with anxiety and negative affect as well as with worse glycemic control in child. Paired-samples t-test showed that mothers were more involved in diabetes management and reported more fear and anxiety compared to fathers, but they did not differ in worries about hypoglycemia. The findings suggest screening for fear of hypoglycemia and subjective well-being in all parents regardless of whether their child experienced severe hypoglycemia. [ABSTRACT FROM AUTHOR]

Background. Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. Objective. To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. Study Design. Systematic review. Method. Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. Results. Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. Conclusions. Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn. [ABSTRACT FROM AUTHOR]

Objectives: Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention. Methods: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation. Results: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities. Conclusions: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control. [ABSTRACT FROM AUTHOR]