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There is often a large time gap between caregivers' initial concerns and the diagnosis of autism spectrum disorder. The current study aimed to identify factors associated with missed or delayed autism spectrum disorder diagnoses among children in Colorado. In a surveillance-based sample of 8-year-old children with autism spectrum disorder (N=572), we examined differences between children who were identified with autism spectrum disorder by a community provider and/or were eligible for special education services under an autism eligibility (documented diagnosis) and children who were first identified with autism spectrum disorder through a systematic record review (newly identified). Compared to documented diagnosis children, newly identified children were more likely to be female, aggressive, and argumentative. They were less likely to have had a developmental regression, sleep abnormalities, or an autism screener or diagnostic measure in their records. Newly identified children also had a poorer quality of information in their records. Furthermore, among documented diagnosis children, variations in clinical presentations were associated with significantly different mean ages at autism spectrum disorder diagnosis; children who showed early delays, motor abnormalities, hyperactivity and attention deficits, and odd responses to sensory stimuli received a diagnosis much earlier than documented diagnosis children with other clinical presentations.

The current study sought to characterize implicit bias toward children with autism and examine whether viewing educational materials about autism would change attitudes toward children with autism. A website developed by Sesame Street containing information about autism and resources for families was distributed to parents of children with autism (n = 473) and parents of children without autism (n = 707). Pre- and post-test measures of implicit bias toward children with autism; explicit attitudes and knowledge about autism; and parenting confidence, strain, and stigma were completed before and after the website was presented. Results indicated that parents of children with autism showed less implicit bias compared with those of non-autistic children during the pre-test, but the groups did not differ at the post-test. Parents without autistic children and those with more negative explicit attitudes showed a greater reduction in implicit bias from the pre- to the post-test. In addition, for parents of children with autism, a more positive change in explicit attitudes and increased knowledge from the pre- to the post-test was associated with more empowerment at the post-test. Together, our findings suggest that the online educational resources can reduce implicit bias against children with autism and help mitigate some of the psychological issues associated with parenting children with autism.

To promote knowledge and acceptance of autism, Sesame Workshop created an online initiative: "See Amazing in All Children." This nationwide evaluation of "See Amazing" assessed whether it increased knowledge and acceptance, promoted community inclusion, reduced parenting strain, and enhanced parenting competence. Survey responses were collected online from parents of children (age [less than or equal to] 6) with and without autism before (N = 1010), 1 week after (N = 510), and, for parents of autistic children, 1 month after (N = 182) they viewed the "See Amazing" materials. Following exposure, parents of non-autistic children showed small but significant increases in knowledge of autism and, like parents of autistic children, greater acceptance of autistic children. Parents of autistic children reported less strain, increased parenting competence, and more hope about involving their child in their community. That the "See Amazing" materials invoked positive changes in the general parent community and in parents of autistic children suggests that "See Amazing" materials have the potential to be an effective resource to increase acceptance and community inclusion, although limitations of self-selection, dropout rate, and lack of control group constrain interpretation. Implications include support for targeting acceptance as a step beyond awareness campaigns, though actual behavior change is a subject for future research.

Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.

There is a lack of research examining differences in functioning in autism spectrum disorder (ASD) across ethnicity, particularly among those without intellectual disability (ID). This study investigated ethnic differences in parent-reported impairment in executive function, adaptive behavior, and social-emotional functioning. White and Black youth (n = 64; ages 6-17) with ASD without ID were compared on each of these domains. Black youth had significantly lower levels of impairment on all three domains. Findings may reflect better daily functioning among Black youth with ASD and/or cultural differences in parent response to questionnaires. Regardless, these findings raise concern about the sensitivity of commonly used measures for Black children with ASD and the impact of culture on daily functioning and symptom manifestation.

Young children develop social and emotional competence through interactions with others in the two major contexts in which they spend time: home and preschool. This study examined whether parenting stress in the home context is related to the children's behaviour while in preschool. Previous research has suggested that parenting stress negatively influences parenting behaviour, which in turn has been shown to impact children's development. This study examined the direct relationship between parenting stress and children's behaviour in two types of preschool programmes: private day care centres and Head Start. Parenting stress was significantly related to teacher ratings of social competence, internalizing behaviours, and externalizing behaviours, and the effects of parenting behaviour do not appear to mediate this relationship. Parenting stress was most strongly related to children's social competence. Parents' reports of expectations for their child's behaviour appear to weakly moderate the relationship between externalizing behaviour and parenting stress. This study suggests that examination of a parent's level of stress, in addition to parenting practices, may be important in research and interventions with preschool children's behaviour and social competence. (Contains 9 tables and 2 notes.)

Teacher ratings of 336 preschool children (mean age = 48 months) attending two urban Head Start programs were collected to examine the influence of contextual variables of teacher training, classroom, and site on the prevalence of significant problems. The prevalence of externalizing behaviors in the "problem range" was higher than expected and fewer children were rated in the "well-adjusted range" on social competence measures. Psychometric characteristics of the ratings indicated that teachers in this urban setting were less consistent in their ratings of internalizing problems, calling into question the lack of elevation of such problems in this population. Ratings by teachers and teacher assistants of the same children showed low agreement; the level of ratings was not affected by differences in training but did vary across classrooms. Hierarchical linear modeling analyses of the entire sample showed significant effects of classroom and site on problem behaviors and social competence. These results reveal the wide variation in problem frequency across classrooms, which needs to be considered in the implementation and evaluation of evidence-based interventions. Further, these results point to the importance of studying possible lasting effects on children exposed to these differing contexts.

Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives: School‐based interventions with parent‐training components might improve access among lower‐income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. Methods: Parents (N = 124) of 3rd−5th grade students diagnosed with Autism Spectrum Disorder or Attention‐Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. Results: Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower‐income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. Conclusions: Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower‐income families. [ABSTRACT FROM AUTHOR]

This study investigated the association of training implementation factors (Quality, Impact, Usefulness) with Mental Health First Aid (MHFA)‐targeted outcomes (e.g., increased knowledge, confidence helping someone). Trainees who completed MHFA USA training in 2016 (N = 1003) were surveyed post training about its influence on their thoughts and behaviors, and about implementation factors. Some trainees completed 3‐ and 6‐month follow‐ups (N = 430, N = 276, respectively). Training Quality, Impact and Usefulness were rated highly. Differences in Quality and Impact across demographic groups were found; trainees from racially and ethnically marginalized backgrounds, and trainees with lower education levels, reported greater effect. Quality and Impact predicted positive changes in MHFA‐targeted constructs such as self‐efficacy, stigma and trainee perceived positive effect of MHFA strategies for those in crisis. Impact predicted positive change in mental health knowledge; this association strengthened over time. Results provide information about acceptability and perceived Impact of MHFA USA training and lead to recommendations for future evaluation and implementation. [ABSTRACT FROM AUTHOR]

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.

Children's literacy about the genetics of late-onset hereditary breast/ovarian cancer (HBOC) often develops through conversations with parents about BRCA gene testing and adults' cancer diagnoses. These conversations may promote early understanding of HBOC, but the long-term impact on children's psychosocial adjustment remains unclear. We investigated cancer genetic health communication in BRCA -tested families to consider benefits, risks, and moderating influences on children's understanding and well-being. Adolescent and young adult children (ages 12–24) of mothers who underwent BRCA testing 1+ years previously completed qualitative interviews that were transcribed, coded (intercoder K ≥.70), and content-analyzed (N = 34). Children readily recalled conversations about BRCA testing and HBOC (100%) that they considered important (94%), but implications for children were ambiguous and obfuscated their concerns. Psychosocial impacts were muted, multifaceted, and displayed a range of favorable (82%), neutral (71%), and unfavorable (59%) response—frequently co-occurring within the same child over different aspects (e.g. medical, concern for self and others). Children verbalized active (50%) and avoidant (38%) coping strategies: about 1:5 endorsed transient thoughts about vulnerability to HBOC, 1:3 had not further considered it, and all reported specific actions they had or would undertake to remain healthy (e.g. diet/exercise). A majority (94%) of children had or would consider genetic testing for themselves, usually later in life (59%). Long-term outcomes highlighted benefits (awareness of HBOC, psychological hardiness, healthier lifestyle behaviors), as well as some psychosocial concerns that could be managed through interventions promoting genetic health literacy. [ABSTRACT FROM AUTHOR]

Screening children to determine risk for Autism Spectrum Disorders has become more common, although some question the advisability of such a strategy. The purpose of this systematic review is to identify autism screening tools that have been adapted for use in cultures different from that in which they were developed, evaluate the cultural adaptation process, report on the psychometric properties of the adapted instruments, and describe the implications for further research and clinical practice. A total of 21 articles met criteria for inclusion, reporting on the cultural adaptation of autism screening in 19 countries and in 10 languages. The cultural adaptation process was not always clearly outlined and often did not include the recommended guidelines. Cultural/linguistic modifications to the translated tools tended to increase with the rigor of the adaptation process. Differences between the psychometric properties of the original and adapted versions were common, indicating the need to obtain normative data on populations to increase the utility of the translated tool. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore perceptions of family-to-family (F2F) information centres by health care providers serving Hispanic and African American families of children with special healthcare needs (CSHCN) and how that information can be used to enhance effective collaboration to address disparities in access to services. Design/methodology/approach -- In this second phase of a formative, qualitative multi-phase, collaborative study by a university centre and three F2Fs to develop strategies to increase the use of their centres by Hispanic and African American populations, the authors report the results of key informant interviews with healthcare providers serving the African American and Hispanic families who participated in focus groups at the three centres. Findings -- Healthcare providers reported that F2Fs play a unique role in providing families support and skills to advocate within systems. However, barriers to healthcare providers recommending F2Fs to families include a lack of knowledge about the specific services provided, the need for face-to-face contact to feel comfortable making a referral and a lack of a formalised referral and feedback process that is in line with their experiences in the medical services system. Practical implications -- F2Fs can increase use of their centres by African American and Hispanic families through provider referrals by: promoting specific services and supports they offer families, rather than describing their programmes; promoting how they can help providers with the care coordination functions that are time consuming; offering providers training opportunities; and developing processes for referrals that include feedback to providers. Originality/value -- There are no studies that currently address strengthening the collaboration between medical homes and F2F centres to improve care coordination, access to information and receiving needed services for Hispanic and African American CSHCN and their families. Understanding how healthcare providers serving Hispanic and African American CSHCN perceive F2Fs and currently work with them will enhance this collaboration. [ABSTRACT FROM AUTHOR]

This study investigated children's interest in and understanding of money. Children's interest was evaluated in a recall memory task and by simple choice of a favorite item. Understanding of money was determined by giving children a choice of 100 pennies or one dollar bill and by evaluating the reasons that they gave for making their choices. One hundred thirty-four children ranging from 3 through 11 years old participated in the study. Between the ages. of 5 and 7, children showed a marked increase in interest in money and rational understanding of money. These results concur with recent findings concerning children and altruism with money. [ABSTRACT FROM AUTHOR]

Selective attention, often considered less efficient in young children, was examined in adults and 5-yr-olds using a new, startle-probe technique. To investigate the allocation of preparatory attention at early stages of processing, we examined the modification of the startle blink reflex to irrelevant acoustic probes presented within the warning interval (WI) of a simple reaction time task. Attention was directed away from the acoustic probes and toward a vibrotactile GO signal during the 6-s WI. Heart rate decelerated prior to the GO signal in both children and adults, implying increased attention. The two groups showed opposite patterns of blink modification, however. In adults, startle blink to the WI probes was increasingly attenuated as the GO signal approached, suggesting a selective pattern of attentional allocation. In contrast, blink amplitude increased linearly across probe positions in children, implying that preparatory attention was allocated to a wider range of sensory input. [ABSTRACT FROM AUTHOR]

Presents information on a study which assessed the influence of gender and verbal intelligence on children's attention. Gender differences in performance; Interaction of gender and intelligence; Relation of attention to brain organization and development.

Reduction of reflex startle by brief changes in prestimulation is a robust phenomenon in adults of several species. Although the phenomenon does not require structures above midbrain, it has a long and uneven developmental course. This study of human infants assessed prestimulus effects at 15 months, within a period which has failed, in past work, to show the usual inhibitory modulation. Magnitude and onset latency of the startle blink and concurrent changes in heart rate were measured under four conditions: 2 single-stimulus conditions, 25-msec, 84-dB, 1000-Hz tone or 50-msec, 109-dB white noise; 2 paired-stimulus conditions, noise bursts preceded by tone at lead times of 125 msec or 225 msec. Compared to noise-alone, paired conditions elicited insignificant increases in blink size, significant shortening of blink onset latency, and significant of heart rate responses. The findings add to growing evidence of a dissociation between modulating effects on blink magnitude and latency and of a dissociation between modulating effects on somatic and autonomic reflexes. [ABSTRACT FROM AUTHOR]

Alternative hypotheses of differential development of auditory and visual systems versus temporal-processing systems were tested to explain prior adult-infant differences in reflex blink latency. The present study removed a confound between stimulus modality and duration, present in prior work, and determined whether age interacted with modality or with duration when they were varied orthogonally. Reflexes were elicited from human adults and infants under 4 stimulus conditions: flash and click, delivered singly and in trains. Age interacted only with duration to affect latency and elicitation probability, reflex characteristics which depend on adequate triggering by a transient change at onset. In contrast, age did not interact with duration to affect peak amplitude which presumably depends on temporal integration. Findings are compatible with the hypothesis that processes or structures, specialized for differentiation of transient stimulus change, mature at a different rate than those specialized for integration of stimulus energy over time. [ABSTRACT FROM AUTHOR]

Two field studies were conducted to assess material altruism in children. The first study examined money altruism (i.e., donation of pennies) of 240 children from ages 3 through 16. The second study examined donations of preferred candy by 263 children in kindergarten through sixth grades. The results of these studies indicate that early elementary school aged children (around age 7) donated fewer pennies and less of a preferred candy than did both younger and older children. These findings corroborate recent reports from other laboratories and contradict the commonly accepted generalization that children's altruism increases steadily with age. [ABSTRACT FROM AUTHOR]

Presents a study which assessed the developmental changes in specific aspects of attentional function into early adolescence. Analysis of performance on the attention measures within age level; Stability and changes in attentional performance over time; Comparisons of developmental trajectories.

ObjectiveMethodResultsConclusionsResearchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response.Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses.More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students.Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample’s diagnostic integrity and engaged children who otherwise would have been excluded. [ABSTRACT FROM AUTHOR]

Objectives: Utilizing a diffusion of innovation (DOI) framework, the study seeks to increase access to information for Hispanic families of children with special health care (SHN) needs by increasing their use of Family-to-family Centers (F2Fs) in their states. Methods: Focus groups were implemented of both English-speaking and Spanish-speaking Hispanic families in two states with a confirming Delphi procedure exploring factors within DOI framework related to using F2Fs and the nature of current family communication networks. Results: Families seeking information at key change points turn to formal sources, although Spanishspeaking families, noted that due to language barriers, they also turned to family and friends. Families prefer getting information in one-on-one encounters rather than via technologies. F2Fs being staffed by parents of children with SHN is a relative advantage over other sources of information and race or ethnicity of the staff was not an essential feature in using F2Fs, although services in Spanish was. Findings indicated that cultural values might impede turning outside the family for support and that concerns about federally funded programs serving all families or being suddenly cut impacted families views of using F2Fs. Conclusions: Increasing the use of F2Fs by Hispanic families will entail increasing awareness and acceptance of the centers by their social networks and by social marketing efforts that focus on factors identified. In addition, at the policy level, there needs to be a recognition of the strong preference for person-to-person support rather than technological approaches, which has fiscal implications. [ABSTRACT FROM AUTHOR]

While Autism Spectrum Disorder (ASD) and other developmental disabilities are being diagnosed at increasing rates, there is strong evidence of disparities in rates of identification and utilization of services by Latino children as compared to non-Latino children. Attempts to reduce these disparities include culturally-informed early screening for ASD risk. In preparation for initiation of a screening program in a primary care setting serving primarily Latino children, focus groups and interviews were conducted with Latino parents (N=31), medical staff (N=15), health care providers (N=4) to better understand the barriers and facilitators to engagement around developmental concerns that contribute to the low identification and service use for Latino children with autism. Using a thematic analysis approach, focus group and interview data revealed themes organized around three issues impacting engagement of Latino parents in screening for ASD: 1) information exchange, 2) culture, and 3) structure. In particular, parents and providers, felt that it was important to connect on the importance of developmental issues, address health literacy, acknowledge differences in language, beliefs, and values, and address structural barriers, like length of patient/provider interaction. Information obtained through this qualitative study informed the intervention, Supported Screening, to facilitate screening and referral for ASD at primary care sites that serve predominantly Latino families. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the impact of Mental Health First Aid (MHFA) in the United States with a theoretically based and psychometrically sound measure, the Mental Health Beliefs and Literacy Scale (MBLS).Design: Online MBLS surveys were administered pre-MHFA training, 3-weeks post-training, and 6-months posttraining.Setting: Mental Health First Aid trainings carried out across the United States.Participants: Six hundred sixty-two trainees were contacted, and 273 (41%) completed the presurvey. Of those, 63% filled out the postsurvey and 35% completed the 6-month survey. Seventy-six individuals completed all 3 surveys.Intervention: Mental Health First Aid is an 8-hour education program to help the general public identify, understand, and respond to signs of mental illness and substance abuse; to date, almost 1 million people have been trained.Measure: The MLBS, based on the Unified Theory of Behavior Change framework, consists of attitudinal, social-, and skill-based constructs affecting the intention to perform and achievement of MHFA actions and reports of their actual completion.Analysis: Change across time points was assessed using multivariate repeated measures analysis of variance.Results: Significant short- and longer term changes were found in internally consistent constructs tapping positive beliefs about MHFA actions, the confidence and intention to perform them as well as mental health literacy.Conclusion: The MBLS documented strong positive effects of MHFA training that were greater in individuals without prior mental health training, the intended targets of MHFA efforts. [ABSTRACT FROM AUTHOR]

Peer delivered, family-to-family (F2F) support-defined as the provision of outreach, engagement, knowledge, care coordination, and support to family members of children and youth with mental health challenges-is a rapidly growing and needed component of the service array. Progress is occurring toward greater specification of program models and core competencies for the parent support providers (PSPs) with lived experience providing these services; however, strategies to inform quality improvement and ensure accountability are lacking. The Family Journey Assessment (FJA), completed by PSPs and family members, fills this gap by tracking caregiver progress toward self-advocacy and self-efficacy. Analyses of 436 FJAs showed a reliable 3-component structure, reflecting progress in the recognition of needs, collaboration to access help from formal and natural supports, and activation of skills to cope with stress, enhance resilience, and develop and carry out plans of care. PSP feedback provided strong evidence for relevance and usability. Examination of FJAs at baseline and follow-up provides one of the first reports showing significant improvement in key indicators of benefit of F2F for participating families. The FJA holds promise as a measure of the impact of F2F services on key goals and as a way to identify benchmarks for focused and individualized peer-to-peer support depending on the family's level of need. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

With research suggesting increasing incidence of pediatric neurodevelopmental disorders, questions regarding etiology continue to be raised. Neurodevelopmental function tests have been used in epidemiology studies to evaluate relationships between environmental chemical exposures and neurodevelopmental deficits. Limitations of currently used tests and difficulties with their interpretation have been described, but a comprehensive critical examination of tests commonly used in studies of environmental chemicals and pediatric neurodevelopmental disorders has not been conducted. We provide here a listing and critical evaluation of commonly used neurodevelopmental tests in studies exploring effects from chemical exposures and recommend measures that are not often used, but should be considered. We also discuss important considerations in selecting appropriate tests and provide a case study by reviewing the literature on polychlorinated biphenyls.

Objective: This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed., Data Sources: We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports., Study Selection: Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure., Data Extraction: Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice., Conclusions: The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet.

Suicide is a leading cause of mortality among adolescents. There is a pressing public health need to investigate triggers and novel vulnerabilities for suicide in order to improve risk assessment and develop innovative prevention strategies. Alcohol is a well established risk factor for adolescent suicide. In this paper, we outline a novel mechanism linking allergy, alcohol, and suicide, reviewing (a) the association between allergic inflammation, depression, and suicide; and (b) the role of alcohol in inducing phosphorylation and rearrangement of tight junction proteins of the blood-brain barrier (BBB) resulting in increased "leakiness", i.e. passage of cells and molecules. Seasonal peaks of suicide in spring have been consistently reported, but their causality is poorly understood. A preliminary epidemiologic study found increased nonviolent suicide rates in females in spring during intervals of high tree pollen, in comparison to similar intervals of low tree pollen. This initial report added to the emerging literature proposing a relationship between allergy and depression, and is being further pursued at clinical, epidemiological, animal and postmortem tissue levels. We propose that allergic inflammation influences depression-related brain function via molecular and cellular mediators, but those mediators have a very limited access to the brain when the BBB is intact. Alcohol intake disrupts BBB, allowing increased brain exposure to cellular mediators of allergy. Considering the greater prevalence of allergy in adolescence when alcohol use starts, studies investigating the connection between allergy, alcohol, and suicide should be expanded to also include a focus on youth.