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Objective: To identify characteristics associated with bullying involvement in pediatric ADHD. Methods: Data from the 2016 to 2017 National Survey of Children’s Health for children aged 6 to 17 years with ADHD were evaluated to assess the association between parent-reported bullying victimization or perpetration and the following potential predictors: demographic characteristics, family factors, school factors, and child conditions/behaviors. Results: Among children with ADHD, 46.9% were bullying victims and 16.2% were perpetrators. Factors associated with victimization included having family financial strain, developmental delay or intellectual disability, friendship difficulties, and school reports about problems. Factors linked to perpetration included being male, receiving government assistance, lack of school engagement, school reports about problems, and having difficulties with friendships, staying calm, and arguing. Conclusions: Children with ADHD frequently were bullying victims and sometimes bullying perpetrators. Factors related to family financial strain, developmental disabilities, emotional regulation, peer relationships, and school functioning may help to identify risk for bullying and opportunities for anti-bullying interventions.

This study evaluated the stability over time of prevalence estimates of mental disorders among school-aged children from the same community.We compared screening status and weighted prevalence of selected mental disorders from the two-stage school-based South Carolina Project to Learn About Youth-Mental Health (Time 1) and its replication study (Time 2) conducted between 2014 and 2017. During stage 1, two teacher screeners were used to group students into high or low risk for a mental disorder. During stage 2, parents of selected students completed a structured diagnostic interview to assess whether their child met criteria for specific disorders.For stage 1, 19.9% of students screened as high risk for a mental disorder at Time 2 compared to 17.8% at Time 1. Among students included at both timepoints, 9.1% screened as high risk at both timepoints while screening status changed for 20.7%. The overall prevalence of included mental disorders was approximately 18% at both time points There were no differences (P-values.05) in prevalence of individual mental disorders between Time 1 (range:0.3%-6.7%) and Time 2 (range:1.2%-7.7%).Study findings demonstrate that similar methodology yielded similar prevalence estimates of mental disorders and can inform community-level planning for improving mental health in children.

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

Infants, children, and adolescents who do not get sufficient sleep are at increased risk for injuries, obesity, type 2 diabetes, poor mental health, attention and behavior problems, and poor cognitive development (1). The American Academy of Sleep Medicine (AASM) provides age-specific sleep duration recommendations to promote optimal health (1). CDC analyzed data from the 2016-2018 National Survey of Children's Health (NSCH) to assess the prevalence of short sleep duration among persons in the United States aged 4 months-17 years. Overall, on the basis of parent report, 34.9% of persons aged 4 months-17 years slept less than recommended for their age. The prevalence of short sleep duration was higher in southeastern states and among racial and ethnic minority groups, persons with low socioeconomic status, and those with special health care needs. The prevalence of short sleep duration ranged from 31.2% among adolescents aged 13-17 years to 40.3% among infants aged 4-11 months. Persons aged 4 months-17 years with a regular bedtime were more likely to get enough sleep. Public health practitioners, educators, and clinicians might advise parents on the importance of meeting recommended sleep duration and implementing a consistent bedtime for healthy development.

Students with special education needs or underlying health conditions have been disproportionately impacted (e.g., by reduced access to services) throughout the COVID-19 pandemic.This study describes challenges reported by schools in providing services and supports to students with special education needs or underlying health conditions and describes schools' use of accessible communication strategies for COVID-19 prevention.This study analyzes survey data from a nationally representative sample of U.S. K-12 public schools (n = 420, February-March 2022). Weighted prevalence estimates of challenges in serving students with special education needs or underlying health conditions and use of accessible communication strategies are presented. Differences by school locale (city/suburb vs. town/rural) are examined using chi-square tests.The two most frequently reported school-based challenges were staff shortages (51.3%) and student compliance with prevention strategies (32.4%), and the two most frequently reported home-based challenges were the lack of learning partners at home (25.5%) and lack of digital literacy among students' families (21.4%). A minority of schools reported using accessible communications strategies for COVID-19 prevention efforts, such as low-literacy materials (7.3%) and transcripts that accompany podcasts or videos (6.7%). Town/rural schools were more likely to report non-existent or insufficient access to the internet at home and less likely to report use of certain accessible communication than city/suburb schools.Schools might need additional supports to address challenges in serving students with special education needs or with underlying health conditions and improve use of accessible communication strategies for COVID-19 and other infectious disease prevention.

The Project to Learn About Youth-Mental Health (PLAY–MH; 2014–2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%–17.8%) and higher in Ohio (33.3%). PLAY–MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

To assess the association of diabetes and mental, behavioral, and developmental disorders in youth, we examined the magnitude of overlap between these disorders in children and adolescents.In this cross-sectional study, we calculated prevalence estimates using the 2016-2019 National Survey of Children's Health. Parents reported whether their child was currently diagnosed with diabetes or with any of the following mental, behavioral, or developmental disorders: attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral problems, Tourette syndrome, or speech/language disorder. We present crude prevalence estimates weighted to be representative of the US child population and adjusted prevalence ratios (aPRs) adjusted for age, sex, and race/ethnicity.Among children and adolescents (aged 2-17 years; n = 121 312), prevalence of mental, behavioral, and developmental disorders varied by diabetes status (diabetes: 39.9% [30.2-50.4]; no diabetes: 20.3% [19.8-20.8]). Compared with children and adolescents without diabetes, those with diabetes had a nearly 2-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 1.72 [1.31-2.27]); mental, emotional, and behavioral disorders (aPR: 1.90 [1.38-2.61]) and developmental, learning, and language disorders (aPR: 1.89 [1.35-2.66]).These results suggest that approximately 2 in 5 children and adolescents with diabetes have a mental, behavioral, or developmental disorder. Understanding potential causal pathways may ultimately lead to future preventative strategies for mental, behavioral, and developmental disorders and diabetes in children and adolescents.

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Adverse childhood experiences (ACEs) are associated with poor health. Childhood experiences of racial/ethnic discrimination and other forms of racism may underlie or exacerbate other ACEs. We explored health-related associations with perceived racial/ethnic discrimination relative to other ACEs, using data from 2016–2019 National Survey of Children’s Health, an annual cross-sectional, nationally representative survey. Parent responses for 88,183 children ages 6–17 years with complete data for ACEs (including racial/ethnic discrimination) were analyzed for associations between racial/ethnic discrimination, other ACEs, demographics, and physical and mental health conditions with weighted prevalence estimates and Wald chi-square tests. To assess associations between racial/ethnic discrimination and health conditions relative to other ACEs, we used weighted Poisson regressions, adjusted for exposure to other ACEs, age, and sex. We assessed effect modification by race/ethnicity. Prevalence of other ACEs was highest among children with racial/ethnic discrimination, and both racial/ethnic discrimination and other ACEs were associated with having one or more health conditions. Adjusted associations between racial/ethnic discrimination and health conditions differed by race/ethnicity (interaction P-values < 0.001) and were strongest for mental health conditions among Hispanic/Latino (adjusted prevalence ratio (aPR)=1.62, 95% confidence interval (CI): 1.24–2.10) and non-Hispanic/Latino Asian American (aPR=2.25, 95% CI: 1.37–3.71) children. Results suggest racial/ethnic discrimination and other ACEs are associated with child health conditions, with differences in relative associations by race/ethnicity. Public health efforts to prevent childhood adversity, including racial/ethnic discrimination and other forms of racism could be associated with improvements in child health.

OBJECTIVE: In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children’s cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade. METHODS: Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade. RESULTS: Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site. CONCLUSION: Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.

Diabetes (DM) is among the most common chronic diseases diagnosed in youth in the United States. In adults, a bi-directional relationship has been demonstrated between DM and mental, behavioral, and developmental disorders (MBDD). Such comorbidities may significantly impact the quality of life of patients with DM and disease management. However, little is known about the association of DM and MBDD in youth. To examine the magnitude of overlap between these chronic conditions, we calculated prevalence estimates using the 2016-2019 National Survey of Children’s Health, an annual, cross-sectional survey of non-institutionalized US children aged 0-17 years (N = 131,774). Parents were asked if their child was ever diagnosed with DM or with any of the following MBDDs: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral or conduct problems, Tourette syndrome, or speech disorder. We present crude prevalence estimates and predictive margins adjusted for age, sex, and race/ethnicity, both weighted to be representative of the US youth population. Among US youth, prevalence estimates were 0.45% (95%CI: 0.36-0.55) for DM and 22.7% (22.2-23.2) for any MBDD. Crude prevalence of any MBDD varied by DM status (DM: 43.7% [34.5-53.4]; no DM: 22.6% [22.1-23.1]). Compared with youth without DM, those with DM had a higher adjusted prevalence of any MBDD (prevalence ratio: 1.55 [1.20-2.00]) and individual MBDDs (p Disclosure C. E. Barrett: None. K. M. Bullard: None. J. Park: None. A. Koyama: None. C. Mercado: None. A. H. Claussen: None. K. Newsome: None. M. E. Pavkov: None.

OBJECTIVE: The aim of the present study was to describe self-regulation (the ability to influence or control one’s thoughts or behavior in response to situational demands and social norms) in children ages 3–5 years using a nationally representative sample and examine risk and protective factors to identify opportunities to support children and families. METHODS: Using a cross-sectional design, we examined data from a parent-reported pilot measure of self-regulation from the 2016 National Survey of Children’s Health (NSCH). We compared U.S. children aged 3–5 years who were described by parents as “on track” with self-regulation development with children who were not. In addition, we described how health care and developmental services, community, family, and child health and development factors are associated with children’s self-regulation. RESULTS: The majority of children (4 of 5) were described by their parents to be developmentally on track with self-regulation. Compared to children described as not on track, children described as on track more often lived in financially and socially advantaged environments and less often experienced family adversity. They also had other positive health and development indicators, whether or not they were receiving developmental services. However, only half of children not on track received developmental surveillance, and only 1 in 4 children described as not on track received educational, mental health, or developmental services. CONCLUSION: The findings are a step towards using self-regulation as an indicator of healthy child development and as a potential strategy to identify groups of children who may need additional support.

OBJECTIVE: Tourette syndrome (TS) and co-occurring mental, behavioral, and developmental disorders (MBDDs) have been shown to affect peer relationships. This study provides nationally representative estimates of diagnosed TS prevalence and the prevalence of parent-reported bullying victimization and perpetration among US children with and without TS. METHODS: This study included 2016–2017 National Survey of Children’s Health data on children aged 6 to 17 years (N = 51,001) with parent-reported responses about TS diagnosis and their child’s experiences with bullying victimization and perpetration. We calculated weighted prevalence estimates of diagnosed TS and of bullying indicators among children ever diagnosed with TS compared with peers without TS. We conducted a logistic regression analysis to estimate adjusted prevalence ratios of bullying involvement by TS status, controlling for age, sex, and co-occurring MBDDs. RESULTS: By parent report, 0.3% of US children had ever received a diagnosis of TS; most children with a TS diagnosis (83.2%) had a co-occurring MBDD. Among children with TS, 56.1% experienced bullying victimization, 20.7% experienced bullying perpetration, and 15.9% experienced both, compared with 21.6%, 6.0%, and 4.1% for children without TS, respectively. After adjusting for age, sex, and co-occurring MBDDs, only the association between TS and bullying victimization remained statistically significant. CONCLUSION: Compared with children without TS, children with TS overall experience more bullying victimization and perpetration. Health care professionals treating children with TS could assess challenges with peer relationships and co-occurring disorders to provide targeted support and referral.

Objective: Children with Tourette syndrome (TS) are at risk for a variety of co-occurring conditions and learning and school problems. The purpose of this study was to determine the impact of TS and co-occurring conditions on school measures. Methods: Parent-reported data from the 2007–2008 and 2011–2012 National Survey of Children's Health were combined (n = 129,353 children aged 6–17 yrs). Parent report of health care provider diagnosis of TS; co-occurring mental, emotional, and behavioral conditions; learning and language conditions; and school measures were assessed. School measures included type of school, individual education plan (IEP), number of school days missed, school problems, doing well in school, doing homework, and repeating a grade. Children with TS were compared with those who never had TS on school measures accounting for co-occurring conditions. Results: After adjusting for demographics, compared with children without TS, children currently with TS were more likely to have an IEP, have a parent contacted about school problems, and not complete homework. After further adjusting for co-occurring conditions, only IEP status remained statistically significant. Compared with children with mild TS, children with moderate or severe TS were more likely to have an IEP, repeat a grade, encounter school problems, and not care about doing well in school. Conclusion: Tourette syndrome severity and co-occurring conditions are associated with school challenges and educational service needs. Awareness among health care providers, teachers and parents of the potential challenges related to both TS and co-occurring conditions would help to best support the child's education.

Clinical guidelines provide recommendations for diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD), with specific guidance on caring for children younger than 6 years. This exploratory study describes ADHD diagnosis and treatment patterns among young children in the United States using 2 nationally representative parent surveys.The National Survey of Children's Health (2007-2008, 2011-2012) was used to produce weighted prevalence estimates of current ADHD and ADHD medication treatment among US children aged 2 to 5 years. The National Survey of Children with Special Health Care Needs (2009-2010) provided additional estimates on types of medication treatment and receipt of behavioral treatment among young children with special health care needs (CSHCN) with ADHD.In 2011 to 2012, 1.5% of young children (approximately 237,000) had current ADHD compared to 1.0% in 2007 to 2008. In 2011 to 2012, 43.7% of young children with current ADHD were taking medication for ADHD (approximately 104,000). In young CSHCN with ADHD, central nervous system stimulants were the most common medication type used to treat ADHD, and 52.8% of young CSHCN with current ADHD had received behavioral treatment for ADHD in the past year.Nearly a quarter million In young CSHCN have current ADHD, with a prevalence that has increased by 57% from 2007 to 2008 to 2011 to 2012. The demographic patterns of diagnosis and treatment described in this study can serve as a benchmark to monitor service use patterns of young children diagnosed with ADHD over time.

This article presents the findings of a qualitative study of maternal perceptions of parenting following participation in Legacy for ChildrenTM (Legacy), an evidence-based parenting program for low-income mothers of young children and infants. To further examine previous findings and better understand participant experiences, we analyzed semistructured focus-group discussions with predominantly Hispanic and Black, non-Hispanic Legacy mothers at two sites (n = 166) using thematic analysis and grounded theory techniques. The qualitative study presented here investigated how mothers view their parenting following participation in Legacy, allowing participants to describe their experience with the program in their own words, thus capturing an "insider" perspective. Mothers at both sites communicated knowledge and use of positive parenting practices targeted by the goals of Legacy; some site-specific differences emerged related to these parenting practices. These findings align with the interpretation of quantitative results from the randomized controlled trials and further demonstrate the significance of the Legacy program in promoting positive parenting for mothers living in poverty. This study emphasizes the importance of understanding real-world context regarding program efficacy and the benefit of using qualitative research to understand participant experiences.

Background Attention deficit/hyperactivity disorder (ADHD) is associated with adverse outcomes and elevated societal costs. The American Academy of Pediatrics (AAP) 2011 guidelines recommend "behavior therapy" over medication as first-line treatment for children aged 4-5 years with ADHD; these recommendations are consistent with current guidelines from the American Academy of Child and Adolescent Psychiatry for younger children. CDC analyzed claims data to assess national and state-level ADHD treatment patterns among young children. Methods CDC compared Medicaid and employer-sponsored insurance (ESI) claims for "psychological services" (the procedure code category that includes behavior therapy) and ADHD medication among children aged 2-5 years receiving clinical care for ADHD, using the MarketScan commercial database (2008-2014) and Medicaid (2008-2011) data. Among children with ESI, ADHD indicators were compared during periods preceding and following the 2011 AAP guidelines. Results In both Medicaid and ESI populations, the percentage of children aged 2-5 years receiving clinical care for ADHD increased over time; however, during 2008-2011, the percentage of Medicaid beneficiaries receiving clinical care was double that of ESI beneficiaries. Although state percentages varied, overall nationally no more than 55% of children with ADHD received psychological services annually, regardless of insurance type, whereas approximately three fourths received medication. Among children with ESI, the percentage receiving psychological services following release of the guidelines decreased significantly by 5%, from 44% in 2011 to 42% in 2014; the change in medication treatment rates (77% in 2011 compared with 76% in 2014) was not significant. Conclusions and comments Among insured children aged 2-5 years receiving clinical care for ADHD, medication treatment was more common than receipt of recommended first-line treatment with psychological services. Among children with ADHD who had ESI, receipt of psychological services did not increase after release of the 2011 guidelines. Scaling up evidence-based behavior therapy might lead to increased delivery of effective ADHD management without the side effects of ADHD medications.

OBJECTIVES:To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants.METHODS:We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing (n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age (n = 11) and controls (n = 40).RESULTS:Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls.CONCLUSIONS:Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children.

This article reviews the state of the science on psychosocial treatments for disruptive behaviors in children, as an update to Eyberg, Nelson, and Boggs (2008). We followed procedures for literature searching, study inclusion, and treatment classification as laid out in Southam-Gerow and Prinstein (2014), focusing on treatments for children 12 years of age and younger. Two treatments (group parent behavior therapy, and individual parent behavior therapy with child participation) had sufficient empirical support to be classified as well-established treatments. Thirteen other treatments were classified as probably efficacious. Substantial variability in effectiveness of different programs within the same treatment family has been previously documented; thus, a particular level of evidence might not hold true for every individual program in a treatment family. Systematic investigations of implementation, dissemination, and uptake are needed to ensure that children and families have access to effective treatments. Investigations into how to blend the strengths of the effective approaches into even more effective treatment might also lead to greater impact.

In this article, the authors posit that programs promoting nurturing parent–child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent–child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.

Background Tic disorders, including Tourette syndrome, are complex, multisymptom diseases, yet the impact of these disorders on affected children, families, and communities is not well understood. Methods To improve the understanding of the impacts of Tourette syndrome, two research groups conducted independent cross-sectional studies using qualitative and quantitative measures. They focused on similar themes, but distinct scientific objectives, and the sites collaborated to align methods of independent research proposals with the aim of increasing the analyzable sample size. Results Site 1 (University of Rochester) was a Pediatric Neurology referral center. Site 2 (University of South Florida) was a Child Psychiatry referral center. A total of 205 children with tic disorders were enrolled from both studies. The University of Rochester also enrolled 100 control children in order to clearly isolate impacts of Tourette syndrome distinct from those occurring in the general population. The majority of children with tic disorders (n = 191, 93.1%) had Tourette syndrome, the primary population targeted for these studies. Children with Tourette syndrome were similar across sites in terms of tic severity and the occurrence of comorbid conditions. The occurrence of psychiatric comorbidities in the control group was comparable with that in the general pediatric population of the United States, making this a well-justified comparison group. Conclusions Through collaboration, two sites conducting independent research developed convergent research methods to enable pooling of data, and by extension increased power, for future analyses. This method of collaboration is a novel model for future epidemiological research of tic disorders.

Proximal environmental variables illustrate aspects of the environment that are experienced directly and specifically by the child. The current study examined the associations between three proximal environmental variables: (1) quality of the home environment, (2) regularity of family routines and (3) frequency of parenting daily hassles and cognitive, language and behavioral outcomes in 36‐month‐old children who were prenatally exposed to cocaine and participating in an early intervention program. The quality of the home environment predicted expressive language and internalizing behavior problems, while daily hassles and family routines only predicted internalizing behavior problems. The results suggest that interventions aimed at changing proximal environmental variables may have positive implications for children who are at‐risk for developmental delay.

The link between social networks and mental health has increasingly been recognized by public health as an important topic of interest. In this paper, we explore this association among a specific group: mothers. Specifically, we discuss how maternal mental health can be understood in the context of social networks, the influence of specific social relationships, and how the type and quality of support can mediate maternal mental health outcomes. We review interventions that foster social networks to address maternal mental health as well as other related health outcomes. Findings suggest that interventions that combine multiple treatment approaches may be more effective in addressing mental health. Also, traditional measures of social networks may not be appropriate for vulnerable populations, with qualitative, rather than quantitative, indicators of social networks being more predictive of maternal health and well-being. The implications of these findings and future research directions are discussed.

This article addresses the clinical issue of selecting assessments of attachment that are relevant to decision making for families. The validity of three commonly used methods of assessing attachment in preschool-aged children was compared using a sample of 51 low-income mother-child dyads. Thirty-eight of the children had been abused or neglected. The dyads were seen in a Strange Situation that was classified using each of the three methods: (a) the Ainsworth-extended method, (b) the Cassidy-Marvin (C-M) method, and (c) the Preschool Assessment of Attachment (PAA). Validity was evaluated in terms of maltreatment status, maternal sensitivity, child DQ, and maternal attachment strategy. The PAA and C-M classifications matched in only 37% of cases. The Ainsworth-extended method differentiated secure versus insecure children on two variables. The CM method differentiated secure versus insecure children on one variable. The PAA differentiated secure versus insecure children on all four variables and subgroups on one. Moreover, it was tied to other family relationship variables in meaningful ways. If applied in clinical settings, these three methods would result in very different groups of children being seen as safe and at risk. We argue that clinicians cannot afford to be uninformed about the validity of alternative means of assessing attachment.

This article brings together information from our experience of providing research-based intervention to more than 600 children who were prenatally exposed to cocaine and from the research literature on the effects of prenatal cocaine exposure. Based on our experience and this literature, it is now clear that there are no large negative independent effects of cocaine exposure and that there is no “crack baby” syndrome. However, many of these children who have been exposed to cocaine are at risk for poor developmental outcomes, particularly in the area of language development, primarily because of the environmental factors that are associated with parental substance abuse. As our intervention research shows, early intervention can be effective in ameliorating some of this risk. Suggestions are made regarding programmatic steps that should be taken next to further improve program effectiveness and enhance the knowledge base.

The present study examined proximal variables in families of children prenatally exposed to cocaine and enrolled in a large-scale intervention program. Fifty-six high-risk families of children enrolled in the center-based (n = 30) or home-based (n = 26) intervention of the Linda Ray Intervention Program were interviewed. Four proximal variables were assessed: (a) quality of the caregiving environment, (b) family's regularity and predictability of daily routines, (c) caregiver's perception of the family's adequacy of resources, and (d) frequency and intensity of caregiver's experience with daily hassles. Results suggested that families of children enrolled in the center-based condition had more predictable daily routines than families of home-based participants. A family's adequacy of resources influenced the quality of the caregiving environment. Families with adequate resources were more likely to provide daily routines. Caregivers with fewer years of education were less able to establish and maintain daily routines which predicted, in part, a poorer caregiving environment.

The internatal period, the time between births of successive children, has become a focal point for risk assessment and health promotion in women's healthcare. This period represents a time when women are at high risk for a depressive disorder. The pediatric venue offers a unique opportunity for the identification and management of depression in the internatal period, as mothers who do not attend their own medical appointments are likely to accompany their child to pediatric visits. This paper discusses the role pediatric providers can undertake to improve women's health in the internatal period through the detection and management of maternal depression at well-child visits. Successful models of the management of depression in other primary care settings are explored for their potential for implementation in the pediatric venue. A specific model developed and implemented as part of a 3-year project is presented to highlight the feasibility of an evidenced-based approach to the management of maternal depression in the pediatric setting. We present evidence demonstrating that pediatric providers can successfully identify postpartum women with depression, monitor symptoms and treatment adherence, and communicate results to a woman's healthcare provider. Yet more investigation is needed to create preventive interventions for maternal depression that integrate evidenced-based practice standards for the treatment of depression in primary care venues into pediatric settings. Future programs and policies targeting maternal depression in the pediatric environment should address patient mental health literacy and stigma, the training and education of pediatric providers, and issues of privacy and reimbursement.

Cette etude a examine de maniere longitudinale les associations entre les interactions mere-enfant a 15 mois et les resultats en matiere cognitive et en matiere de comportement a l'âge de 36 mois chez un echantillon de jeunes enfants a risque. Les participants pour cette etude actuelle etaient 58 bebes/jeunes enfants exposes prenatalement a la cocaine et leur mode de soin maternel. Ces bebes etaient issus d'un milieu socioeconomique bas et faisaient partie d'un cadre d'intervention. Quand les enfants avaient 12, 15, et 36 mois, ils participerent a des seances de recherche avec leur mode de soin maternel. Le developpement cognitif a 12 mois et le comportement maternel et infantile a 15 mois ont ete mesures pour predire le resultat comportemental et cognitif a 36 mois. De plus hauts niveaux de controle maternel a 15 mois etaient marginalement importants dans la prediction de plus niveaux de comportement a probleme a 36 mois, alors que de plus hauts niveaux de resistance infantile au controle predisant des niveaux plus bas de comportement a probleme. De plus, le comportement resistant au contro le dont les bebes ont fait etat servait de tampon unique contre le comportement a probleme, meme apres avoir controle les facteurs maternels et les aptitudes cognitives. Ces resultats suggerent que les tentatives de contro le maternel et les reactions infantiles a ces comportement de controle maternel jouent un role important dans le developpement de patterns de comportement adaptatif et maladaptatif durant l'enfant precoce.

Prenatal cocaine exposure is an indicator for adverse developmental outcomes. To prevent developmental disabilities, an early intervention program for children birth to 3 years was developed that included three groups: center-based, home-based, and primary care comparison. The intervention was implemented across 10 years and data were collected on 342 children and families who were primarily urban, poor, and members of traditionally underrepresented groups. At 36 months of age, center and home-based intervention participants had more advanced cognitive and language abilities and fewer behavior problems than the primary care group participants. In addition, center-based participants had more advanced language abilities than home-based participants. The findings indicate that the early intervention impact is sustainable over time and has a positive effect on children at risk due to prenatal cocaine exposure.

The Dependency Drug Court (DDC) in Miami, Florida, addresses the needs of families affected by substance abuse through a comprehensive and therapeutic approach. The DDC works with community agencies to provide services that effectively treat the family as a unit. This article discusses the process of adapting a parenting program to meet the needs of families in the DDC.

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center- and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.

The development of joint attention skills is a major milestone of infancy. Recent research suggests that the development of these skills may be affected by disorganized (D) attachment. This hypothesis was examined in a longitudinal study of attachment and joint attention skill development in a sample of infants at risk for developmental–behavioral morbidity. The results revealed that toddlers with D classifications initiated joint attention with an experimenter significantly less often than did secure, or even other insecure, toddlers. However, no group differences in the capacity to respond to the joint attention bids of others were observed in this study. These data suggest that a disturbance in the tendency to initiate episodes of joint attention with others may be indicative of early social–cognitive and social–emotional disturbance among infants affected by disorganized attachment status. Theory and research is reviewed to suggest that an early impairment in joint attention facility may make a significant contribution to risk for negative cognitive and emotional outcomes among these infants.

This study tested the motor development of 73 infants who were prenatally exposed to cocaine using the Peabody Developmental Motor Scales at 6, 12, 18, and 24 months of age. Repeated measures MANOVA found a main effect for age with scores decreasing as children increased in age. The significant interactive effect between age and skill type indicated that fine motor quotient scores decreased more than the comparable gross motor scores. T-tests showed significant differences between the two skill types: fine motor skills were higher at the first two testing periods and lower at the last two periods. This article discusses the nature of the delays at specified age periods and the implications for future assessment and programming.

Four and five-year-old children, 22 with mild mental retardation and 27 with learning disabilities, were matched with normally achieving children of the same age, gender, and ethnicity. All were presented a battery of eight cognitive tasks being considered for inclusion in a new screening test. Five tasks were selected based on their high levels of classification accuracy. One of the selected tasks required the child to point to pictures in a systematic manner, one to find the odd or different picture, one to define a common word, one to generate items belonging to a specific category and one to verbalize differences among people. The results support the contention that a broad array of cognitive measures may enable more effective early identification of young children with mild learning problems.

Although maltreatment is known to have detrimental effects on socioemotional development, the relation of those effects to type of maltreatment and child age is not clear. Most studies either focus solely on physical abuse or do not differentiate among types of maltreatment. Furthermore, most concentrate on young children. Studies of psychological maltreatment in young children indicate that physical abuse and psychological maltreatment tend to co-occur, severity of injury is not related to severity of psychological maltreatment or to developmental problems, and severity of psychological maltreatment is related to developmental outcomes. The present study investigated (a) relations among types of physical and psychological maltreatment and (b) their effect on development in an ethnically diverse sample of maltreated school-age children and adolescents. The results indicated that, as in young children, physical and psychological maltreatment co-occurred in most cases. As with young children, severity of emotional abuse was related to severity of physical neglect in school-age children; among adolescents, however, it was related to severity of physical injury. Moreover, severity of emotional abuse was related to both behavior problems and depression. The differences between the patterns of effects for school-age children and those for adolescents are discussed, as are implications of the findings for intervention.

Sixty-two 4- and 5-year-old exceptional children, with either mild mental retardation or learning disabilities, were matched on age, sex, and ethnicity with children who were making normal progress. All 62 pairs were presented a minibattery that included 6 cognitive tasks: two memory, three oddity, and a word definition task. The exceptional group performed more poorly than their normal matches on all dependent measures. Discriminant function analyses resulted in classification accuracy levels for the normally achieving group of no less than 89%. Ninety-seven percent of preschoolers with mild mental retardation were correctly identified, as were 84% of children classified as learning disabled. When the two groups with mild cognitive deficiencies were combined, 90% of the children with special educational needs were correctly classified. Cutoff scores applied to frequency distributions were associated with similar levels of accuracy. These results support the contention that a screening test composed of a broad array of cognitive measures should enable more effective identification of young children with mild mental retardation or learning disabilities.

The relation among family relationships was explored for (a) couple pairings and (b) parent-child dyads. In S3 maltreating and adequate families, mothers' and male partners' quality of attachment (drawn from interviews) was compared with each other and with child quality of attachment (drawn from the Strange Situation). The notion of internal representational models, drawn from attachment theory, provided the basis for seeking continuity, that is, matches and meshes between partners and coherence from parent to child. Both concordance and discordance were found; in particular, a hypothesis of meshed adult relationships and parent-child transformations was supported. The conditions leading to meshed partnerships and transformed parent-to-child patterns require further study. In addition, the results suggest the need for greater incorporation of regulation of affect in assessment procedures, greater theory development, and precision in validation and application of assessment procedures. Finally, this study highlights the advantages of using atypical samples to explore aspects of normative development that are obscured in normative samples.

This study examined whether infant joint attention (JA) skills predicted social behaviors in a sample of at-risk preschool children (n = 30) with a history of prenatal exposure to cocaine. JA behaviors were assessed with the Early Social and Communication Scales at 12, 15, and 18 months of age. Three classes of JA were measured: Initiating JA (IJA), Responding to JA (RJA), and Requests. Behavioral outcomes were measured at 36 months and included ratings of disruptive and withdrawn behaviors and social competence. JA behaviors were related to behavioral outcomes after controlling for language and cognitive ability. The functionally distinct uses of JA were differentially related to behavioral outcome. IJA negatively predicted disruptive behaviors, whereas Requests positively predicted disruptive behaviors. Infant RJA negatively predicted withdrawn behaviors and positively predicted social competence. These results are interpreted in the context of competing theories that attempt to explain variability in the expression of JA skills in the second year of life.