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Pediatric positive health refers to children's assessments of their well-being. The purpose of this study was to contrast positive health for children aged 8 to 17 years with and without chronic physical and mental health conditions.Data were drawn from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) research program. Participants included 1764 children ages 8 to 17 years from 13 ECHO cohorts. We measured positive health using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health and Life Satisfaction patient-reported outcome (PRO) measures. We used multiple regression to examine cross-sectional associations between the PROs and parent-reported health conditions and sociodemographic variables. We defined a meaningful difference in average scores as a PROMIS T-score difference of3.The sample included 45% 13 to 17-year-olds, 50% females, 8% Latinx, and 23% Black/African-American. Fifty-four percent had a chronic health condition. Of the 16 chronic conditions included in the study, only chronic pain (β = -3.5; 95% CI: -5.2 to -1.9) and depression (β = -6.6; 95% CI: -8.5 to -4.6) were associated with scoring3 points lower on global health. Only depression was associated with3 points lower on life satisfaction (β = -6.2; 95% CI: -8.1 to -4.3). Among those with depression, 95% also had another chronic condition.Many children with chronic conditions have similar levels of positive health as counterparts without chronic conditions. The study results suggest that negative associations between chronic conditions and positive health may be primarily attributable to presence or co-occurrence of depression.

Objective Physical activity (PA) and sleep are leading health indicators for individuals of all ages. Monitoring young children’s PA and sleep using psychometrically sound instruments could help facilitate timely interventions to promote healthy development. This article describes the development of the PROMIS® Early Childhood (EC) Parent Report Physical Activity (PA) and Sleep Problems (SP) measures for children aged 1–5 years. Methods Item pools were generated by interviewing parents, input from content experts, and literature review. Data from a U.S. general population sample were used to determine factor structures of item pools via factor analytic approaches, estimate item parameters via item response theory (IRT) models, and establish norms. Pearson correlations were used to evaluate across-domain associations. Analysis of variance was used and known-groups’ validity of PA and SP by comparing their scores to PROMIS EC Parent Report Global Health: child’s physical, emotional, and mental conditions. Results Initial item pools consisted of 19 and 26 items for PA and SP, respectively. Factor analyses’ results supported unidimensionality of 5 and 16 items measuring PA and SP, respectively, which were then calibrated using IRT. Norms were established by centering to a probability-based U.S. general population. Computerized adaptive testing algorithms were established. Some analyses supported initial measure validity. Conclusions The PROMIS EC PA calibrated scale and SP item banks are user-friendly and brief, yet produce precise scores. Both measures enable psychometrically sound assessment of PA behavior and sleep problems. Future studies to comprehensively evaluate the validity of these two measures are warranted.

Objective Provide an overview of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Early Childhood Parent Report measurement development project and describe its qualitative methods. Methods The PROMIS Early Childhood (PROMIS EC) initiative used the PROMIS mixed-methods approach to patient-reported outcome development, with insight from the developmental specification framework to create parent report measures appropriate for assessing young children’s health-related quality of life. Qualitative methods to develop these instruments included expert input, literature and measure review, and parent concept elicitation and cognitive interviews to confirm the measure frameworks, item understandability, and developmental appropriateness. Results Twelve measures resulted from the PROMIS EC initiative. These parent report instruments cover young children’s physical, mental, and social health. Conclusions The new PROMIS EC Parent Report instruments offer clinicians and researchers brief and psychometrically robust tools to evaluate young children’s physical, mental, and social health outcomes. Aligned with the PROMIS Pediatric instruments, the early childhood versions enable coherent lifespan measurement starting at age 1 while maintaining developmental sensitivity.

Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.

Background: The financial hardships and social isolation experienced during the COVID-19 pandemic have been found to adversely affect children’s developmental outcomes. While many studies thus far have focused on school-aged children and the pandemic-related impacts on their academic skills and behavior problems, relatively less is known about pandemic hardships and associations with children’s development during their early years. Using a racially and economically diverse sample, we examined whether hardships experienced during the pandemic were associated with children’s development with a particular focus on communication and socioemotional development. Methods: Participants from eight cohorts of the Environmental influences on Child Health Outcomes program provided data on pandemic-related financial and social hardships as well as child developmental outcomes. Financial hardship was defined as at least one parent experiencing job loss or change, and social hardship was defined as families’ quarantining from household members or extended family and friends. The development of children under 4 was assessed longitudinally, before and during the pandemic (N = 684), using the Ages and Stages Questionnaire (ASQ). The Generalized Estimating Equations, which accounted for within-child correlation, were used for analysis. Results: Families from minority backgrounds and low socioeconomic status disproportionately experienced pandemic-related hardships. Male children had higher odds of experiencing negative changes in communication and personal social skills from pre- to during-pandemic visits (ORs ranged between 2.24 and 3.03 in analysis with binary ASQ outcomes and ranged from −0.34–0.36 in analyses with ASQ z-scores, ps = 0.000). Pandemic-related hardships in the social and financial areas did not explain within-individual changes in children’s developmental outcomes. Conclusion: Negative developmental changes from pre- to during-pandemic were found in boys, yet we did not find any associations between increased experience of pandemic-related hardships and children’s development. E how pandemic hardships affect development using a larger sample size and with longer follow-up is warranted.

Assessing stressful life events in large-scale epidemiologic studies is challenged by the need to measure potential stressful events in a reasonably comprehensible manner balanced with burden on participants and research staff. The aim of this paper was to create a short form of the Crisis in Family Systems-Revised (CRISYS-R) plus 17 acculturation items, a measure that captures contemporary life stressors across 11 domains. Latent class analysis (LCA) was used to segment the sample of 884 women from the PRogramming of Intergenerational Stress Mechanisms (PRISM) study experiencing different patterns of exposure to stressful events and identify items from each domain that best discriminate between individuals with different patterns of stressful-event exposures (high vs. low stress exposure). The results from the LCA, in conjunction with the expert opinions provided by the original developers of the CRISYS, yielded a 24-item item short form (CRISYS-SF) with at least one question from each of the original domains. Scores on the 24-item CRISYS-SF had high correlations with scores on the 80-item CRISYS.

OBJECTIVES The family stress model proposes economic hardship results in caregiver distress and relational problems, which negatively impact youth outcomes. We extend this model to evaluate the impact of coronavirus disease 2019 pandemic-related family hardships on caregiver and youth stress, and, in turn, youth’s psychological well-being. We also investigate how social supports moderate this relationship. METHODS We used 2 samples of cross-sectional survey data collected between May 2020 and May 2021: children aged 2 to 12 years (n = 977) and adolescents aged 11 to 17 years (n = 669). Variables included pandemic-related family hardships, stress, social support, and youth life satisfaction. Data were analyzed using structural equation modeling. RESULTS Experiencing more pandemic-related family hardships was associated with increased caregiver and youth stress (b = 0.04 to 0.21, SE = 0.01–0.02) and, in turn, decreased youth life satisfaction (b = –0.36 to –0.38, SE = 0.04–0.07). Social connectedness (b^ = 0.11–0.17, SE = 0.04) and family engagement (b^ = 0.12–0.18, SE = 0.05–0.06) had direct positive associations with life satisfaction; for children aged 2 to 12 years, greater family engagement was associated with decreased effect of child stress on life satisfaction (b^ = 0.15, SE = 0.05). For adolescents, females had higher levels of stress compared with males (b^ = 0.40, SE = 0.6), and having anxiety and/or depression was associated with decreased life satisfaction (b^ = –0.24, SE = 0.11). CONCLUSIONS Caregivers and youth who experienced more coronavirus disease 2019 pandemic hardships had higher levels of stress, particularly adolescent females. Although stress negatively impacted life satisfaction across all ages, family engagement was a protective factor for children aged 2 to 12 years, whereas having anxiety and/or depression was a risk factor for adolescents. For all youth, however, being more socially connected and engaged with family promoted life satisfaction.

PURPOSE: To assess the association between children’s sleep quality and life satisfaction; and to evaluate the underlying mechanisms of this relationship. METHODS: Three pediatric cohorts in the National Institutes of Health (NIH) Environmental influences on Child Health (ECHO) Research Program administered Patient Reported Outcome Measurement Information System (PROMIS®) parent-proxy measures to caregivers (n=1111) who reported on their 5–9-year-old children’s (n=1251) sleep quality, psychological stress, general health, and life satisfaction; extant sociodemographic data was harmonized across cohorts. Bootstrapped path modeling of individual patient data meta-analysis was used to determine whether and to what extent stress and general health mediate the relationship between children’s sleep quality and life satisfaction. RESULTS: Nonparametric bootstrapped path analyses with 1000 replications suggested children’s sleep quality was associated with lower levels of stress and better general health, which, in turn, predicted higher levels of life satisfaction. Family environmental factors (i.e., income and maternal mental health) moderated these relationships. CONCLUSION: Children who sleep well have happier lives than those with more disturbed sleep. Given the modifiable nature of children’s sleep quality, this study offers evidence to inform future interventional studies on specific mechanisms to improve children’s well-being.

Background: The financial hardships and social isolation experienced during the COVID-19 pandemic have been found to adversely affect children’s developmental outcomes. While many studies thus far have focused on school-aged children and the pandemic-related impacts on their academic skills and behavior problems, relatively less is known about pandemic hardships and associations with children’s development during their early years. Using a racially and economically diverse sample, we examined whether hardships experienced during the pandemic were associated with children’s development with a particular focus on communication and socioemotional development. Methods: Participants from eight cohorts of the Environmental influences on Child Health Outcomes program provided data on pandemic-related financial and social hardships as well as child developmental outcomes. Financial hardship was defined as at least one parent experiencing job loss or change, and social hardship was defined as families’ quarantining from household members or extended family and friends. The development of children under 4 was assessed longitudinally, before and during the pandemic (N = 684), using the Ages and Stages Questionnaire (ASQ). The Generalized Estimating Equations, which accounted for within-child correlation, were used for analysis. Results: Families from minority backgrounds and low socioeconomic status disproportionately experienced pandemic-related hardships. Male children had higher odds of experiencing negative changes in communication and personal social skills from pre- to during-pandemic visits (ORs ranged between 2.24 and 3.03 in analysis with binary ASQ outcomes and ranged from −0.34–0.36 in analyses with ASQ z-scores, ps = 0.000). Pandemic-related hardships in the social and financial areas did not explain within-individual changes in children’s developmental outcomes. Conclusion: Negative developmental changes from pre- to during-pandemic were found in boys, yet we did not find any associations between increased experience of pandemic-related hardships and children’s development. E how pandemic hardships affect development using a larger sample size and with longer follow-up is warranted.

The Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) both measure emotional and behavioral problems in children and adolescents, and scores on the two instruments are highly correlated. When administrative needs compel practitioners to change the instrument used or data from the two measures are combined to perform pooled analyses, it becomes necessary to compare scores on the two instruments. To enable such comparisons, we score linked three domains (Internalizing, Externalizing, and Total Problems) of the CBCL and SDQ in three age groups spanning 2-17 years. After assessing linking assumptions, we compared item response theory (IRT) and equipercentile linking methods to identify the most statistically justifiable link, ultimately selecting equipercentile linking with loglinear smoothing due to its minimal bias and the ability to link raw SDQ scores with both T-scores and raw scores from the CBCL. We derived crosswalk conversion tables to convert scores on one measure to the metric of the other and discuss the use of these tables in research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND/OBJECTIVES: Older children with atopic dermatitis (AD) suffer from poor sleep and attention problems. However, until recently, the dearth of developmentally sensitive assessment tools impeded characterization in younger children. We aimed to characterize sleep and attention problems in young children with AD and identify modifiable factors. METHODS: A cross-sectional study of children with AD aged 1–4 years was stratified by disease severity (Patient-Oriented Eczema Measure), age, and racial/ethnic groups. Developmentally sensitive surveys assessed attention (Multidimensional Assessment Profile of Attention Regulation), sleep, and itch (Patient-Reported Outcomes Measurement Information System). Linear regression models identified predictors of sleep health and attention dysregulation. RESULTS: Parents (n = 60) of children aged 2.78 ± 0.98 years with severe (n = 25), moderate (n = 25), or mild (n = 10) AD were recruited across the United States. Significantly reduced sleep health (T-score ≥ 60) was reported in 86% of children with moderate/severe disease (n = 43), and 50% had ≥5 nights of disturbed sleep per week. A suboptimal sleep environment was identified with 32% of children with too much light, noise, or electronic device usage. With regard to attention regulation, in children with severe AD, 80% had trouble sitting still and 72% of children had trouble paying attention no matter their surroundings. In fully adjusted models, AD severity was a significant predictor of poor sleep health (B = 0.79 [0.31–1.28], p < .01) and attention dysregulation (B = 1.22 [0.51–1.93], p < .01). CONCLUSIONS: More severe AD correlates with poor sleep health and attention dysregulation. In addition to aggressive treatment of AD, clinicians should advise on modifiable sleep hygiene practices and consider screening for attention dysregulation in young children.

Objective Create and validate developmentally sensitive parent-report measures of emotional distress for children ages 1–5 years that conceptually align with the Patient-Reported Outcome Measurement Information System (PROMIS®) pediatric measures. Methods Initial items were generated based on expert and parent input regarding core components of emotional distress in early childhood and review of theoretical and empirical work in this domain. Items were psychometrically tested using data from two waves of panel surveys. Item response theory (IRT) was applied to develop item calibration parameters (Wave 1), and scores were centered on a general U.S. population sample (Wave 2). Final PROMIS early childhood (EC) instruments were compared with existing measures of related constructs to establish construct validity. Results Experts and parents confirmed the content validity of the existing PROMIS Pediatric emotional distress domains (i.e., anger, anxiety, and depressive symptoms) as developmentally salient for young children. Existing items were adapted and expanded for early childhood by employing best practices from developmental measurement science. Item banks as well as 4- and 8-item short forms, free from differential item functioning across sex and age, were constructed for the three domains based on rigorous IRT analyses. Correlations with subscales from previously validated measures provided further evidence of construct validity. Conclusions The PROMIS EC Anger/Irritability, Anxiety, and Depressive Symptoms measures demonstrated good reliability and initial evidence of validity for use in early childhood. This is an important contribution to advancing brief, efficient measurement of emotional distress in young children, closing a developmental gap in PROMIS pediatric emotional distress assessment.

Objective The early expression of lifespan health and disease states can often be detected in early childhood. Currently, the Patient-Reported Outcome Measurement Information System (PROMIS®) includes over 300 measures of health for individuals ages 5 years and older. We extended PROMIS to early childhood by creating developmentally appropriate, lifespan coherent parent-report measures for 1–5-year-olds. This paper describes the psychometric approaches used for these efforts; Methods 2 waves of data from parents of children ages 1–5 were collected via 2 internet panel companies. Wave 1 data (n = 1,400) were used to evaluate item pool unidimensionality, model fit, and initial item parameters. Combined data from wave 1 and wave 2 (reference sample; n = 1,057) were used to estimate final item parameters. Using item response theory methods, we developed and tested 12 item pools: Global Health, Physical Activity, Sleep Disturbance, Sleep-related Impairment, Anger/Irritability, Anxiety, Depressive Symptoms, Positive Affect, Self-Regulation, Engagement, Family Relationships, and Peer Relationships; Results Wave 1 analyses supported the unidimensionality of Physical Activity, Positive Affect, Anger/Irritability, Anxiety, Depressive Symptoms, and Global Health. Family Relationships and Peer Relationships were combined to form “Social Relationships”; Sleep Disturbance and Sleep-related Impairment were combined to form “Sleep Problems.” Self-Regulation was divided into “Flexibility” and “Frustration Tolerance”; Engagement was divided into “Curiosity” and “Persistence.” Short forms were developed for item banks with more than 10 items; and Conclusions Using rigorous mixed-methods, we successfully extended PROMIS to early childhood (1–5-year-olds). Measures are now publicly available in English and Spanish (www.healthmeasures.net).

Objective Apply the Patient-Reported Outcome Measurement Information System (PROMIS®) mixed-methods approach to develop and validate new parent-report measures of young children’s (1–5 years) family and peer relationships that conceptually align to those for 5–17 year olds. Methods Expert input, parent interviews, and reviews of theoretical and empirical literature were used to develop draft item pools, which were administered in two waves of panel surveys (N = 1,750). Psychometric evaluation was conducted using item response theory-based methods. Scores were normed to the general U.S. population. Initial validation analyses were conducted using Pearson’s correlations and analysis of variance to examine known-group differences between children with various health conditions. Results Experts and parents confirmed the content validity of existing PROMIS family and peer relationships domain frameworks and suggested adding child–caregiver interactions and empathic behaviors, respectively. Bi-factor model analysis supported sufficient unidimensionality where family and peer relationships were modeled as distinct subdomains of a broader concept, Social Relationships. The new measure was robust in discriminating young children with poor social relationships. Correlational and known-group analyses revealed positive associations with general health and well-being and negative associations with emotional and physical distress. Conclusions The PROMIS Early Childhood Parent-Report Social Relationships item bank enables clinicians and researchers a brief, efficient, and precise way to evaluate early relational health. Subdomain short forms also offer the ability to assess specific components (i.e., child–caregiver, family, and peer) for more targeted interventions and analyses.

Objective Expand the current Patient-Reported Outcome Measurement Information System (PROMIS®) well-being measures to early childhood (1–5 years) using best practices from PROMIS and developmental science. Methods Qualitative methods included expert input, literature and measure review, and parent interviews to confirm measure frameworks, item understandability, and developmental appropriateness. Quantitative methods included two waves of field testing and item response theory (IRT)-based psychometric evaluation of reliability and validity, as well as IRT centering and item calibration. Correlational analyses with other PROMIS Early Childhood (EC) Parent Report measures and known-group differences analyses by health status were conducted to evaluate construct validity. All measures were normed to the general U.S. population. Results Qualitative results suggested three primary early childhood well-being domains: Positive Affect, Engagement, and Self-Regulation. Quantitative results revealed a unidimensional factor structure for Positive Affect and multidimensional factor structures for Engagement and Self-Regulation, both of which had two factors accounting for >10% of modeled variance reflecting unique unidimensional domains. This resulted in five final PROMIS EC well-being measures: Positive Affect, Engagement—Curiosity, Engagement—Persistence, Self-Regulation—Flexibility, and Self-Regulation—Frustration Tolerance. Correlations and known-groups differences analyses showed robust construct validity across a range of chronic health conditions. Conclusions The new PROMIS EC Parent Report well-being measures offer clinicians and researchers a brief, efficient, and precise way to evaluate young children’s well-being. All five measures include only positively valanced item content, which pushes the field to evaluate the presence of children’s positive assets rather than the absence of problems.

Objective Assessing general (“global”) health is important to clinicians caring for patients, researchers studying patient subgroups, and epidemiologists tracking population trends. The Patient-Reported Outcomes Measurement Information System® (PROMIS®) introduced an adult self-report Global Health measure (ages 18+) in 2009 and pediatric versions (ages 5–17 years) in 2014. Our aim was to extend global health assessment to 1–5-year olds. Methods We used the PROMIS mixed-methods approach to develop PROMIS Early Childhood (EC) Global Health, emphasizing qualitative measure development guidance utilizing input from experts and parents. Quantitatively, we conducted two data collection waves with parents of 1–5-year olds and applied state-of-the-science measure development methods, including exploratory, confirmatory, and bi-factor analytics, particularly regarding potentially multi-dimensional Global Health item content. We conducted a series of hypothesis-based across-domain association analyses, which were more exploratory in nature, and known-groups validity analyses. Results Experts emphasized the physical, mental, and social facets of global health, and parents described the broader, overarching construct. Using Waves 1 (N = 1,400) and 2 (N = 1,057) data, we retained six items directly sourced from the age 5–17 version and two new items. The resulting 8-item PROMIS EC Global Health was sufficiently unidimensional, so we fit item responses to the graded response model for parameter estimation. This produced an 8-item scale with one total score. Across-domain associations and known-groups validity analyses largely supported our hypotheses. Conclusions We achieved our aim to extend global health assessment to 1–5-year olds and to thereby expand the range of PROMIS life course global health assessment from children aged 1–17 years, to adults of all ages.

Depression is a leading mental health concern across the U.S. and worldwide. There are myriad assessments to evaluate depressive symptoms, including the Edinburgh Postnatal Depression Scale (EPDS), which is widely used to evaluate women's pre- and postnatal depression but not as prevalent at other timepoints in adulthood, limiting its utility for longitudinal research. As part of the National Institutes of Health's (NIH) Environmental influences on Child Health Outcomes (ECHO) Research Program, the current study sought to develop a common metric so that scores on the EPDS can be converted to the standardized Patient-Reported Measurement Information System (PROMIS®) T-score metric. Drawing on data from the ECHO-Prenatal Alcohol in SIDS and Stillbirth cohort, this study used a single-group linking design, where 1,263 mothers completed the EPDS and PROMIS-Depression measures at the same time. Score linking was conducted using equipercentile and item response theory (IRT) methods. Results showed both linking methods provide robust, congruent results, and subgroup invariance held across age, race, ethnicity, education, and geographic location. The IRT-based unidimensional fixed-parameter calibration was selected due to its model simplicity, and a crosswalk table was established to convert scores from the EPDS to PROMIS T-scores. Overall, this study provides a way to aggregate data across various depression measures and timepoints, such that researchers and clinicians now have the ability to directly compare and combine EPDS data with PROMIS and other depression measures already score-linked to PROMIS. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PURPOSE: To identify and evaluate methods for assessing pediatric patient-reported outcome (PRO) data quality at the individual level. METHODS: We conducted a systematic literature review to identify methods for detecting invalid responses to PRO measures. Eight data quality indicators were applied to child-report data collected from 1780 children ages 8–11 years. We grouped children with similar data quality patterns and tested for between-group differences in factors hypothesized to influence self-report capacity. RESULTS: We identified 126 articles that described 494 instances in which special measures or statistical techniques were applied to evaluate data quality at the individual level. We identified 22 data quality indicator subtypes: 9 direct methods (require administration of special items) and 13 archival techniques (statistical procedures applied to PRO data post hoc). Application of archival techniques to child-report PRO data revealed 3 distinct patterns (or classes) of the data quality indicators. Compared to class 1 (56%), classes 2 (36%) and 3 (8%) had greater variation in their PRO item responses. Three archival indicators were especially useful for differentiating plausible item response variation (class 2) from statistically unlikely response patterns (class 3). Neurodevelopmental conditions, which are associated with a range of cognitive processing challenges, were more common among children in class 3. CONCLUSION: A multi-indicator approach is needed to identify invalid PRO responses. Once identified, assessment environments and measurement tools should be adapted to best support these individuals’ self-report capacity. Individual-level data quality indicators can be used to gauge the effectiveness of these accommodations.

Disruptive behavior in childhood is common. It spans from normative child misbehaviors to clinically-significant and impairing problems. While there are many rating scales evaluating such behaviors, historically, measurement has emphasized counting the number of symptoms present rather than assessing the normal-abnormal spectrum of behavioral expression. This study uses data from 644 early school age children aggregated from two data sources to statistically link a commonly used symptom count measure, the Child Behavior Checklist (CBCL), to a more developmentally-sensitive measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). Two links between conceptually similar scales on each measure were developed: CBCL Conduct Problems and MAP-DB Aggression; and CBCL Oppositional Defiant Problems and MAP-DB Temper Loss. We compared two innovative methods-Item Response Theory (IRT) and Deming regression-to determine the optimal linking relationship. Results suggest IRT methods were superior in reducing linking error compared to Deming regression. While Deming regression accurately modeled the mean scores (thus minimizing linking bias), this method could not adequately address the floor effect for scores on the CBCL. For practical purposes, this study provides a crosswalk of score conversions between the CBCL and MAP-DB, such that data aggregation and group comparisons can be made across the two measures; this enables longitudinal analyses with historically-collected CBCL data to transition to the more innovative dimensional scales of the MAP-DB without undo loss of extant data. This study furthers efforts to shift from historical symptom counts to more developmentally-sensitive measurement across the disruptive behaviors spectrum.

Purpose of reviewDiverse methodological approaches pose significant challenges to assess environmental exposure effects on child health outcomes. Although transdisciplinary research efforts offer unique opportunities for understanding the complex and multidimensional facets of lifespan health and di

RESEARCH OBJECTIVE: To address the need for whole‐child assessments of risk to inform the many innovative national, state, and local efforts underway to promote whole‐child well‐being, we sought to: (1) develop and validate a risk index that acknowledges the complexity of the medical, social, and relational health risks children may simultaneously experience; (2) discern associations across types of risks and whether and to what extent relational and social health risks uniquely contribute to children's medical health risks, their healthcare utilization, and positive health outcomes; and (3) provide a baseline national and state level epidemiologic profile on a valid, whole‐child indicator of children's complex risks useful for the analyzing the need for and impact of policies and programs over time. STUDY DESIGN: Data from the 2016–2019 National Survey of Children's Health were used to create and validate the Whole Child Complexity Index (WCCI) assessing children's complex medical, social and relational health risks. Confirmatory factor analysis (CFA) and convergent/divergent regression analyses were employed to assess validity. National and state sociodemographic variations were evaluated and each state's findings compared to assess variations that may inform policy. POPULATION STUDIED: US children and youth age 0–17. PRINCIPAL FINDINGS: CFA validated the WCCI 3‐domain structure. Children with risks on more domains were more likely to have emergency and forgone care and less likely to flourish and engage/be ready to engage in school. Outcomes for children with only social health risks (SHR) and relational health risks (RHR) were similar to those experiencing only medical health risks (MHR), yet the former group was 5.75 times more likely to experience forgone care. Most children with MHR experienced SHR and/or RHR (64.3%). Wide variations across states was observed. Nearly one‐third (28.8%; publicly insured: 46%‐state range 35.2%–53.2%) experienced risks on two or more domains; 8.8% on all three domains (16.2% publicly insured). Wide household income and race/ethnicity disparities in were observed, yet, the WCCI accounted for variations in study outcomes. CONCLUSIONS: The WCCI sets a high bar to qualify for risk and is a valid, robust indicator of the complexity of medical, social and relational health risks children experience. RHR are prevalent, distinct from SHR, and significantly associated with worse outcomes for children with MHR and/or SHR. Substantial variations in prevalence of complex risks across states and sociodemographic populations of children present important opportunities to promote equity and improve child health by proactively assessing and address complex social, relational as well as medical health needs. IMPLICATIONS FOR POLICY OR PRACTICE: The coronavirus pandemic has highlighted the reality that our children's physical, social and relational lives are inextricably intertwined and collectively promote or diminish both their early development and lifelong well‐being. Prior to the pandemic, child well‐being in the US has lagged behind other developed countries, and large socioeconomic inequities persist. The Whole Child Complexity Index provides a national and across state profile of opportunities to promote a whole child health policy and is useful to inform innovative, cross‐sector efforts that promote equitable whole‐child well‐being, prevent and mitigate risks, reduce avoidable medical health care costs and pay for high‐value care. PRIMARY FUNDING SOURCE: The Robert Wood Johnson Foundation.

OBJECTIVES:To investigate children’s general health and life satisfaction in the context of chronic illness.METHODS:Caregivers (n = 1113) from 3 concurrent cohort studies completed the Patient-Reported Outcomes Measurement Information System Parent-Proxy Global Health measure, which is used to assess a child’s overall physical, mental, and social health, as well as the Patient-Reported Outcomes Measurement Information System Parent-Proxy Life Satisfaction measure between March 2017 and December 2017 for 1253 children aged 5 to 9 years. We harmonized demographic factors and family environmental stressors (single parent, maternal mental health, and income) to common metrics across the cohorts. To examine associations between chronic illness and children’s general health and life satisfaction, we fit linear regression models with cohort fixed effects and accounted for the multilevel data structure of multiple children nested within the same family (ie, twins and other siblings) with generalized estimating equations.RESULTS:Children with chronic illness had worse general health than those without illness (adjusted β = −1.20; 95% confidence interval: −2.49 to 0.09). By contrast, children with chronic illness had similar levels of life satisfaction (adjusted β = −.19; 95% confidence interval: −1.25 to 0.87). Additionally, children’s psychological stress had the strongest negative association with both outcomes, even after adjusting for demographics and family environmental stressors.CONCLUSIONS:Although children with chronic illness have lower parent-reported general health, their life satisfaction appears comparable with that of peers without chronic illness. With this study, we provide evidence that chronic illnesses do not preclude children from leading happy and satisfying lives.

Tablet computers are increasingly becoming commonplace in classrooms around the world. More than half of early childhood educators in the U.S. now have access to tablets, making it imperative to understand how they are using the device and what influences such use. The current study draws on survey data from 411 preschool educators serving 3- to 5-year-olds in school-based, center-based, and Head Start preschool programs to investigate how TPACK contextual factors (e.g., student background, teacher attitudes, and school support) influence teachers' traditional and student-centered tablet computer practices. Results suggest that teacher-level factors-especially positive attitudes toward technology-are most influential. Overall, this study emphasizes the need for preschool teachers and teacher educators to understand and address the critical contextual factors of tablet computer use in preschool education. Implications for education policy include expanding traditional funding models beyond technology access to provide on-going educator support, and developing new initiatives that encourage novel professional development models based on the same learned-centered practices that teachers are encouraged to use themselves. Explores contextual TPACK factors and early childhood educator tablet computer use.Teachers of low-income students use tablets more for student-centered learning.Attitudes and confidence consistently predict teachers' tablet computer integration.School support predicts teachers' use of tablets in student-centered practices.Teachers use diverse apps, but primarily literacy, STEM, and general education apps.

This article urges children and media scholars to consider the broader consequences of the ubiquitous media environment in which children live today. We consider, within a broader sociocultural context, the ways in which media and interactive technology serve as more knowledgeable others, scaffolding children's learning and development. Given this context, it is imperative for researchers to consider the consequences of living in the digital age and how broader developmental trajectories may be influenced. We call upon children and media researchers to contemplate more thoughtful research agendas that begin to assess the larger impact of media on children’s learning and developmental trajectories.

Amid growing concerns about the future of the U.S. economy and workforce, educators and policymakers alike have increasingly emphasized the need to expand the number of students interested in, qualified for and actually pursuing careers in science, technology, engineering and mathematics (STEM). The current study draws on survey responses from a sample of 3852 high school students at inclusive STEM schools across the U.S. to investigate how project- and problem-based learning (PBL) may work to address this need. Multivariate regression results indicate that student ratings of PBL are associated with interest in pursuing a career in STEM, as well as with intrinsic motivation for science and students’ ability beliefs for both science and math. Further, mediation analysis using Hayes’ (2014) MEDIATE macro suggests that science intrinsic motivation and ability beliefs mediate the relationship between perceived PBL experiences and student interest in a future STEM career (IFSC). Our results highlight the important potential of PBL for increasing student STEM attitudes and interest in future STEM careers. As one of the only large-scale quantitative analyses of its kind, this study provides critical information for educators, school administrators and policymakers as they continue to seek effective ways of encouraging students to pursue STEM careers.

The relatively recent invention of mobile tablets has changed the way children and adolescents use media technologies. Given that children and adolescents differ developmentally, we use Uses and Gratifications theory to explore ownership of mobile devices by young people and how children and adolescents use newer media technologies, including the Internet and mobile devices. Results from a national study of 909 children and adolescents, 8 to 17 years old, demonstrate that even younger children are avid users of new mobile devices, although ownership and use of mobile phones and tablets increases with age. Further, Internet use varies as a function of age, suggesting that children and adolescents may have different interests in and motivations to use new media technology, which play a role in their media use behavior.

The current study uses path modeling to investigate the relationship between extrinsic and intrinsic factors that influence early childhood educators’ digital technology use. Survey data from 1234 early childhood educators indicate that attitudes toward the value of technology to aid children’s learning have the strongest effect on technology use, followed by confidence and support in using technology. Additionally, student SES has the strongest effect on attitudes, while support and technology policy influence teacher confidence, which in turn influences attitudes. In contrast, more experienced teachers have more negative attitudes. Overall, the study provides the first path model investigating early childhood educators’ technology use and provides practical considerations to aid teachers’ use of technology in the classroom.

While online spaces and communities were once seen to transcend geography, the ubiquity of location-aware mobile devices means that today’s online interactions are deeply intertwined with offline places and relationships. Systems such as online dating applications for meeting nearby others provide novel social opportunities, but can also complicate interaction by aggregating or “co-situating” diverse sets of individuals. Often this aggregation occurs across traditional spatial or community boundaries that serve as cues for self-presentation and impression formation. This paper explores these issues through an interview study of Grindr users. Grindr is a location-aware real-time dating application for men who have sex with men. We argue that co-situation affects how and whether Grindr users and their behavior are visible to others, collapses or erases contextual cues about normative behavior, and introduces tensions in users’ self-presentation in terms of their identifiability and the cues their profile contains relative to their behavior.

The Internet is quickly becoming a favored medium for children, but few studies have investigated the content and types of activities children engage with online. The current study uses data collected from a national sample of 442 8- to 12-year-old children to investigate children's Internet content preferences during middle childhood. Results indicate that YouTube and Facebook were the two most favored Web sites. Additionally, there were significant differences by age and gender. Overall, results suggest children's Web site preferences are consistent with emotional, social, and cognitive development encountered in middle childhood.

The increased access to, but continued under-use of, technology in education makes it imperative to understand the barriers teachers face when integrating technology into their classrooms. While prior research suggests teachers encounter both first-order extrinsic barriers and second-order personal barriers, much of this research has focused on K-12 teachers, not early childhood educators. Applying the Unified Theory of Acceptance and Use of Technology to early childhood education, the current study examines predictors of early childhood educators' access to and use of traditional technologies and newer mobile devices. Findings from 1329 teachers of 0-4-year-olds reveal that while extrinsic barriers influence access to a range of technologies, positive beliefs in children's learning from technology significantly predicted actual use of technology. Overall, the study provides new insight into factors influencing technology integration specifically for early childhood educators, a subgroup that has not been represented in much of the literature on technology integration in formal education.

The rise of mobile media over recent years has brought promise and potential for children’s learning and development. With new—and often highly interactive—ways for children to engage with digital media and technology, as well as the ability to engage anywhere at anytime, mobile media is providing new and different opportunities unavailable with prior technologies. At the same time, these novel opportunities have led to more questions regarding the developmental appropriateness of digital media and technology, as well as how to best leverage the novel features of mobile media (e.g., touchscreens, anywhere/anytime engagement) to support young children’s learning and development. What has not changed, however, is the foundational importance of understanding not just whether and how children engage with mobile media but the content and context of that engagement. Indeed, emerging technologies afford new types of content (e.g., interactive) and contexts (e.g., mobile media can be taken anywhere), and have shifted traditional notions of screens and screen time. This chapter explores how new content and contexts afforded by mobile media fit into the daily lives of children and their influence on children’s learning and development.

Inclusive STEM (traditionally known to stand for “Science, Technology, Engineering, and Math”) high schools are emerging across the country as a mechanism for improving STEM education and getting more and diverse students into STEM majors and careers. However, there is no consensus on what these schools are or should be, making it difficult to both evaluate their effectiveness and scale successful models. We addressed this problem by working with inclusive STEM high school leaders and stakeholders to articulate and understand their intended school models. This “bottom-up” approach is in contrast with other studies that have taken a “top-down,” literature-based approach to defining STEM schools. Through this process, we identified 76 critical components of STEM schools and derived a theoretical framework of eight elements that represent the common goals and strategies employed by inclusive STEM high schools across the country: Personalization of Learning; Problem-Based Learning; Rigorous Learning; Career, Technology, and Life Skills; School Community and Belonging; External Community; Staff Foundations; and External Factors. This framework offers a clear picture of what exactly inclusive STEM schools are and common language for both researchers and practitioners. Interestingly, STEM disciplinary content did not emerge as a defining component across school models. Findings suggest that STEM school leaders and stakeholders view their STEM school identity as rooted in pedagogy, transferrable skills, school culture, and rigorous instruction across all subjects, including, but not restricted to, STEM. This raises questions about the goals of inclusive STEM high schools and the STEM discipline outcomes that we should reasonably expect to see from STEM schools.