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Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis. [This study was conducted in collaboration with the Developmental and Behavioral Pediatrics Research Network (DBPNet).]

Overweight and obesity are common in pediatric populations. Children with autism spectrum disorder and disruptive behavior may be at higher risk. This study examined whether children with autism spectrum disorder and disruptive behavior are more likely to be overweight or obese than matched controls. Baseline data from medication-free children with autism spectrum disorder who participated in trials conducted by the Research Units on Pediatric Psychopharmacology Autism Network (N = 276) were compared to 544 control children from the National Health and Nutrition Examination Survey database matched on age, sex, race, parent education, and era of data collection. The mean age of the children with autism spectrum disorder was 7.9 ± 2.6 years; 84.4% were males. In the autism spectrum disorder group, the prevalence was 42.4% for overweight and 21.4% for obesity compared to 26.1% for overweight and 12.0% for obesity among controls (p < 0.001 for each contrast). Within the autism spectrum disorder sample, obesity was associated with minority status and lower daily living skills. These findings suggest that children with autism spectrum disorder and disruptive behavior are at increased risk for obesity and underscore the need for weight management interventions in this population.

Although intimate partner violence (IPV) is an important risk factor for child physical abuse, most IPV-exposed children are not evaluated for abusive injuries. A Community Advisory Board (CAB) was formed to (a) optimize a program to evaluate IPV-exposed children for abusive injuries and (b) inform research methods to engage IPV victims and their children. The objectives of this study were to implement and to evaluate the family violence CAB. Following best practices on CAB formation, we recruited local stakeholders with key roles as service providers, community leaders, and knowledge experts in IPV, child abuse, and emergency care. Fourteen members met bimonthly to develop a family-centered intervention and to inform research and advocacy activities. A shared memorandum of understanding outlined goals and objectives. One year after the CAB's implementation, a research assistant interviewed CAB members to understand their experiences, perceived benefits of participation, and desired improvements. Eleven CAB members, including an IPV survivor, participated. Emerging categories included (a) motivations to join the CAB (victim advocacy), (b) benefits of participation (development of relationships among members and increased acceptability of research methods), (c) facilitators of sustainability (program adaptability and development of trust), and (d) desired improvements (case-based follow-up). The CAB was successfully implemented and facilitated the development of collaborative relationships among stakeholders with key roles in IPV and child abuse. The CAB led to community member-proposed changes in research activities and clinical care for victims of IPV. [ABSTRACT FROM AUTHOR]

It is unclear if surveillance bias (increased reports to Child Protective Services [CPS] related to program involvement) has a substantial impact on evaluation of home visiting (HV) prevention programs. We estimated surveillance bias using data from Connecticut's HV program, birth certificates, CPS, and hospitals. Using propensity score matching, we identified 15,870 families similar to 4015 HV families. The difference-in-differences approach was used to estimate surveillance bias as the change in investigated reports from the last 6 months of program involvement to the next 6 months. The median age of the children at program exit was 1.2 years (range: 60 days, 5 years). We estimated that 25.6% of investigated reports in the HV group resulted from surveillance bias. We reviewed CPS reports of 194 home-visited families to determine if a home visitor made the report and found that 10% were directly from home visitors. Program evaluations should account for surveillance bias. [ABSTRACT FROM AUTHOR]

Objectives: Published protocols for forensic interviewing for child sexual abuse do not include specific questions about what prompted children to tell about sexual abuse or what made them wait to tell. We, therefore, aimed to: (1) add direct inquiry about the process of a child's disclosure to a forensic interview protocol; (2) determine if children will, in fact, discuss the process that led them to tell about sexual abuse; and (3) describe the factors that children identify as either having led them to tell about sexual abuse or caused them to delay a disclosure. Methods: Forensic interviewers were asked to incorporate questions about telling into an existing forensic interview protocol. Over a 1-year period, 191 consecutive forensic interviews of child sexual abuse victims aged 3-18 years old in which children spoke about the reasons they told about abuse or waited to tell about abuse were reviewed. Interview content related to the children's reasons for telling or for waiting to tell about abuse was extracted and analyzed using a qualitative methodology in order to capture themes directly from the children's words. Results: Forensic interviewers asked children about how they came to tell about sexual abuse and if children waited to tell about abuse, and the children gave specific answers to these questions. The reasons children identified for why they chose to tell were classified into three domains: (1) disclosure as a result of internal stimuli (e.g., the child had nightmares), (2) disclosure facilitated by outside influences (e.g., the child was questioned), and (3) disclosure due to direct evidence of abuse (e.g., the child's abuse was witnessed). The barriers to disclosure identified by the children were categorized into five groups: (1) threats made by the perpetrator (e.g., the child was told (s)he would get in trouble if (s)he told), (2) fears (e.g., the child was afraid something bad would happen if (s)he told), (3) lack of opportunity (e.g., the child felt the opportunity to disclose never presented), (4) lack of understanding (e.g., the child failed to recognize abusive behavior as unacceptable), and (5) relationship with the perpetrator (e.g., the child thought the perpetrator was a friend). Conclusions: Specific reasons that individual children identify for why they told and why they waited to tell about sexual abuse can be obtained by direct inquiry during forensic interviews for suspected child sexual abuse. Practice implications: When asked, children identified the first person they told and offered varied and specific reasons for why they told and why they waited to tell about sexual abuse. Understanding why children disclose their abuse and why they wait to disclose will assist both professionals and families. Investigators and those who care for sexually abused children will gain insight into the specific barrier that the sexually abused child overcame to disclose. Prosecutors will be able to use this information to explain to juries why the child may have delayed his or her disclosure. Parents who struggle to understand why their child disclosed to someone else or waited to disclose will have a better understanding of their child's decisions. (Contains 6 tables.)

Objective: To survey the self-perceived capability of medically oriented child maltreatment teams in the US to provide mental health referrals and services when needed and to evaluate children with special health care needs (CSHCN). Methods: Mailed questionnaire with 5 items related to mental health, 12 items on services for CSHCN, and 28 items on financial issues previously reported. Results: Responses were received from 320 of 472 organizations (67.8%); 153 respondents had at least 1 physician or nurse practitioner and were included in the analysis; 91 were hospital-based teams (HBTs); and 62 were community-based teams (CBTs). CBTs were significantly more likely to offer mental health treatment (65.0% vs 35.6%). When mental health services were needed in another language, only half (50.7%) indicated that services were available in Spanish, less than a third (29.3%) could find services in sign language, and only 20.3% expected to find services for patients who used other languages. Of all children evaluated, 31.2% had special health care needs. CBTs reported seeing significantly more CSHCN than HBTs (38.3% vs 26.5%). Over two-thirds (67.7%) did not have a special program or specialized staff to serve CSHCN. Overall, teams had some training and experience with CSHCN. Children who were deaf were evaluated by 84.5% of teams, while only 50.5% reported using professionally trained sign language interpreters. Most teams (82.2%) indicated that more time was needed to evaluate CSHCN, and 69.1% found arranging for mental health treatment for CSHCN more difficult than children without special needs. Conclusions: Medically oriented child maltreatment teams are generally able to arrange for mental health services for the children served, and most feel capable of serving CSHCN. Significantly more mental health service providers are needed for children and families who communicate in languages other than English (e.g., Spanish, American Sign Language [ASL]). Practice implications: Our results suggest that medically oriented child maltreatment teams and mental health services for maltreated children would improve gaps in services by: (1) recruiting and training bilingual professionals, (2) ensuring that children or family members who are deaf receive professional ASL services, and (3) ensuring that training is provided related to the needs of CSHCN.

Objective: To describe a clinical approach to the recognition of overt and latent concerns of parents and children when children are evaluated for suspected sexual abuse by medical examiners. Method: Description of a clinical approach. Results: We describe 10 concerns-six of parents: (1) should we believe our child?; (2) worries about the child's body; (3) expressing emotions; (4) why the child delayed in telling; (5) how to talk to my child; (6) when will the perpetrator be arrested?; and four of children: 7) who will know about this?; (8) protecting one's parents; (9) worry about one's own body; and (10) what about my sexuality? Conclusions: We believe that by addressing these concerns in the medical evaluation of suspected sexual abuse, clinicians can help families focus on important issues, including ensuring the child's safety, acknowledging family members' feelings, and arranging counseling for the child and parents. (Contains 1 table.)