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Purpose: We aimed to develop normative growth curves for articulation rate during sentence repetition for typically developing children. Our primary goal was the development of quantile/percentile growth curves so that typical variation in articulation rate with age could be estimated. We also estimated when children became adultlike in their articulation rate, and we examined the contributions of age and utterance length to articulation rate. Method: This cross-sectional study involved collection of in-person speech samples from 570 typically developing children (297 girls; 273 boys) who passed speech, language, and hearing screening measures. Pauses greater than 150 ms in duration were removed from the samples, and articulation rate was measured in syllables per second (sps). Results: Articulation rate reliably increased with age and utterance length. Rate in all key percentiles increased with age. The median rate (50th percentile) increased from 2.7 sps at 36 months to 3.3 sps at 96 months. The 5th percentile increased from 2.3 to 3.1 sps over the same age range. Using 3.2 sps as a benchmark for adultlike speech, we found the 25th, 50th, and 75th percentiles reached adultlike rates at 99, 75, and 53 months, respectively. Conclusions: Articulation rate increases from early childhood into middle childhood, and it is generally adultlike by 10 years of age. Variability in articulation rate among typical children was substantial. Implications for prior research and for clinical usage are discussed.

Purpose: We extended our earlier study on normative growth curves for intelligibility development in typical children from 30 to 119 months of age. We also determined quantile-specific age of steepest growth and growth rates. A key goal was to establish age-specific benchmarks for single-word and multiword intelligibility. Method: This cross-sectional study involved collection of in-person speech samples from 538 typically developing children (282 girls and 256 boys) who passed speech, language, and hearing screening measures. One thousand seventy-six normal-hearing naïve adult listeners (280 men and 796 women) orthographically transcribed children's speech. Speech intelligibility was measured as the percentage of words transcribed correctly by naive adults, with single-word and multiword intelligibility outcomes modeled separately. Results: The age range for 50% single-word intelligibility was 31-47 months (50th-5th percentiles), the age range for 75% single-word intelligibility was 49-87 months, and the age range for 90% intelligibility for single words was 83-120+ months. The same milestones were attained for multiword intelligibility at 34-46, 46-61, and 62-87 months, respectively. The age of steepest growth for the 50th percentile was 30-31 months for both single-word and multiword intelligibility and was later for children in lower percentiles. The maximum growth rate was 1.7 intelligibility percentage points per month for single words and 2.5 intelligibility percentage points per month for multiword intelligibility. Conclusions: There was considerable variability in intelligibility development among typical children. For children in median and lower percentiles, intelligibility growth continues through 9 years. Children should be at least 50% intelligible by 48 months.

Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD‐11) significantly confounds both research and practice. Using a diverse sample of trauma‐exposed youth (N = 1,542, age range: 8–20 years), we compared these two diagnostic approaches along with an expanded version of the ICD‐11 PTSD criteria that included three additional reexperiencing symptoms (ICD‐11+). Within the sample, PTSD was more prevalent using the DSM‐5 criteria (25.7%) compared to the ICD‐11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ =.57. The inclusion of additional reexperiencing symptoms (i.e., ICD‐11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM‐5 criteria, κ =.73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%–83.6%). Most youths who met the DSM‐5 PTSD criteria also met the criteria for ICD‐11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD‐11+ criteria (95.5%). Symptom‐level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM‐5 and ICD‐11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM‐5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM‐5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to examine longitudinal growth in intelligibility in connected speech from 2 to 8 years of age in children with cerebral palsy. Method: Sixty-five children with cerebral palsy participated in the longitudinal study. Children were classified into speech-language profile groups using age-4 data: no speech motor impairment (SMI), SMI with typical language comprehension, and SMI with impaired language comprehension. We fit a Bayesian nonlinear mixed-effects model of intelligibility growth at the child and group levels. We compared groups by age of steepest growth, maximum growth rate, and predicted intelligibility at 8 years of age. Results: The no SMI group showed earlier and steeper intelligibility growth and higher average outcomes compared to the SMI groups. The SMI groups had more variable growth trajectories, but the SMI with typical language comprehension group had higher age-8 outcomes and steeper rates of maximum growth than the SMI with impaired language comprehension group. Language comprehension impairment at age of 4 years predicted lower intelligibility outcomes at age of 8 years, compared to typical language at age of 4 years. Interpretation: Children with SMI at age of 4 years show highly variable intelligibility growth trajectories, and comorbid language comprehension impairment predicts lower intelligibility outcomes.

Purpose: We sought to establish normative growth curves for intelligibility development for the speech of typically developing children as revealed by objectively based orthographic transcription of elicited single-word and multiword utterances by naïve listeners. We also examined sex differences, and we compared differences between single-word and multiword intelligibility growth. Method: One hundred sixty-four typically developing children (92 girls, 72 boys) contributed speech samples for this study. Children were between the ages of 30 and 47 months, and analyses examined 1-month age increments between these ages. Two different naïve listeners heard each child and made orthographic transcriptions of child-produced words and sentences (n = 328 listeners). Average intelligibility scores for single-word productions and multiword productions were modeled using linear regression, which estimated normal-model quantile age trajectories for single- and multiword utterances. Results: We present growth curves showing steady linear change over time in 1-month increments from 30 to 47 months for 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Results showed that boys did not differ from girls and that, prior to 35 months of age, single words were more intelligible than multiword productions. Starting at 41 months of age, the reverse was true. Multiword intelligibility grew at a faster rate than single-word intelligibility. Conclusions: Children make steady progress in intelligibility development through 47 months, and only a small number of children approach 100% intelligibility by this age. Intelligibility continues to develop past the fourth year of life. There is considerable variability among children with regard to intelligibility development.

Purpose: We examined whether there were differences among speech-language profile groups of children with cerebral palsy (CP) in age of crossing 25%, 50%, and 75% intelligibility thresholds; age of greatest intelligibility growth; rate of intelligibility growth; maximum attained intelligibility at 8 years; and how well intelligibility at 36 months predicts intelligibility at 96 months when group membership is accounted for. Profile groups were children with no speech motor impairment (NSMI), those with speech motor impairment and language comprehension that is typically developing (SMI-LCT), and those with speech motor impairment and language comprehension impairment (SMI-LCI). Method: Sixty-eight children with CP were followed longitudinally between 24 and 96 months of age. A total of 564 time points were examined across children (M = 8.3 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations, allowing for differences between profile groups. We used the fitted model trajectories to generate descriptive analyses of intelligibility growth by group and to generate simulations to analyze how well 36-month intelligibility data predicted 96-month data accounting for profile groups. Results: Children with CP who have NSMI have different growth and better intelligibility outcomes than those with speech motor impairment. Children with SMI-LCT tend to have better outcomes but similar intelligibility growth as children with SMI-LCI. There may be a subset of children that cut across SMI-LCI and SMI-LCT groups who have severe speech motor involvement and show limited growth in intelligibility. Conclusions: Intelligibility outcomes for children with CP are affected by profile group membership. Intelligibility growth tends to be delayed in children with speech motor impairment. Intelligibility at 3 years is highly predictive of later outcomes regardless of profile group. Intervention decision making should include consideration of early intelligibility, and treatment directions should include consideration of augmentative and alternative communication.

Purpose: Children with cerebral palsy (CP) are at risk for significant communication problems. Reduced speech intelligibility is common, even for those who do not have speech motor deficits. Development of intelligibility has not been comprehensively quantified in children with CP; as a result, we are currently unable to predict later speech outcomes. Such information would advance treatment decision making. We sought to examine growth in speech intelligibility among children with CP using a prospective longitudinal design, with a focus on age of crossing target intelligibility thresholds, age of greatest intelligibility growth, and how well intelligibility at 36 months predicted intelligibility at 96 months. Method: Sixty-nine children with CP were followed longitudinally between 24 and 96 months of age. A total of 566 time points were examined across children (M = 8.2 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations and then used the fitted model trajectories to generate descriptive analyses of growth. We used results of the model to generate a set of simulations, which we analyzed to determine how well 36-month intelligibility data predicted 96-month data. Results: Half of children crossed 25% and 50% intelligibility thresholds at 36 and 49 months of age, respectively. Slightly more than half of children did not reach 75% intelligibility by 96 months of age. Age of crossing 25%, 50%, and 75% intelligibility thresholds was highly negatively correlated with intelligibly at 96 months. Children had the steepest intelligibility growth at 36 months, followed by 48 and 60 months. Intelligibility at 36 months was highly predictive of intelligibility at 96 months. Conclusions: The developmental window from 3 to 5 years constitutes a time of rapid growth in speech intelligibility in children with CP. Children who cross intelligibility thresholds of 25%, 50%, and 75% at earlier ages have better outcomes when they are older; early performance is highly predictive of later speech intelligibility outcomes. Children with CP as a group have delayed speech intelligibility development but are still growing through 96 months of age.

Objective Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns and examine associations with birth outcomes in a cohort of twin pregnancies. Study Design Prenatal and delivery records were examined for 320 twin pregnancies from a maternal–fetal medicine practice in Austin, TX 2011-2019. Prenatal weights for those with >1 measured weight in the first trimester and ≥3 prenatal weights were included in analyses. Trajectories were estimated to 32 weeks (mean delivery: 33.7 ± 3.3 weeks) using flexible latent class mixed models with low-rank thin-plate splines. Associations between trajectory classes and infant outcomes were analyzed using multivariable Poisson or linear regression. Results Weight change from prepregnancy to delivery was 15.4 ± 6.3 kg for people with an underweight body mass index, 15.4 ± 5.8 kg for healthy weight, 14.7 ± 6.9 kg for overweight, and 12.5 ± 6.4 kg for obesity. Three trajectory classes were identified: low (Class 1), moderate (Class 2), or high gain (Class 3). Class 1 (24.7%) maintained weight for 15 weeks and then gained an estimated 6.6 kg at 32 weeks. Class 2 (60.9%) exhibited steady gain with 13.5 kg predicted total gain, and Class 3 (14.4%) showed rapid gain across pregnancy with 21.3 kg predicted gain. Compared to Class 1, Class 3 was associated with higher birth weight z -score (β = 0.63, 95% confidence interval [CI]: 0.31,0.96), increased risk for large for gestational age (IRR = 5.60, 95% CI: 1.59, 19.67), and birth <32 weeks (IRR = 2.44, 95% CI: 1.10, 5.4) that was attenuated in sensitivity analyses. Class 2 was associated with moderately elevated birth weight z -score (β = 0.24, 95% CI: 0.00, 0.48, p = 0.050). Conclusion Gestational weight change followed a low, moderate, or high trajectory; both moderate and high gain patterns were associated with increased infant size outcomes. Optimal patterns of weight change that balance risk during the prenatal, perinatal, and neonatal periods require further investigation, particularly in high-risk twin pregnancies. Key Points A majority gained weight below IOM twin recommendations. Three patterns of GWC across pregnancy were identified. Moderate or high GWC was associated with infant size. [ABSTRACT FROM AUTHOR]

Background: Dexamethasone was approved for use in hospitalized COVID-19 patients early in the pandemic based on the RECOVERY trial, but evidence is still needed to support its real-world effectiveness in heterogeneous populations of patients with a wide range of comorbidities. Methods: COVID-19 inpatients represented within the National COVID Cohort Collaborative (N3C) Data Enclave, prior to vaccine availability, were studied. Primary outcome was in-hospital death; secondary outcome was combined in-hospital death and severe outcome defined by use of ECMO or mechanical ventilation. Missing data were imputed with single imputation. Dexamethasone-treated patients were propensity score (PS) matched to non-dexamethasone-treated controls, stratified by remdesivir treatment and based on demographics, baseline laboratory values, comorbidities, and amount of missing data before imputation. Treatment benefit was quantified using logistic regression. Further sensitivity analyses were performed using clinical adjusters in matched groups and in strata defined by quartiles of PS. Results: Dexamethasone treatment was associated with reduced risk of in-hospital mortality for n = 1,263 treated, matched 1:3 to untreated, patients not receiving remdesivir (OR = 0.77, 95% CI: 0.62 to 0.95, p = 0.017), and for n = 804 treated, matched 1:1 to untreated, patients receiving remdesivir (OR = 0.74, 95% CI: 0.53 to 1.02, p = 0.054). Treatment showed secondary outcome benefit. In sensitivity analyses, treatment effect generally remained similar with some heterogeneity of benefit across quartiles of PS, possibly reflecting concentration of benefit among the more severely affected. Conclusions: We add evidence that dexamethasone provides benefit with respect to mortality and severe outcomes in a diverse, national hospitalized sample, prior to vaccine availability. [ABSTRACT FROM AUTHOR]

Background It is unclear whether there are racial/ethnic disparities in the risk of upper respiratory viral infection acquisition and/or lower respiratory manifestations. Methods We studied all children and children with asthma aged 6 to 17 years in the National Health and Nutrition Examination Survey (2007–2012) to evaluate (1) the association between race/ethnicity and upper respiratory infection (URI) and (2) whether race/ethnicity is a risk factor for URI-associated pulmonary eosinophilic inflammation or decreased lung function. Results Children who identified as Black (adjusted odds ratio [aOR], 1.38; 95% CI, 1.10–1.75) and Mexican American (aOR, 1.50; 95% CI, 1.16–1.94) were more likely to report a URI than those who identified as White. Among those with asthma, Black children were more than twice as likely to report a URI than White children (aOR, 2.28; 95% CI, 1.31–3.95). Associations between URI and pulmonary eosinophilic inflammation or lung function did not differ by race/ethnicity. Conclusions Findings suggest that there may be racial and ethnic disparities in acquiring a URI but not in the severity of infection. Given that upper respiratory viral infection is tightly linked to asthma exacerbations in children, differences in the risk of infection among children with asthma may contribute to disparities in asthma exacerbations. [ABSTRACT FROM AUTHOR]