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The American Academy of Pediatrics (AAP) recommends screening children for developmental delay and autism. Studies of current screening practice to date have been limited in scope and primarily focused on small, local samples. This study is designed to determine compliance with AAP screening recommendations: (1) developmental screening at 9, 18, and 24 or 30 months; (2) screening when concerns are raised at a surveillance visit; and (3) autism screening at 18 and 24 months and to examine pediatrician and practice characteristics associated with compliance. Pediatricians from 6 states completed a 38-item web-based questionnaire (N = 406) regarding compliance with recommendations, screening implementation, changes in screening practice since the publication of guidelines, and pediatrician and practice demographics. Overall, 17.8% of pediatricians were compliant with all 3 screening recommendations. A total of 41.6% of pediatricians screened for development at the 9-month visit, 58% at the 18-month visit, and 52% at the 24- or 30-month visit. A total of 59.8% of physicians screened for autism at the 18-month visit and 50.2% at 24-month visit. As compared with 5 years ago, 44.8% of pediatricians currently screen for development more often and 72.2% screen for autism more often. Pediatricians with 10%‐50% of patients of non-White race/ethnicity in their practice were significantly less likely to screen for developmental delay than pediatricians with more than 50% of patients (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.13, 0.69; p = .004). Similarly, pediatricians with 10%‐30% of Medicaid-insured patients were less likely to screen for developmental delay than pediatricians with more than 30% of patients (OR = 0.45; 95% CI = 0.25, 0.80; p = .0007). In contrast, pediatricians with 10%‐30% of Medicaid-insured patients were significantly more likely to screen patients for autism than pediatricians with more than 30% of patients (OR = 2.46; 95% CI = 1.38, 4.40; p = .0002). Increasing numbers of pediatricians are screening children for developmental delays and autism. Economically disadvantaged children are significantly more likely to be screened for developmental delay but less likely to be screened for autism than do less disadvantaged children. Key words: autism, developmental screening, pediatricians, young children

Though attention deficit, hyperactivity disorder ADHD is a common problem in childhood. Thai teachers' knowledge regarding the disease has never been assessed.To identify knowledge of Thai teachers regardingADHD and its influencingfactors.Cross-sectional study was operated in three primary schools in Ayutthaya, Thailand. Standardized questionnaires comprised ofdemographic data, ADHD experiences and the Knowledge of Attention Deficit Disorder Scale, KADDS, were distributed to participating teachers. Results were reported using frequency, percent, mean, and standard deviation. Association between demographic and ADHD experiences and the KADDS score was identified by logistic regression analysis.Lack ofknowledge of ADHD among teachers was apparent. Only 19.4% of them passed the total scale of KADDS. Teachers under 31-years-old were more likely to pass general information and signs, symptomsdiagnosis subscales and total scale. In addition, familiarity with ADHD patients was associated with passing scores of general information subscale and total scale.Despite public awareness of ADHD, Thai teachers lacked knowledge concerning the disease. Young teachers were more acquainted with ADHD. Direct experience with ADHD patient might help teachers develop their knowledge on ADHD.

To identify markers of maternal depressive symptoms in medical records of children aged 1-6 years.Using a case-control methodology, mothers who were screened for depressive symptoms with the Quick Inventory of Depressive Symptomatology Self-Rated Questionnaire (QIDS-SR) at well-child visits between June 2006 and June 2008 in an inner-city pediatric clinic were grouped into cases with depressive symptoms (QIDS-SR score ≥ 11) and controls with no symptoms (QIDS-SR score ≤ 5). Potential markers for maternal depressive symptoms were collected from the children's medical record and grouped into 3 domains: (1) child health and development (eg, maternal concerns/negative attributions regarding the child's behavior); (2) child health care utilization (eg, missed appointments); and (3) maternal psychosocial factors (eg, single parent). The association between maternal depressive symptoms and each factor was determined using multiple logistic regression to calculate aORs.Maternal depressive symptoms were significantly associated with reports of concerns/negative attributions about the child's behavior (aOR, 2.35; P = .01) and concerns about speech (aOR, 2.40; P = .04) and sleep (aOR, 7.75; P.001); these were identified at the visit when the depression screening was done. Other associations included history of maternal depression (aOR, 4.94; P = .001) and a previous social work referral (aOR, 1.98; P = .01).Information readily available to pediatricians was associated with maternal depressive symptoms and can serve as clinical markers to help identify at-risk mothers during well-child visits.

CASE Quintin is a 7-and-a-half-year-old male who presents to you with his long-term foster parents stating that the school "wants to put him in a special behavior class." You have cared for the child since he went into the foster parents/biological aunt and uncle's care at 14 months of age.Quintin has been healthy and is on no medication; he has no chronic diseases or other medical problems. He has never had physical trauma, but when you first met him at 14 months of age, his aunt and uncle could give no history about his infancy. The aunt's sister who is the biological mother is currently incarcerated for drug trafficking, and his biological father is an unknown.His toddler years were fairly uneventful. The aunt and uncle have 2 children of their own who are currently 12 and 15 years of age-at the time Quintin joined the family they were 5 and 8 years of age and so the initial adjustment was stressful for the family. The aunt worked full time throughout Quintin's toddlerhood and often in childcare he would have difficulty with drop-off.When he began at head start, he was often described as "too busy" and "trouble on the playground," but he was highly verbal and intellectually curious, had many friends, and did well. Kindergarten was fairly uneventful in a full-day program, although he began to be more provocative at home, often getting into his cousins video games and once breaking his cousin's smart phone.He did well academically at the beginning of first grade. He was a solid reader by January of the year, but his activity and oppositionality were increasing. He was suspended 4 times between January and March for "unsafe behavior" including bolting from the playground during recess following the dare of an older student. His aunt and uncle present at primary care at their wits end. They state that at home he is increasingly angry. He responds much better to his uncle but can be very provocative with his aunt stating "I don't have to listen to you because you are not my mother." His aunt expressed concern when she was told by his teacher that "Either he starts medication or he needs to go to a special classroom." Where do you go from there?