Behavior Assessment System For Children Research Articles

Assessing the utility of a telehealth autism spectrum disorder assessment battery including the TELE-ASD-PEDS and the BASC-3

Objectives The goal of this research was to examine aspects of utility of an autism diagnostic tool created for telehealth use: the TELE-ASD-PEDS. This research also assessed associated clinical characteristics related to other behavior scales commonly used to assess children. Three hypotheses were examined: (1) Children with different diagnoses will have different scores on the TELE-ASD-PEDS; (2) There will be a positive correlation between the TELE-ASD-PEDS total score and the clinical subscales of the Behavior Assessment System for Children, 3rd edition (BASC-3); and (3) There will be a negative correlation between the TELE-ASD-PEDS and other selected subscales of the BASC-3. Methods Participants included children referred to a rural, Appalachian, state-funded, autism diagnostic clinic. A one-way ANOVA was conducted to compare TELE-ASD-PEDS scores with diagnoses received. TELE-ASD-PEDS scores and BASC-3 subscale scores were compared through bivariate correlation. Results When compared to the Autism group, both the Rule Out and the No Autism groups had lower scores on the TELE-ASD-PEDS. The BASC-3 subscale Withdrawal had a positive correlation with the TELE-ASD-PEDS. Finally, the adaptive subscales in the BASC-3 Social Skills, Functional Communication, and Activities of Daily Living had negative correlations with the TELE-ASD-PEDS. Conclusions Current data provided partial support for all hypotheses.

How do fathers’ educational level contribute to children’s school problems? Overparenting and children’s gender and surgency in a moderated mediation model

This study aims to investigate (a) the mediating role of overparenting between father’s educational level and children’s school problems, and (b) the joint moderating role of children’s gender and surgency in the indirect relationship between father’s educational level and school problems. Participants were 203 school children, 96 boys (47.3%) and 107 girls (52.7%), aged 7–8 years (M = 92.42 months, SD = 3.52). Fathers reported their educational level, age and employment status and their children’s gender and number of siblings, as well as their overparenting behaviors by Anticipatory Problem Solving (APS) scale. Teachers informed children’s school problems by the Behavior Assessment System for Children (BASC T-2). Parents together informed their children’s surgency levels by a subscale of Children’s Behavior Questionnaire (CBQ). Results showed that, in girls, the father’s educational level was negatively related to the child’s school problems via overparenting behaviors, controlling the number of siblings and father’s age and employment status. However, among boys, fathers’ overparenting protect their shy sons from the risk of a low educational level for school problems. These findings highlight the relevance of considering the gender and surgency to a better understanding of the effects of contextual factors on children’s outcomes.

Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot

To assess the association between primary (PR) and staged repair (SR) of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children. Multi-center cohort (n=9 sites) study of sTOF patients who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers' ratings of executive function with the Behavior Rating Inventory of Executive Function (BRIEF), and psychosocial functioning with the Behavior Assessment System for Children - 3rd Edition (BASC-3). Results were compared with normative data and by treatment strategy (PR versus SR). A parent survey assessed history of disabilities and access to services related to neurodevelopment. Although the majority of patients (median age 8.3 years, interquartile range 5.7-11.2) had median BRIEF and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (BRIEF 24-30% and BASC 20-37%). There were no statistically significant differences based on treatment strategy for either the BRIEF or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services. Elevated executive and psychosocial concerns are present in the sTOF patient population. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity, and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neuro-developmental services in this high-risk group.

Properties of the prefrontal tracts and cingulum bundle in children with prenatal alcohol exposure

BackgroundPrenatal alcohol exposure (PAE) significantly impacts brain structure and function, including cognition and behavior. The cingulum bundle and frontal lobe mediate social-, emotional- and cognitive-related functioning that are affected by PAE. However, the neurobehavioural development of the cingulum and intra-frontal tracts has not been examined in people with PAE. MethodsWe recruited 29 children and adolescents with PAE and 42 age- and gender-matched unexposed controls. Diffusion magnetic resonance imaging (MRI) data were acquired on a 3 T scanner. The rostral, dorsal and parahippocampal cingulum as well as medio-orbitofrontal, lateral-orbitofrontal, dorsolateral-prefrontal and medial-prefrontal tracts, were delineated and their fractional anisotropy and mean (MD), radial (RD), and axial (AD) diffusivities were calculated using constrained spherical deconvolution and deterministic tractography. We measured behavioural and emotional difficulties using the Behavior Assessment System for Children, 2nd Edition, Parent Rating Scale, and then explored their associations with diffusion metrics that differed between groups. ResultsWe found lower MD, RD, and AD in the right parahippocampal cingulum and multiple intra-frontal tracts in youth with PAE compared to controls; however, these differences did not withstand correction for multiple comparisons. While, youth with PAE showed significantly more emotional and behavioural difficulties compared to unexposed controls, these challenges were not associated with differences in diffusion metrics between groups. ConclusionPAE may be weakly associated with restricted diffusion in the right parahippocampal cingulum and multiple intra-frontal tracts. However, diffusivity changes related to PAE might not be the primary contributor to emotional and behavioural challenges in children and adolescents with PAE.

A - 37 ADHD-Related Hyperactivity and Impulsivity: Distinct or Overlapping Dimensions?

Abstract Objective It is debated whether hyperactivity and impulsivity should remain combined within the (DSM) hyperactivity/impulsivity domain or be separated. To address this dispute, we sought to determine whether hyperactivity and impulsivity are differentially related to executive functioning (EF), a common deficit area in ADHD. Method Participants included 120 children (ages 8–11; 89.9% White; 51.6% girls) from a community sample tested in a laboratory setting. To be included, they must have ADHD (59.4%) or be typically developing (40.6%). Hyperactivity and impulsivity scales were created from symptoms from a parent-report Behavior Assessment System for Children and DSM-IV questionnaire, ADHD section. The Behavior Rating Inventory of Executive Functioning (BRIEF) Working Memory scale (WMsc) and the Children’s Memory Scale Picture Locations (visuospatial sketchpad), Numbers Forward (phonological loop), and Sequences (central executive) subtests were used to assess working memory (WM). Inhibition was assessed with the BRIEF Inhibition scale (Isc) and A Developmental Neuropsychological Assessment (NEPSY) Tower Rule Violations (RV). Emotional control (EC) was measured with the BRIEF’s EC scale. Results Confirmatory linear regressions (SPSS Enter method) with all EF measures as IVs revealed Isc and WMsc were significant predictors of impulsivity [F(7,120) = 24.85, p < 0.001]. For hyperactivity [F(7,120) = 21.40, p < 0.001], WMsc, Isc, and RV were significant predictors. Exploratory analyses revealed WMsc was related to hyperactivity in controls but impulsivity in ADHD. Conclusions Similarities and differences were found between hyperactivity and impulsivity in relation to EF. Whereas inhibition was similarly related to hyperactivity and impulsivity, WM’s relationships were dissociable between groups. Hence, further research is needed, including areas affected in ADHD besides EF.

A - 46 Relationship between Working Memory and Externalizing Behaviors in Children from a Clinical Population: an Exploration of the Role of Expressive Language

Abstract Objective Externalizing behaviors affect children’s functioning in different domains. Previous studies revealed the impact of working memory, mainly through its role in goal keeping, goal-related search, and response selection. This study explored the role of expressive language in the relationship between working memory and externalizing behaviors in children. Method The data were collected from 50 children at a private practice agency (male: 76%; Age M = 4.16, SD = 1.13). All participants were diagnosed with at least one neurodevelopmental disorder. Their index score on the Externalizing Problems from Behavior Assessment System for Children, 3rd Edition, index score on the Working Memory from Stanford-Binet Intelligence Scales, 5th Edition, and expressive language subscale score from Vineland Adaptive Behavior Scales, 3rd Edition were collected. A mediation analysis was performed. Results The mediation analysis results showed a significant indirect effect (B = −0.081, 95% CI [−0.172, −0.015]) of working memory on externalizing behaviors through expressive language. It suggested that poorer working memory was associated with less expressive language, which then resulted in more externalizing behaviors. The direct effect between working memory and externalizing behavior was statistically significant (B = −0.331, p < 0.001), indicating that expressive language only partially mediated the relationship between working memory and externalizing behaviors. Conclusions The study provided empirical support for the mediating effect of expresive langaguge on the relationship between working memory and externaizing behaviors in children from a clinical population. It informs that the use of evidence-based interventions on expressive langauge skills might potentially help address externalizing behaviors in children.

A - 58 Grit and Resilience Predict Emotional Functioning in Pediatric Cancer Survivors

Abstract Objective Grit—one’s “perseverance and passion for long-term goals” (Duckworth et al., 2007)—is distinct from resilience, one’s ability to bounce back after negative events. In healthy populations, both promote emotional well-being and quality-of-life (Datu et al., 2019; Sharkey et al., 2017). Limited research has investigated how grit and resilience affect emotional functioning after pediatric cancer. We hypothesized resilience would mediate grit’s effects on emotional functioning in pediatric cancer survivors. Methods Our clinically referred sample of 214 pediatric cancer survivors ages 4–25 years was predominantly lower- to upper-middle class (73%) and racially diverse (Caucasian = 53%, Hispanic = 25%, Black = 12%). We administered the parent-report Behavior Assessment System for Children, Third Edition (BASC-3; variables: Resiliency, Anxiety, Depression), parent-report Short Grit Scale, and self-report BASC-3 (variables: Sense of Inadequacy, Locus of Control). Multiple regression and simple mediation analyses were conducted. Results Overall, the sample demonstrated average grit and resilience. Leukemia and brain tumor survivors demonstrated greater grit and resilience than survivors of other cancers. Grit predicted Anxiety (p = 0.026), Depression (p = 0.001), and Sense of Inadequacy (p ≤ 0.001). Resiliency had a significant indirect effect on grit’s prediction of Anxiety (β = −0.107, 95% CI [−0.206, −0.011]) and Depression (β = −0.192, 95% CI [−0.271, −0.117]), but not Sense of Inadequacy (β = −0.055, 95% CI [−0.200, 0.102]). Conclusion Higher levels of grit predicted better emotional outcomes in pediatric cancer survivors. Grit affected anxiety and depression in this sample via resiliency. Exploratory analyses regarding cancer type and age at diagnosis will be described. Findings support the need for further research on “positive neuropsychology” factors affecting neuropsychological outcomes in pediatric cancer survivors.

Psychosocial and executive functioning late effects in pediatric brain tumor survivors after proton radiation.

Pediatric brain tumor survivors can experience detrimental effects from radiation treatment. This cross-sectional, large cohort study examined late psychosocial and executive functioning effects in pediatric patients treated ≥ 3years after proton radiation therapy (PRT). Parents of 101 pediatric brain tumor survivors completed the Behavior Assessment System for Children and the Behavior Rating Inventory of Executive Function. Standard scores were compared to published normative means, rates of impairment (T-score > 65) were calculated, and demographic and clinical characteristics were examined. Mean age at PRT was 8.12years and mean interval from PRT to assessment was 6.05years. Half were female (49.5%), 45.5% received craniospinal irradiation (CSI), and 58.4% were diagnosed with infratentorial tumors. All mean T-scores were within normal range. Mean T-scores were significantly elevated compared to the norm on the withdrawal, initiate, working memory, and plan/organize scales. Rates of impairment were notably high in working memory (24.8%), initiate (20.4%), withdrawal (18.1%), and plan/organize (17.0%). Greater withdrawal was significantly associated with CSI and also with chemotherapy and diagnosis of hearing loss. Mean T-scores were significantly lower than the norm on the hyperactivity, aggression, conduct problems, and inhibition scales. No significant problems were identified with social skills or depression. Interval since treatment was not correlated with any scale. Although psychosocial and executive functioning was within the normal range, on average, social withdrawal and metacognitive executive functioning (working memory, initiating, planning/organizing) were areas of concern. Targeted yearly screening and proactive executive skill and social interventions are needed for this population.

Prevalence of Common Child Mental Health Disorders Using Administrative Health Data and Parent Report in a Prospective Community-Based Cohort from Alberta, Canada: Prévalence des troubles communs de santé mentale de l'enfant à l'aide des données de santé administratives et des rapports des parents dans une cohorte prospective communautaire d'Alberta, Canada.

Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data"). Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources. The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood. Prevalence of child mental health disorders according to different data sources in Canada.

Behavior and Parenting Stress Characteristics in Young Children With Severe Food Allergies According to the Severity Score System.

Limited knowledge exists regarding the psychosocial characteristics of young Asian children affected by food allergies (FAs) and their caregivers. This study aims to assess the usefulness of the Food Allergy Severity Score (FASS) system in evaluating the risk of emotional impacts on young children and caregivers who are dealing with severe FA. Children between 2 and 10 years of age who were diagnosed with FA and following an elimination diet were enrolled in the study. The FASS, Korean Parenting Stress Index, and Korean Behavior Assessment System for Children-2 were used for evaluating the above mentioned risk. Among the 75 participants, 64.0% had a history of anaphylaxis, and 56.0% reported multiple FAs. A total of 160 cases of FASS was documented across 21 types of food and classified as mild (n = 5, 1.07), moderate (n = 100, 2.01-4.01), or severe (n = 55, 4.24-6.84). The concordance of calculated- and stakeholder interpreted-FASS was moderate (kappa 0.587). Children with severe FASS (sFASS) showed increased risk for functional communication (relative risk [RR], 1.57; 95% confidence interval [CI], 0.99-2.48) and increased parental reinforcement (RR, 1.40; 95% CI, 0.91-2.14). Their caregivers exhibited reduced levels of demandingness (RR, 0.59; 95% CI, 0.37-0.94) and role restriction (RR, 0.62; 95% CI, 0.39-0.98). Receiver operating characteristic curves suggested that functional communication (numeric FASS cutoff, 3.47; area under the curve [AUC], 0.695), withdrawal (cutoff, 3.40; AUC, 0.657), developmental social disorders (cutoff, 3.96; AUC, 0.648), and reinforces parent (cutoff, 3.15; AUC, 0.646) were possibly be affected. The FASS provides an objective tool to assess pediatric FA severity. Early psychosocial intervention for young children with severe FASS and their caregivers may improve prognosis by identifying possible adaptive skill deficiencies and excessive parenting stresses.

QOL-02. PREDICTING NEUROCOGNITIVE OUTCOMES AMONG CHILDREN EXPERIENCING VARYING DEGREES OF POSTOPERATIVE POSTERIOR FOSSA SYNDROME

Abstract BACKGROUND Postoperative posterior fossa syndrome (PFS) has historically been diagnosed as present vs. absent despite a continuum of severity in presentations. We recently demonstrated categorizing children into PFS1 (complete mutism) and PFS2 (diminished speech) has prognostic utility for neurological recovery. Given children who experience PFS are also at increased risk for neurocognitive impairments, we investigated whether these PFS variants predict neurocognitive outcomes while considering well-established risk factors (i.e., age and treatment intensity). METHODS Children treated for medulloblastoma at St. Jude on a prospective, risk-stratified protocol (SJMB12; NCT 01878617) were study eligible if they had at least two neurocognitive evaluations. SJMB12 participants received neurological and neurocognitive evaluations prior to irradiation and annually for 5 years. Neurocognitive outcomes included intellectual functioning (Wechsler Intelligence Scale for Children [WISC-IV] estimated IQ [EIQ]), processing speed (WISC-IV Processing Speed Index [PSI]), working memory (WISC-IV Working Memory Index [WMI]), and adaptive functioning (Behavior Assessment System for Children [BASC2] Activities of Daily Living [ADL]). RESULTS 149 patients (age at diagnosis= 10.7±5.6; 64% male; 9% 15Gy, 40% 23.4Gy, 51% ≥36Gy) were included. No significant differences between PFS1 (n=34) or PFS2 (n=16) compared to NonPFS (n=99) were identified in age, sex, or irradiation dose (ps>.05). Multivariable linear mixed models indicate NonPFS have better EIQ than PFS1 and PFS2 (p<.03), with EIQ improving over time (p=.01). NonPFS have better PSI than PFS1 and PFS2 (p<.001). PSI declines over time irrespective of age (p>.05); however, PSI declines for those receiving 36Gy while improving for those receiving 15Gy (p<.001). NonPFS have better WMI than PFS1 and PFS2 (p<.05); older age at diagnosis is associated with improvement in WMI over time (p<.0005). ADL declines only in PFS1 patients (p<.05). CONCLUSIONS PFS variants add value beyond established risk factors in predicting neurocognition. Severity of PFS, in addition to treatment intensity, predicts worse outcomes.

Impact of a Service-Learning Program Using Soccer Training on the Emotional and Behavioral Problems of Children with Developmental Disabilities.

Children with developmental disabilities may develop emotional and behavioral problems that arise from difficulties in social interaction, and therefore, a process of providing and testing intervention activities for emotional and behavioral issues in the early stages of development is required. This study evaluated the effects of a 12-week service-learning exercise program on children with developmental disabilities, contrasting it with a control group not engaged in specific physical activities. The participants included 18 children with developmental disabilities who participated in the service-learning exercise program (SLG) and 18 children with developmental disabilities (Non-SLG) who did not participate. The Korean Behavior Assessment System for Children-2 was used to evaluate children's emotional and behavioral problems. A two-way repeated-measures ANOVA was conducted to verify the interaction effect between the group and period according to program participation. The results showed the positive internalization of problem behaviors in the emotional domain (F = 4.291, p = 0.011), attention deficit/hyperactivity (F = 4.761, p = 0.012), and personal adjustment (F = 4.116, p = 0.023) in the SLG group. These results suggest that participation in a service-learning exercise program positively affected emotional and behavioral problems in children with developmental disabilities. This could provide a basis for future research on service-learning exercise programs for children with developmental disabilities.

Behaviour Concerns in Preschool Cardiac Surgery Survivors

BackgroundBehaviour concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes. MethodsA prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001 to 2017 determined Behaviour Assessment System for Children (BASC-II/III) parent rating scales at 4.5 years. T scores ≥60 for externalizing, internalizing, and the Behavioural Symptoms Index and ≤40 for adaptive behaviour defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using the purposeful selection method gave odds ratios (ORs) with 95% confidence intervals (CIs). ResultsSurvivors (n = 585; 61% boys, 40% single ventricle) were assessed at a median age of 55 months (interquartile range: 53, 57 months). Independent predictors were noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.015) for externalizing; noncardiac hospitalizations (OR: 1.14, 95% CI: 1.05, 1.24; P = 0.003), female sex (OR: 1.62, 95% CI: 1.04, 2.52; P = 0.031), and single ventricle (OR: 1.82, 95% CI: 1.04, 3.17; P = 0.035) for internalizing; noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.017), socioeconomic status (SES) (OR: 0.98, 95% CI: 0.96, 0.10; P = 0.031), and years of maternal schooling (OR: 0.91, 95% CI: 0.84, 0.10; P = 0.04) for adaptive; and extracorporeal life-saving support (OR: 2.03, 95% CI: 1.01, 3.96; P = 0.041) for the Behavioural Symptoms Index, indicating more pervasive behaviours. ConclusionsThe number of noncardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent noncardiac hospitalization may be modifiable.

Single nucleotide polymorphisms of ANKK1, DDR4, and GRIN2B genes predict behavior in a prospective cohort of Mexican children and adolescents.

Numerous studies have established associations between single nucleotide polymorphisms (SNPs) and various behavioral and neurodevelopmental conditions. This study explores the links between SNPs in candidate genes involved in central nervous system (CNS) physiology and their implications for the behavioral and emotional aspects in children and teenagers. A total of 590 participants, aged 7-15 years, from the Early Life Exposures In Mexico To Environmental Toxicants (ELEMENT) cohort study in Mexico City, underwent genotyping for at least one of 15 CNS gene-related SNPs at different timepoints. We employed multiple linear regression models to assess the potential impact of genetic variations on behavioral and cognitive traits, as measured by the Behavioral Assessment System for Children (BASC) and Conners parent rating scales. Significant associations were observed, including the rs1800497 TC genotype (ANKK1) with the Cognitive Problems/Inattention variable (p value =0.003), the rs1800955 CT genotype (DDR4) with the Emotional Lability Global index variable (p value =0.01), and the rs10492138 GA and rs7970177 TC genotypes (GRIN2B) with the Depression variable (p values 0.007 and 0.012, respectively). These finds suggest potential genetic profiles associated with "risk" and "protective" behaviors for these SNPs. Our results provide valuable insights into the role of genetic variations in neurobehavior and highlight the need for further research in the early identification and intervention in individuals at risk for these conditions.

Cluster-specific associations between the gut microbiota and behavioral outcomes in preschool-aged children

BackgroundThe gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes.MethodsStool samples were collected from a community sample of 248 typically developing children (3–5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated.ResultsFour different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner.ConclusionsThese data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes.BZUULjYHP9-uSx-sQtCLaZVideo

Profiles of Autistic Youth with and Without Co-occurring Behavioral Health and Neurodevelopmental Disorders: A Latent Class Analysis.

Autism spectrum disorder (ASD) diagnosis relies on clinical observation and documentation, but the presence of comorbidities can affect diagnostic validity across clinicians and exacerbate access to timely care. This study used latent class analysis to optimize subgroup identification based on functional level and associated comorbidities using the Behavior Assessment System for Children, Third Edition (BASC-3), and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), in a pediatric population referred for autism evaluation. This retrospective study reviewed clinical data extracted over a 3-year period (2018-2021). A latent class analysis was used to explore the presence of latent groups guided by the likelihood ratio test and fit indices. Additional analyses contrasted ASD and non-ASD groups on the BASC-3 and Vineland-3 variables. There were 191 included participants (mean age 65.9 months, 76.4% male), of whom over half (60.7%) had an ASD diagnosis. Using 185 cases, the exploratory latent class analysis showed the emergence of 4 distinct subgroups. Composition of classes varied on ASD diagnosis, neurodevelopmental difficulties, behavioral health concerns, and intellectual disability. When contrasting ASD and non-ASD groups, significant between-group differences were observed across Vineland-3 variables and BASC-3 adaptive skills subscales indicating poorer social and adaptive functioning. Latent class analysis of commonly used behavioral and adaptive measures can help distinguish between subgroups of pediatric patients referred for ASD evaluations and assist in triage of cases based on severity.

White matter microstructure of children with sensory over-responsivity is associated with affective behavior.

Sensory processing dysfunction (SPD) is linked to altered white matter (WM) microstructure in school-age children. Sensory over-responsivity (SOR), a form of SPD, affects at least 2.5% of all children and has substantial deleterious impact on learning and mental health. However, SOR has not been well studied using microstructural imaging such as diffusion MRI (dMRI). Since SOR involves hypersensitivity to external stimuli, we test the hypothesis that children with SOR require compensatory neuroplasticity in the form of superior WM microstructural integrity to protect against internalizing behavior, leaving those with impaired WM microstructure vulnerable to somatization and depression. Children ages 8-12years old with neurodevelopmental concerns were assessed for SOR using a comprehensive structured clinical evaluation, the Sensory Processing 3 Dimensions Assessment, and underwent 3 Tesla MRI with multishell multiband dMRI. Tract-based spatial statistics was used to measure diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) metrics from global WM and nineteen selected WM tracts. Correlations of DTI and NODDI measures with measures of somatization and emotional disturbance from the Behavioral Assessment System for Children, 3rd edition (BASC-3), were computed in the SOR group and in matched children with neurodevelopmental concerns but not SOR. Global WM fractional anisotropy (FA) is negatively correlated with somatization and with emotional disturbance in the SOR group but not the non-SOR group. Also observed in children with SOR are positive correlations of radial diffusivity (RD) and free water fraction (FISO) with somatization and, in most cases, emotional disturbance. These effects are significant in boys with SOR, whereas the study is underpowered for girls. The most affected white matter are medial lemniscus and internal capsule sensory tracts, although effects of SOR are observed in many cerebral, cerebellar, and brainstem tracts. White matter microstructure is related to affective behavior in children with SOR.

Environment-based approaches to improve participation of young people with physical disabilities during COVID-19.

To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID-19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. An interrupted time-series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8-week self-chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed-effects models were used. The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0-3.2] and 3.2 points [95% CI: 2.4-3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body-function level. Environmental-based interventions can improve participation even during adverse times such as the COVID-19 pandemic. Significant improvement with large effect sizes occurred in both activity performance and satisfaction. Intervention was effective for all; those without mental health problems benefited more. Improvements in body-function outcomes were partially observed, especially in motor-related outcomes. Body functions may improve through participation even if not targeted by the intervention.

Agreement Between Two Behavioral Rating Scales in Preschoolers Born Very Preterm.

Broadband parent rating scales are commonly used to assess behavioral problems in children. Multiple rating scales are available, yet agreement between them is not well-understood. The objective of this study was to evaluate agreement between the Behavior Assessment System for Children, Third Edition (BASC-3), and Child Behavior Checklist 1.5 to 5 years (CBCL) in a sample of children born very preterm. We assessed 73 children born < 30 weeks' gestational age whose caregivers completed the BASC-3 and CBCL at age 4. We examined correlations, within-person differences, and agreement in clinical categorization for all corresponding subscales and composites. Comparable subscales on the BASC-3 and CBCL were significantly correlated, albeit to differing magnitudes. Subscales indexing hyperactivity and attention problems were the most comparable across the 2 measures, evidenced by strong correlations and few to no differences in mean T-scores. Composite scores indexing internalizing, externalizing, and total problems were also strongly correlated, and there were no differences in the mean T-scores for externalizing or total problems across measures. Agreement in clinical classifications were weak to moderate, though again, the highest agreement was found for hyperactivity, attention, externalizing, and total problems. Agreement between BASC-3 and CBCL subscales was weak to moderate, with the exception of subscales related to attention and hyperactivity, as well as composite scores indicating overall behavior problems. Researchers and clinicians should consider these discrepancies when interpreting the results of behavior rating scales with preschool children because conclusions could differ based on the assessment that is used.

Social adjustment in children diagnosed with sickle cell disease: A retrospective study.

Children with sickle cell disease (SCD) are at risk for physical, psychological, and social adjustment challenges. This study sought to investigate social adjustment and related factors in children living with SCD. Data from 32 children (50% male, mean age=10.32years, SD=3.27) were retrospectively collected from a neuropsychology clinic at a tertiary care pediatric hospital. Social adjustment was measured using the Behavior Assessment System for Children (BASC-3) parent-proxy, withdrawal subscale, and the Pediatric Quality of Life Inventory (PedsQL) Generic Module Social Functioning self- and parent-proxy subscales. Other measures captured executive functioning (i.e., Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) Parent Form) and non-disease-related associations with social adjustment, including number of years in Canada and family functioning (i.e., PedsQL Family Impact Module). Sixteen percent of patients reported elevated social adjustment difficulties. Multiple linear regression found better family functioning [B=.48, t=2.65, p=.016], and higher executive functioning [B=-.43, t=-2.39, p=.028] were related to higher scores on the PedsQL parent-proxy ratings of social adjustment [F(4,18)=5.88, p=.003]. Male sex [B=.54, t=3.08, p=.005], and having lived more years in Canada [B=.55, t=2.81, p=.009], were related to higher PedsQL self-reported social adjustment [F(4,23)=3.75, p=.017]. The model examining the BASC-3 withdrawal subscale was not statistically significant [F(4,16)=1.63, p=.22]. Social adjustment in children diagnosed with SCD warrants future research to understand the influence of executive function, and non-disease-related factors, particularly focusing on sociocultural factors.