Children's Responses Research Articles

Development of systemic and mucosal immune responses against gut microbiota in early life and implications for the onset of allergies.

The early microbial colonization of human mucosal surfaces is essential for the development of the host immune system. Already during pregnancy, the unborn child is prepared for the postnatal influx of commensals and pathogens via maternal antibodies, and after birth this protection is continued with antibodies in breast milk. During this critical window of time, which extends from pregnancy to the first year of life, each encounter with a microorganism can influence children's immune response and can have a lifelong impact on their life. For example, there are numerous links between the development of allergies and an altered gut microbiome. However, the exact mechanisms behind microbial influences, also extending to how viruses influence host-microbe interactions, are incompletely understood. In this review, we address the impact of infants' first microbial encounters, how the immune system develops to interact with gut microbiota, and summarize how an altered immune response could be implied in allergies.

Exploring Children's Varied Responses to Interactive Read‐Alouds

AbstractThe responses children make during read‐alouds bridge meaning from stories. Educators must grasp the value of children's responses and reactions to literature. Children's discourse is central to the reading process; thus, children must be allowed to participate in this learning process. Due to this, the read‐aloud process in the classroom should focus on the quality of interactions for the sake of literacy growth and development. Engaging learners in read‐alouds permits them to communicate with the teacher and peers, fosters space for ideas to be valued, and results in a community of learning.

Latent profiles of infant negative affect and respiratory sinus arrhythmia during the still‐face paradigm: The role of maternal sensitivity

AbstractWe examined if there were profiles of infants' behavioural and physiological responses during the still‐face and if these profiles were predicted by maternal sensitivity. Participants included 230 mothers (40.4% non‐white) and their 2‐month‐old infants (48.7% female). Three profiles were identified: continually increasing negative affect and decreasing respiratory sinus arrhythmia (RSA) (17.39%); modest, classic still‐face effect for negative affect and RSA (64.35%); high negative affect, late decreasing RSA (18.26%). Infants of highly sensitive mothers were more likely to be in the modest, classic still‐face effect for negative affect and RSA profile than in the continually increasing negative affect and decreasing RSA and the high negative affect, late decreasing RSA profiles. Additionally, infants of mothers who were high in maternal sensitivity were more likely to be in the continually increasing negative affect and decreasing RSA profile compared to the high negative affect, late decreasing RSA profile. The findings demonstrate heterogeneity in infant responses and that maternal sensitivity is an important predictor of children's behavioural and physiological responses to stressors.

Can behaviorally inhibited preschoolers make friends?

Preschoolers who display extremely inhibited behavior are at risk for the development of anxiety disorders. However, behavioral inhibition (BI) is a multifaceted characteristic. Some children with BI are fearful when confronted by unfamiliar adults, peers, and objects; others are fearful when separated from their parents. In the present study, we examined specific features of BI that predicted observed friendship formation among preschoolers who are behaviorally inhibited. We also examined whether teacher ratings of classroom behaviors predicted friendship formation. Sixty highly inhibited children (35 female, Mage = 52.57 months) were observed during eight weekly free-play sessions with initially unfamiliar inhibited peers. Free-play periods occurred before weekly intervention sessions for children with BI and their parents. An observational protocol was developed to identify children who made a friend during the eight weekly sessions. Before the first session, different subtypes of BI were assessed by parents; preschool teachers assessed the children's classroom behaviors with familiar peers. Twenty-six children met the criteria for having made and kept a friend. Probit regression analyses revealed that parent ratings of BI among unfamiliar peers and teacher ratings of children's social anxiety before the intervention were associated with a decreased probability of making a friend. No evidence was found linking children's responses to the intervention and friendship formation. Results suggest that extremelyinhibited preschoolers are capable of making friends. Implications for future research and intervention efforts that focus on individual differences of children with BI are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing physiological arousal and emotional valence during behavioral intervention for pediatric feeding difficulties: A pilot study

AbstractThis study's purpose is to introduce a new measurement system that objectively assesses the social validity of behavioral feeding intervention from the child's perspective via the concurrent measurement of two dimensions of emotion. To date, the primary measures of social validity for behavioral feeding intervention are caregiver treatment acceptability and satisfaction surveys. This is the first study to objectively measure two dimensions of emotion, physiological arousal and emotional valence, while children received behavioral intervention for feeding difficulties. Data collectors used a new open‐source data collection software, cometrics, developed to synchronize and record physiological and observational data. Physiological data was collected using a wearable biosensor and observers recorded an index of child happiness, unhappiness, or neither using definitions by Phipps et al. (2022) for six children with a pediatric feeding disorder. Two out of six children needed programmed habituation to the device before data collection. All children assented to wearing the device during data collection. Recorded indices mapped to separable physiological states using electrodermal activity and its constituent components, skin conductance responses and skin conductance level, in addition to skin temperature. Findings demonstrated the feasibility of measuring two dimensions of child emotions during behavioral feeding intervention and revealed that children's physiological responses were distinctly different during intervals scored as happy, unhappy, or neither. This new data collection system has implications for future research on the child's emotional experience of behavioral feeding treatment and increases the possibilities for improving clinical practice.

Measuring Children's Reward and Punishment Sensitivity: An Initial Psychometric Evaluation of the Contingency Response Rating Scale.

Existing research shows that children's responses to rewards and punishments are essential for understanding attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and callous-unemotional traits. The present study developed the Contingency Response Rating Scale (CRRS) to fulfill the need for a reliable and valid measure of children's contingency response style that is brief, easy to use in applied settings, and provides additional information to existing clinical measures. We examined the psychometric properties of the CRRS in a sample of 196 children (ages 5-12), most of whom were referred to evaluate attention and behavior problems in an outpatient clinic. Using principal axis factoring, we identified five factors: (a) punishment ineffectiveness, (b) reward ineffectiveness, (c) punishment dysregulation, (d) reward dysregulation, and (e) contingency insensitivity. The subscales based on these factors showed acceptable test-retest and internal consistency reliability, and scale intercorrelations varied from low to moderate. The subscales also captured significant variance not explained by child or parent demographics and were associated with measures of psychopathology and impairment. The results provide preliminary evidence that the CRRS may be a helpful tool for assessing reward and punishment sensitivity in children with attention and behavior problems.

Parents' Experiences of Communicating With Children About Their Diagnosis of Nonterminal Cancer and Its Related Issues: A Systematic Review of Qualitative Studies.

Many children experience serious symptoms when they are diagnosed with and treated for cancer. Through appropriate parent-child communication, parents were able to identify children's physical and psychological problems, adjust their behavior, and help them cope with the disease. This study aimed to systematically search for and integrate evidence from qualitative studies on communication between parents and children with nonterminal cancer from parents' perspectives. A thorough systematic review and metasynthesis of qualitative studies were conducted. Articles were searched from PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, and PsycArticles from the database inception to November 6, 2022. After screening and quality appraisal, 14 articles were finally included in the metasynthesis. Three themes and 11 subthemes were identified: (1) communication content, including diagnosis, treatment, health management, health risk, and emotion; (2) factors influencing communication, including ages of children, parents' experience of communication, parents' awareness of protection, and culture; and (3) children's responses, including acceptance and resistance. This systematic review found that parents were influenced by various factors during the decision-making process of parent-child communication about childhood cancer and its related issues. Parents tended to adjust their communication content and style to protect their children. Future research should be conducted to explore children's experiences of communicating with their parents and analyze the similarities and differences between the communication needs of parents and children. Healthcare professionals should provide professional communication guidance to facilitate the parent-child relationship and improve the mental health of both children and their parents.

The Neural Bases of Language Processing During Social and Non-Social Contexts: A fNIRS Study of Autistic and Neurotypical Preschool-Aged Children.

Little is known about how the brains of autistic children process language during real-world "social contexts," despite the fact that challenges with language, communication, and social interaction are core features of Autism Spectrum Disorder (ASD). We investigated the neural bases of language processing during social and non-social contexts in a sample of N=20 autistic and N=20 neurotypical (NT) preschool-aged children, 3 to 6 years old. Functional near-infrared spectroscopy (fNIRS) was used to measure children's brain response to "live language" spoken by a live experimenter during an in-person social context (i.e., book reading), and "recorded language" played via an audio recording during a non-social context (i.e., screen time). We examined within-group and between-group differences in the strength and localization of brain response to live language and recorded language, as well as correlations between children's brain response and language skills measured by the Preschool Language Scales. In the NT group, brain response to live language was greater than brain response to recorded language in the right temporal parietal junction (TPJ). In the ASD group, the strength of brain response did not differ between conditions. The ASD group showed greater brain response to recorded language than the NT group in the right inferior and middle frontal gyrus (IMFG). Across groups, children's language skills were negatively associated with brain response to recorded language in the right IMFG, suggesting that processing recorded language required more cognitive effort for children with lower language skills. Children's language skills were also positively associated with the difference in brain response between conditions in the right TPJ, demonstrating that children who showed a greater difference in brain response to live language versus recorded language had higher language skills. Findings should be considered preliminary until they are replicated in a larger sample. Findings suggest that the brains of NT children, but not autistic children, process language differently during social and non-social contexts. Individual differences in how the brain processes language during social and non-social contexts may help to explain why language skills are so variable across children with and without autism.

The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children.

We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.

How mothers talk to their children about failure, mistakes and setbacks is related to their children's fear of failure.

Many people fear failure and making mistakes. This fear can be transmitted from parents to children, suggesting that parental communication regarding failures and setbacks may play a critical role in shaping a child's perception of mistakes. In this study, we investigated how everyday parent-child conversations about setbacks influence children's fear of making mistakes. Drawing on the large pre-birth Growing Up in New Zealand cohort, we focused on a sub-sample of 231 mother-child dyads who engaged in a recorded conversations about a "recent disappointment or setback" when the children were 8 years old. Conversations between mothers and children about the recent disappointments were coded to identify whether parents recognised or acknowledge their child's emotional response, if action plans were discussed, and the types of resources that the child could draw on. The children also completed a questionnaire about their global self-worth and their fear of making mistakes. The discussion of clear action plans, in the absence of a discussion about collaborative resources, was found to be associated with an increased fear of making mistakes among children. Conversely, when mothers clearly acknowledged their child's emotions and discussed ways to work collaboratively with their child on future problems, there was a notable decrease in the child's fear of mistakes. However, it is noteworthy that many mothers in our study either minimally acknowledged or dismissed their child's emotions(40%), rarely discussed action plans (55%), or collaborative resources (79%)when discussing the recent setback.

Reception Baseline Assessment and ‘small acts’ of micro‐resistance

AbstractIn September 2021, following the global COVID‐19 pandemic, the Department for Education introduced a national standardised digital Reception Baseline Assessment (RBA) for all English 4‐year‐old children. We analyse RBA and its associated Quality Monitoring Visits, as a further intensification of the new public management of early years education to produce ‘school‐ready’ human capital. This paper reports on professionals' and children's responses to RBA by analysing the mixed‐methods data from a nationwide survey of early years professionals (n = 1032) and six in‐depth case study Reception classes with teacher interviews (n = 14) and researcher observations (n = 12). An adult thematic analysis of the responses suggests that some children and their teachers used their agency in creative ‘small acts’ of micro‐resistance. These ‘small acts’ of resistance and refusal are theorised as micro‐political contestations of a policy that is antithetical to early education's socio‐cultural approach. More research is needed to further understand the politics of young children's rights, agency, micro‐resistance and refusal.

Adults' interpretation of invitations using the word ‘time’

AbstractThe present study examined adults' interpretations of invitations using the word ‘time’. Recent research has demonstrated that children may misunderstand these invitations as solely requesting temporal information (Friend et al., 2022). This study tested whether adults perceive the ambiguity in these invitations and whether they understand the source of children's pseudotemporal errors. We examined 401 adult participants' perceptions of invitations using the word ‘time’, varying the phrasing of the invitation (about the time vs. what happened) and whether the participant had exposure to a child's pseudotemporal response. Adults largely interpreted the invitations as requests for what happened during an event, not requests for when an event occurred. They rated the invitations as clear, not difficult and appropriate for elementary‐aged children. However, they were more likely to rate about the time invitations as temporal compared to what happened invitations. Additionally, their perceptions of clarity and age appropriateness decreased when they were exposed to children's overtly pseudotemporal responses. These results suggest that although adults typically fail to identify the ambiguity in invitations using the word ‘time’, they are able to adjust their interpretation of the questions, at least when they are provided clear evidence of children's misinterpretation.

Psychometric Properties of the Pictorial Scale of Perceived Movement Skill Competence for Young Norwegian Children.

The objective of this study was to examine the psychometric properties of the Pictorial Scale of Perceived Movement Skill Competence (PMSC) for young Norwegian children, a scale that is aligned with skills assessed in the Test of Gross Motor Development- Third Edition. We used convenience sampling to recruit 396 Norwegian-speaking children (7-10-year-olds) who completed the PMSC. A confirmatory factor analysis (CFA) confirmed factorial validity for the proposed three-factor model of the PMSC, encompassing measures of self-perceived ball, locomotor, and active play competence. Internal item consistency coefficients of these sub-scales were acceptable, and subsequent measurement invariant analysis found a gender difference such that boys rated their competence higher than girls in running, jumping forward, hitting a ball (racket), kicking, throwing a ball and rope climbing, while girls rated themselves higher, compared to boys, in galloping and skating/blading. Furthermore, there was a slightly better model fit for boys than for girls. Several items were significantly related to children's age, and the three-factor model exhibited differential age related factor mean differences across older and younger children. Overall, we found the PMSC to have acceptable psychometric properties for confident use in assessing perceived motor competence among 7-10-year-old Norwegian children, though we observed age and gender differences in children's responses that warrant careful interpretation of results and further research investigation.

Unveiling the magic of mega-city block environments: investigating the intriguing mechanisms shaping children's spontaneous play preferences.

This study delves into the spatial preferences of children for play spaces within high-density urban block environments, specifically targeting the area of Baihua Second Road in Shenzhen, China. Recognizing the critical role of play in children's development, and the unique challenges posed by dense urban settings, this research employs multiclass logistic regression models and negative binomial regression models to construct a detailed mathematical analysis of neighborhood spatial elements and children's play space preferences. Data was meticulously gathered through both objective observations of 14 different types of spaces within the block, and subjective assessments via children's responses to a series of environment photos, capturing the essence of over 3,000 child participants' interactions and choices. Key findings reveal a pronounced preference among children for soft facility features and visually appealing spatial experiences, suggesting a nuanced understanding of play space needs beyond traditional playground designs. Notably, the study identifies that while cartoon-style designs in play facilities might increase moderate attractiveness, ordinary designs hold broader appeal, indicating a preference for diversity in play space aesthetics. These insights offer profound implications for urban planners and designers, advocating for a child-centered approach in the creation of urban play environments that prioritize aesthetic diversity, and the integration of natural elements. Moreover, the study situates Baihua Second Road as a paradigmatic case, illustrating the methodology and analytical framework applied in addressing the complex interplay between children's play preferences and urban spatial configurations. By incorporating a comprehensive data-driven analysis, this research contributes significantly to the discourse on child-friendly urban design, offering valuable strategies for cultivating inclusive and engaging urban play spaces for children amidst the constraints of high-density city living.

Development and validation of the newly developed Preschool Theory of Mind Assessment (ToMA-P).

Theory of mind (ToM) refers to the ability to understand and attribute mental states to oneself and others. A ToM measure is warranted for preschool children to assess their ToM development from a multidimensional perspective (i.e., cognitive and affective dimensions). This study aimed to develop the Preschool Theory of Mind Assessment (ToMA-P) and to evaluate its construct validity and applicability. The ToMA-P was developed based on comprehensive literature review and revised with expert panel feedback. Its psychometric properties were evaluated in 205 typically developing preschoolers with Rasch analysis for its dimensionality, item difficulties, and convergent validity. The results indicated that all ToMA-P items, except for one, fit the hypothesized two-dimensional construct. The item difficulties in the cognitive and affective dimensions followed developmental sequences. The ToMA-P scores exhibited good convergent validity, as evidenced by its significant correlations with age, verbal comprehension, adaptive functions, and daily ToM performance (p < 0.05). Children's responses and behaviors also showed that the ToMA-P has good applicability. This study provides empirical evidence that the ToMA-P measures cognitive and affective ToM following developmental sequences, and that it has potential as a clinical tool for assessing ToM in preschool children.

Do we listen to what makes children happy? A systematic literature review of voices of children aged 3–7 years in educational research

Research shows that children’s views and experiences are usually overlooked in discussions related to their own happiness and wellbeing. In fact, the largest international study to date on children’s wellbeing only included children aged 8-12. A review of reviews further reveals that no previous studies have focused on exploring factors that make children aged 3-7 happy. This research addresses this gap in the literature by conducting the first systematic review of international studies exploring young children's perspectives on happiness. The EPPI-Centre framework guided this systematic review of international research published covering almost a decade of research (2015-2024). This comprehensive approach aimed to provide an overview of the current research landscape to inform future research and policy decisions. Out of 2594 papers arguing to listen to children, only five focused on exploring children’s happiness and wellbeing from an interpretivist perspective. Results showed that there are studies listening to children’s voices, however, very limited studies genuinely explore what makes children happy. Factors contributing to children’s happiness and wellbeing include spending time with loved ones, receiving praise, achieving goals and engaging in sociodramatic play. Negative factors include feeling ignored, limited interaction with peers/friends and forced activities. Methodological limitations identified include unclear sample selection, regional bias, subjective data interpretation, and pre-determined prompts influencing children's responses. The findings can inform future research directions and policy decisions aimed at promoting children's happiness and well-being in schools. As such, this paper provides a unique insight and makes an original and significant contribution to the field.

Effects of Speech Cues on Acoustics and Intelligibility of Korean-Speaking Children With Cerebral Palsy.

Reduced speech intelligibility is often a hallmark of children with dysarthria secondary to cerebral palsy (CP), but effects of speech strategies for increasing intelligibility are understudied, especially in children who speak languages other than English. This study examined the effects of (the Korean translation of) two cues, "speak with your big mouth" and "speak with your strong voice," on speech acoustics and intelligibility of Korean-speaking children with CP. Fifteen Korean-speaking children with CP repeated words and sentences in habitual, big mouth, and strong voice conditions. Acoustic analyses were performed and intelligibility was assessed by means of 90 blinded listeners' ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC). In response to both cues, children's vocal intensity and utterance duration increased significantly and differentially, whereas their vowel space area gains did not reach statistical significance. EoU increased significantly in the big mouth condition at word, but not sentence, level, whereas in the strong voice condition, EoU increased significantly at both levels. PWC increases were not statistically significant. Considerable variability in children's responses to cues was noted overall. Korean-speaking children with CP modify their speech styles differentially when provided with cues aimed to increase their articulatory working space and vocal intensity. The results provide preliminary support for the use of the strong voice cue, in particular, to increase EoU. While the findings do not offer conclusive evidence of the intelligibility benefits of these cues, investigation with a larger sample size should provide further insight into optimal cueing strategies for increasing intelligibility in this population. Implications for language-specific versus language-independent treatment approaches are discussed. https://doi.org/10.23641/asha.25521052.

Mother-child dyadic responses to children facing challenges: An examination across ethnicities.

The current study (a) examined ethnic differences in mothers' and children's responses to children's performance in a challenging task, (b) tested the associations among children's desire for assistance, maternal control, and children's emotional responses to the challenge, and (c) explored whether these associations held across three ethnicities-Asian Americans (AA), Latinx Americans (LA), and European Americans (EA). Results showed that children's emotional arousal significantly increased and emotional valence became significantly less positive over the course of children experiencing repeated challenges in front of their mothers. In terms of ethnic differences, LA mothers exhibited more control than EA mothers, but LA children responded less negatively to the challenging task than EA children. AA dyads did not significantly differ from LA or EA dyads on any maternal or child responses. However, regardless of ethnicity, stronger child desire for assistance was associated with greater maternal control and greater maternal control was associated with less emotional arousal and more positive child emotional valence. These findings suggest that, in a challenging context, maternal control is likely experienced by children as guidance that mitigates decreases in positive emotion. Our work has implications for interventions to encourage more emotionally responsive parental involvement with children in late childhood and early adolescence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effects of parental presence on amygdala and mPFC activation during fear conditioning: An exploratory study.

Learning safe versus dangerous cues is crucial for survival. During development, parents can influence fear learning by buffering their children's stress response and increasing exploration of potentially aversive stimuli. Rodent findings suggest that these behavioral effects are mediated through parental presence modulation of the amygdala and medial prefrontal cortex (mPFC). Here, we investigated whether similar parental modulation of amygdala and mPFC during fear learning occurs in humans. Using a within-subjects design, behavioral (final N=48, 6-17 years, mean=11.61, SD=2.84, 60% females/40% males) and neuroimaging data (final N=39, 6-17 years, mean=12.03, SD=2.98, 59% females/41% males) were acquired during a classical fear conditioning task, which included a CS+ followed by an aversive noise (US; 75% reinforcement rate) and a CS-. Conditioning occurred once in physical contact with the participant's parent and once alone (order counterbalanced). Region of interest analyses examined the unconditioned stress response by BOLD activation to the US (vs. implicit baseline) and learning by activation to the CS+ (vs. CS-). Results showed that during US presentation, parental presence reduced the centromedial amygdala activity, suggesting buffering of the unconditioned stress response. In response to learned stimuli, parental presence reduced mPFC activity to the CS+ (relative to the CS-), although this result did not survive multiple comparisons' correction. These preliminary findings indicate that parents modulate amygdala and mPFC activity during exposure to unconditioned and conditioned fear stimuli, potentially providing insight into the neural mechanisms by which parents act as a social buffer during fear learning. RESEARCH HIGHLIGHTS: This study used a within-participant experimental design to investigate how parental presence (vs. absence) affects youth's neural responses in a classical fear conditioning task. Parental presence reduced the youth's centromedial amygdala activation to the unconditioned stimulus (US), suggesting parental buffering of the neural unconditioned response (UR). Parental presence reduced the youth's mPFC activation to a conditioned threat cue (CS+) compared to a safety cue (CS-), suggesting possible parental modulation of fear learning.

Outdoor aeroallergen impacts on asthma exacerbation among sensitized and nonsensitized Philadelphia children

Outdoor aeroallergens, such as pollens and molds, are known triggers of asthma exacerbation; however, few studies have examined children's aeroallergen response based on sensitization. Our aim was to compare the relative impact of aeroallergen levels on asthma exacerbation between pediatric patients with asthma who tested positive or negative for sensitization to particular allergens. A case-crossover design study was conducted to examine associations between outdoor aeroallergen levels and asthma exacerbation events among children living in Philadelphia, Pennsylvania, who were treated within a large pediatric care network. Sensitization to common allergens was characterized in a subset of patients with asthma exacerbation who had undergone skin prick testing (5.5%). Odds ratios (ORs) and 95% CIs were estimated in all patients with asthma exacerbation and in those sensitized or not sensitized to aeroallergens. Children who were sensitized to a particular allergen had higher odds of asthma exacerbation with exposure to the allergen (ie, early-season tree pollen, oak tree pollen, early-season weed pollen, and late-season molds) than did all patients with asthma or nonsensitized patients. For example, the association between early-season tree pollen and asthma exacerbation among sensitized children (>90th percentile vs ≤25th, OR= 2.28 [95% CI= 1.23-4.22]) was considerably stronger than that estimated among all patients (OR= 1.34 [95% CI= 1.19-1.50]), and it was also substantially different from the lack of association seen among nonsensitized children (OR= 0.89 [95% CI= 0.51-1.55] [P value for heterogeneity= .03]). More prevalent allergy testing may be useful for prevention of asthma exacerbation by informing interventions targeted to sensitized children and tailored for particular aeroallergens.