Control In Young Children Research Articles

Self-regulation through storytelling: A demonstration study detailing the educational book Game On for resilience building in early school children

ABSTRACT Resilience to cope with setbacks has acquired a prominent place within Australia’s school curricula. One core component of resilience is children’s capacity to resolve conflict. Conflict resolution is the ability to regulate emotions, understand your temperament, and solve problems. This article demonstrates how a storytelling book, titled Game On, helps early school children understand their temperament and regulate their feelings. Using qualitative data from semi-structured interviews with teachers and sport deployment officers, as well as structured focus groups with children aged 4–7, this case-study evaluated the participants’ perspectives of Game On to improve self-regulation and stress control in young children. It demonstrates that teaching self-regulation through storytelling at an early age has the potential to equip young children with strategies of coping with normative stress. Such strategies include regulating or altering one’s psychological state or behaviour, and voluntarily inhibiting, activating and changing attention or behaviour through self-authored responses.

A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma

BackgroundPerianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS. MethodsA retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted. ResultsSurgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence. ConclusionsCombined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.

Enhancing Internal Locus of Control in Young Children through Play Activities: A Case of Model-Preschool, Haramaya University, Ethiopia

This study aimed to investigate the practice of play activities in enhancing the internal locus of control among young children at Haramaya University's Model-Preschool. Employing a qualitative approach with an intrinsic case study design, data was obtained through semi-structured interviews with four preschool teachers, one preschool principal, and observation of play activities. The data was analyzed through the thematic data analysis technique, from which three major themes emerged: utilization of play activities, teachers' participation in facilitating play activities, and challenges encountered while facilitating play activities. The study's finding indicate that various play activities, such as open-ended play, problem-solving play, and creativity play, are employed to promote this crucial developmental skill. The preschool teachers reported employing a range of strategies to facilitate play activities that foster an internal locus of control, such as providing children with choices and constructive feedback. However, bottlenecks such as an inaccessible school environment, large class sizes, inadequate preschool teacher training, and insufficient resources were also identified as limiting factors in facilitating play activities that encourage an internal locus of control. Ultimately, the research concludes that participation in play activities can effectively aid in the development of young children's internal locus of control. Teachers who intentionally provide children with opportunities to make decisions, solve problems, and receive positive feedback can assist in cultivating a sense of self-efficacy and the conviction that they have control over their own outcomes.

Assessing inhibitory control in kindergarten children: Validity of integrating response accuracy and response latency

Assessing inhibitory control in young children poses a challenge because of its rapid and non-linear development. This study examined the validity of integrating response accuracy and latency through a two-factor model, based on the data of 271 children who completed a computerized inhibitory control task. Although integrating response accuracy and latency slightly improved measurement precision, multigroup analyses of younger and older children showed inconsistent associations between response accuracy and latency if response latencies from incorrect responses were not excluded. A time-on-task analysis revealed that the extent of the accuracy gain by taking more time depended on the individual’s skill level. The validity of task performance as an indicator of inhibitory control was highest when response accuracy was the primary determinant of the inhibitory control score and response latency was only considered after the child had surpassed an accuracy threshold to further improve the score. These findings suggest that integrating response accuracy and latency into a single score should only be performed for children who can maintain high accuracy levels despite giving fast responses.

A comparative study using insulin pump therapy and continuous glucose monitoring in newly diagnosed very young children with type 1 diabetes: it is possible to bend the curve of HbA1c.

The target of metabolic control (HbA1c < 7% or 53mmol/mol) recommended by the ADA and ISPAD is attained by 30% of children with Type 1 Diabetes (T1D). Advances in technologies for T1D aim to improve metabolic outcomes and reduce complications. This observational study assesses the long-term outcomes of advanced technologies for treatment of T1D compared to conventional approach started at onset in a group of very young children with T1D. 54 patients with less 4years old at onset of T1D were enrolled and followed for up to 9years after diagnosis. 24 subjects started continuous subcutaneous insulin (CSII) treatment and 30 subjects received MDI therapy from onset. Auxological data, HbA1c and total daily insulin dose (TDD/kg) have been collected at admission and every 4months. HbA1cAUC>6%, rates of acute complications, glycemic variability indices and glucometrics were also recorded. Patients with CSII therapy had significantly lower mean HbA1c values compared to subjects receiving MDI treatment. CSII approach also recorded lower mean HbA1cAUC>6% and TDD/kg than MDI therapy. At the last download data, the time in range (TIR) was higher in patients with CSII and hyperglycemia events were lower. Better glycemic variability indices have been described during CSII therapy, including mean glycemia, standard deviation, coefficient of variation (CV), glycemia risk index (GRI) and high blood glucose index (HBGI). There was no statistically significant difference between frequency of severe hypoglycemia and ketoacidosis episodes between groups. Early initiation of diabetes technologies is safe and able to determine a better long term glycemic control in young children with T1D. It also allows to flatten the trajectory of HbA1c, probably reducing microvascular, macrovascular and neurological complications of diabetes in this very peculiar age group.

A novel approach to measuring the developmental interactions between working memory and inhibitory control in young children

This pre-registered study examined the development of working memory and inhibitory control in a sample of 144 children aged between 3 and 6 years. Two paradigms – one a version of a spatial conflict task, the other a combined continuous performance test and go/no-go task – were adapted to allow the orthogonal manipulation of working memory and inhibitory demands. This allowed for the simultaneous measurement of these functions within each paradigm, removing concerns of task-specific variance and testing an interactive model of executive function that assumes that working memory and inhibition compete for a shared pool of executive resources. In addition, latent working memory and inhibition variables extracted from the tasks were correlated with parental reports of participants’ temperament, including effortful control. The novel experimental tasks successfully and reliably captured developmental and individual differences in working memory and inhibitory control. However, these factors did not interact with one another in an over-additive fashion or correlate meaningfully with parental ratings of effortful control. These findings support the separability of executive functions in this age range while raising important questions about how best to measure the development of executive functioning among young children.

924-P: Glycemic Outcomes Improved and Maintained Regardless of Demographic Characteristics of Young Children with Type 1 Diabetes Using Closed-Loop System

Automated insulin delivery improves glycemic control in young children with type 1 diabetes (T1D). We investigated the potential impact of baseline participant characteristics on glycemic improvements when using the Tandem t:slim X2 insulin pump with Control-IQ technology (CIQ). After a 13 wk randomized, multi-center, controlled trial comparing CIQ (CLC) to standard care insulin delivery plus CGM (SC) in 102 children with T1D age 2 to &amp;lt;6 years, 95 continued CLC for 13 wks (CLC-CLC, N=62) or transitioned to CLC (SC-CLC, N=33). We compared glycemic outcomes from the RCT to the extension phase in subgroups based on baseline characteristics. At baseline, participants were 3.9 ± 1.2 years old with 25% minority race/ethnicity; 48% household income &amp;lt;$100,000; 57% parents with bachelor’s degree or less; 21% public insurance; 69% baseline HbA1c ≥7%; and 34% used multiple daily injections. In the SC-CLC group, time 70-180 mg/dL (TIR) improved in all subgroups regardless of race/ethnicity, family income, education, health insurance type, baseline HbA1c, and experience with devices (Table 1). In the CLC-CLC group, TIR improvement with CLC during the RCT was maintained regardless of subgroup. Our results support the findings that young children with T1D benefit from using CIQ regardless of their baseline characteristics. The benefit is maintained over a 26-week period. Disclosure L.Ekhlaspour: Consultant; Ypsomed AG, Tandem Diabetes Care, Inc., Other Relationship; NIH - National Institutes of Health, Research Support; MannKind Corporation, Tandem Diabetes Care, Inc., JDRF, Speaker's Bureau; Insulet Corporation. C.Kollman: Research Support; Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc. R.Beck: Consultant; Eli Lilly and Company, Novo Nordisk, Diasome, Insulet Corporation, Research Support; Tandem Diabetes Care, Inc., Beta Bionics, Inc., Dexcom, Inc., Bigfoot Biomedical, Inc., Medtronic, Ascensia Diabetes Care, Roche Diabetes Care, Eli Lilly and Company, Novo Nordisk. M.D.Breton: Consultant; Dexcom, Inc., Tandem Diabetes Care, Inc., Roche Diabetes Care, Sanofi, Arecor, Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Novo Nordisk. Pedap trial study group: n/a. Z.Reed: None. B.A.Buckingham: Advisory Panel; Medtronic, Novo Nordisk, Consultant; Lilly, Research Support; Medtronic, Insulet Corporation, Tandem Diabetes Care, Inc. M.D.Deboer: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. G.P.Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. R.S.Kingman: None. M.Schoelwer: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation. R.Wadwa: Consultant; Eli Lilly and Company, Other Relationship; Dexcom, Inc., Eli Lilly and Company, Research Support; Dexcom, Inc., Eli Lilly and Company, Beta Bionics, Inc., Tandem Diabetes Care, Inc. J.W.Lum: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK127551); Tandem Diabetes Care, Inc; Dexcom, Inc.

Trends &amp; Technology

Trends & Technology| June 2023 Trends & Technology ASA Monitor June 2023, Vol. 87, 16–17. https://doi.org/10.1097/01.ASM.0000938808.42211.e6 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Trends & Technology. ASA Monitor 2023; 87:16–17 doi: https://doi.org/10.1097/01.ASM.0000938808.42211.e6 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: trend In the NIH-funded Pediatric Artificial Pancreas (PEDAP) Trial, artificial pancreas technology improved blood glucose control in young children between ages 2 and 5 with type 1 diabetes. The study was a 13-week randomized, controlled trial that enrolled 102 participants between ages 2 and 5 at three pediatric diabetes centers across the U.S. The participants were randomly assigned to either the artificial pancreas group or the standard care comparison group. The artificial pancreas, also known as closed-loop control, is a diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the insulin when needed using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with delivery of insulin by multiple daily injections or a pump controlled by the patient or caregiver. Participants in the artificial pancreas group spent 12% more time within their target blood glucose range compared to the... You do not currently have access to this content.

Disentangling the relationships between motor control and cognitive control in young children with symptoms of ADHD

ABSTRACT Children with ADHD experience difficulties with motor and cognitive control. However, the relationships between these symptoms are poorly understood. As a step toward improving treatment, this study investigated associations between specific aspects of motor control and cognitive control in children with varying levels of hyperactive-impulsive symptoms. A heterogeneous sample of 255 children of 4 to 10 years of age (median = 6.50, MAD = 1.36) completed a battery of tests probing motor generation, visuomotor fluency, visuomotor flexibility, cognitive inhibition, verbal and visuospatial working memory, and cognitive flexibility. Their caregivers were interviewed regarding their hyperactive-impulsive symptoms. 25.9% of the main sample met diagnostic criteria for ADHD. Multiple linear regression analysis was used to determine whether specific aspects of motor control were associated with specific aspects of cognitive control, and whether any associations were moderated by hyperactive-impulsive symptoms. Additionally, cognitive modeling (the drift diffusion model approximated with EZ-DM) was used to understand performance on a cognitive inhibition task. Visuomotor fluency was significantly associated with cognitive inhibition. Visuomotor flexibility was significantly associated with cognitive flexibility. There were no significant moderation effects. Cognitive modeling was inconclusive. In conclusion, the ability to fluently perform visually guided continuous movement is linked with the ability to inhibit the effects of distracting information. The ability to spontaneously use visual information to flexibly alter motor responses is related to the ability to cognitively shift from one frame of mind to another. These relationships appear to be quantitatively and qualitatively similar across the childhood hyperactive-impulsive continuum as rated by parents.

Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes

BackgroundClosed-loop control systems of insulin delivery may improve glycemic outcomes in young children with type 1 diabetes. The efficacy and safety of initiating a closed-loop system virtually are unclear.MethodsIn this 13-week, multicenter trial, we randomly assigned, in a 2:1 ratio, children who were at least 2 years of age but younger than 6 years of age who had type 1 diabetes to receive treatment with a closed-loop system of insulin delivery or standard care that included either an insulin pump or multiple daily injections of insulin plus a continuous glucose monitor. The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. Secondary outcomes included the percentage of time that the glucose level was above 250 mg per deciliter or below 70 mg per deciliter, the mean glucose level, the glycated hemoglobin level, and safety outcomes.ResultsA total of 102 children underwent randomization (68 to the closed-loop group and 34 to the standard-care group); the glycated hemoglobin levels at baseline ranged from 5.2 to 11.5%. Initiation of the closed-loop system was virtual in 55 patients (81%). The mean (±SD) percentage of time that the glucose level was within the target range increased from 56.7±18.0% at baseline to 69.3±11.1% during the 13-week follow-up period in the closed-loop group and from 54.9±14.7% to 55.9±12.6% in the standard-care group (mean adjusted difference, 12.4 percentage points [equivalent to approximately 3 hours per day]; 95% confidence interval, 9.5 to 15.3; P<0.001). We observed similar treatment effects (favoring the closed-loop system) on the percentage of time that the glucose level was above 250 mg per deciliter, on the mean glucose level, and on the glycated hemoglobin level, with no significant between-group difference in the percentage of time that the glucose level was below 70 mg per deciliter. There were two cases of severe hypoglycemia in the closed-loop group and one case in the standard-care group. One case of diabetic ketoacidosis occurred in the closed-loop group.ConclusionsIn this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; PEDAP ClinicalTrials.gov number, NCT04796779.)

Effect of Age on Hypertension Recognition in Children With Chronic Kidney Disease: A Report From the Chronic Kidney Disease in Children Study.

Young age has been associated with poorer control of hypertension in children with chronic kidney disease (CKD). Using data from the CKiD Study (Chronic Kidney Disease in Children), we examined the relationship between age, hypertensive blood pressure (BP) recognition, and pharmacologic BP control in children with nondialysis-dependent CKD. Participants included 902 CKiD Study participants with CKD stages 2 to 4. A total of 3550 annual study visits met inclusion criteria and participants were stratified by age (0 to <7, ≥7 to <13, ≥13 to ≤18 years). Generalized estimating equations to account for repeated measures were applied to logistic regression analyses to evaluate the association of age with unrecognized hypertensive BP and medication use. Children <7 years of age had a higher prevalence of hypertensive BP and a lower prevalence of antihypertensive medication use compared with older children. At visits where participants <7 years of age had hypertensive BP readings, 46% had unrecognized, untreated hypertensive BP compared with 21% of visits for children ≥13 years of age. The youngest age group was associated with higher odds of unrecognized hypertensive BP (adjusted odds ratio, 2.11 [95% CI, 1.37-3.24]) and lower odds of antihypertensive medication use among those with unrecognized hypertensive BP (adjusted OR, 0.51 [95% CI, 0.27-0.996]). Children younger than 7 years of age with CKD are more likely to have both undiagnosed and undertreated hypertensive BP. Efforts to improve BP control in young children with CKD are needed to minimize development of cardiovascular disease and slow CKD progression.

Cardiopulmonary Fitness of Preschoolers with Congenital Heart Disease: An Observational Study.

With advancements in cardiopulmonary rehabilitation over the past few decades, the survival rate of patients with congenital heart disease (CHD) has increased. However, the Cardiopulmonary fitness (CPF) of these patients is poor. Here, we aimed to investigate CPF in preschoolers with CHD (aged 4 to 6 years) using cardiopulmonary exercise testing. We retrospectively compared 102 healthy preschoolers with 80 preschoolers with CHD. The latter had lower peak oxygen consumption, oxygen consumption at anaerobic threshold and metabolic equivalent at anaerobic threshold. The same result was observed in boys with CHD, but not in girls, when sex was sub-analyzed. Considering the body composition, children with CHD had a lower fat-free mass index (FFMI) than their healthy peers. Healthy preschoolers with a normal body mass index (BMI) had higher anaerobic threshold and peak metabolic equivalent values than overweight or underweight children. This was categorized under the BMI reference of the Ministry of Health and Welfare in Taiwan. In conclusion, the CPF difference between the CHD and healthy groups was identified as early as in preschool age, and better CPF in healthy preschoolers within the normal BMI range suggests the importance of weight control in young children.

Prefrontal activation in preschool children is associated with maternal adversity and child temperament: A preliminary fNIRS study of inhibitory control.

Exposure to adversity is a well-documented risk factor for cognitive, behavioral, and mental health problems. In fact, the consequences of adversity may be intergenerational. A growing body of research suggests that maternal exposures to adversity, including those prior to childbirth, are associated with offspring biobehavioral development. In a sample of 36 mothers and their preschool-age children (mean child age=4.21±0.92 years), we used functional near-infrared spectroscopy to replicate and extend this work to include brain activation during inhibitory control in young children. We found that measures of maternal exposure to adversity, including cumulative, childhood, and preconception exposures, were significantly and positively associated with activation in the right frontopolar prefrontal cortex (PFC) and in the left temporal and parietal clusters during inhibitory control. In addition, and consistent with previous findings, children's increased negative affect and decreased effortful control were associated with increased right PFC activation during inhibitory control. These findings provide preliminary evidence that maternal and dispositional risk factors are linked to alterations in PFC functioning during the preschool years. Children of mothers with a history of exposure to adversity, as well as children who are less temperamentally regulated, may require increased neural resources to meet the cognitive demands of inhibitory control.

Using Accuracy and Response Times to Assess Inhibitory Control in Kindergarten Children: An Analysis with Explanatory Item Response Models

ABSTRACT Inhibitory control is a core executive function that develops during childhood and is measured with tasks that require the inhibition of a dominant response. The current study examined the diagnostic value of using response accuracy and latency in a simple inhibitory control test, the computerized Pointing-Stroop Task (cPST), for kindergarten children. The cPST was completed by 135 children, ages 3 through 6 years with diverse national and cultural backgrounds. In explanatory response models, item difficulties and time intensities could be predicted very reliably by congruency and item position, with incongruent responses causing more errors and longer response latency. Moreover, the prediction of fluid intelligence (a close correlate of inhibitory control) from children’s performance in the cPST was enhanced by using response accuracy and response latency, which had a multiplicative effect, indicating that efficient (accurate and fast) inhibitory control is related to fluid intelligence. These results suggest that measuring the efficiency of inhibitory control in young children is a more appropriate assessment than using either response accuracy or response latency.

Priming Behavioral Control Enhances Sharing in Preschoolers.

Although young children demonstrate knowledge of fairness norms, their actual sharing is often inconsistent with their understanding. A possible explanation for this discrepancy is the failure of behavioral control in young children. Thus, the present research manipulated behavioral control experimentally and examined its effect on the sharing behavior in 3- to 4-year-olds (N = 64). Children were randomly assigned to either the behavioral control or the neutral prime conditions. In the behavioral control prime condition, the children listened to a story in which a protagonist exerted behavioral control actively, refraining from eating candies. In the neutral prime condition, the children listened to a story in which a protagonist did not explicitly engage in behavioral control. The children then participated in the dictator game. The experimenter asked the children to share as many stickers as they wanted or should with an anonymous child. Children in the behavioral control prime condition shared more stickers than those in the neutral prime condition. However, the two groups did not differ in their judgments of fairness and emotional experiences. The current research provides evidence that preschoolers’ sharing behaviors can be facilitated by behavioral control.

Promoting glycemic control in young children with type I diabetes: Results from a pilot intervention for parents.

Nutrition and physical activity are key components of daily diabetes care in young children with type I diabetes (T1D). Normative developmental behavioral challenges related to nutrition and physical activity complicate management of T1D. The current pilot study evaluated the feasibility, acceptability, and indications of behavior change of an intervention aimed at improving nutrition and physical activity in young children with T1D. Thirty-6 parents of young children (ages 2-5 years, M = 4.2) with T1D from 2 clinics in the Washington, DC area were randomized to receive the type One Training (TOTs) program or Usual Care (UC). Assessments included recruitment and completion rates, participant acceptability, and outcomes including glycemic variability via continuous glucose monitoring, nutritional intake via remote food photography, physical activity via accelerometers, and parental report on behavior and psychosocial functioning. Despite recruitment challenges, the TOTs program was feasible to administer, with high program and assessment completion rates. Acceptability ratings were very high but differed by recruitment site. Participants randomized to TOTs had an increase in percent of time in target glycemic range and reduction in behavioral feeding problems between baseline and follow-up while those randomized to UC did not. Participants in UC demonstrated a decrease in in moderate to vigorous physical activity at follow-up. The TOTs program demonstrated preliminary feasibility and acceptability. Future research will examine components of treatment for evidence of efficacy and target the intervention to those most likely to benefit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Closed-Loop Insulin Pump Therapy in Young Type 1 Diabetic Children

Source: Ware J, Allen JM, Boughton CK, et al. Randomized trial of closed-loop control in very young children with type 1 diabetes. N Engl J Med. 2022;386:209-219; doi: 10.1056/NEJMoa2111673Investigators from multiple institutions conducted a crossover randomized trial to compare the effectiveness and safety of a closed-loop system (ie, artificial pancreas) to sensor-augmented insulin pump therapy in young children with type 1 diabetes. Participants were children 1-7 years old with a diagnosis of type 1 diabetes for at least 6 months, recruited from diabetes centers in 4 European countries. The closed-loop system consisted of a continuous glucose sensor and insulin pump connected to a smartphone app. The app included an algorithm that automatically adjusted insulin delivery based on real-time sensor glucose readings. With the sensor-augmented pump, insulin therapy was stopped if an algorithm predicted that sensor glucose levels were likely to drop below a specified threshold. Study children were randomized to receive 16 weeks of treatment with the closed loop system, followed by 16 weeks using the augmented-sensor pump, or vice versa. The primary outcome was percentage of time spent in the target glucose range (70 to 170 mg/dL) during each treatment period. Secondary outcomes included percentage of time spent in a hyperglycemic range (>180 mg/dL) and hypoglycemic range (<70 mg/dL) and mean glucose levels. These outcomes were based on readings from the glucose sensors. Glycated hemoglobin levels were measured at baseline and at the end of each treatment period. Differences in outcomes between the closed-loop and sensor-augmented pump treatment period were assessed with repeated-measures linear regression models. Data on adverse events also were collected.Data were analyzed on 74 children with a mean age of 5.6 ±1.6 years. The mean glycated hemoglobin level at baseline was 7.3 ±0.7%. The mean time spent in the target glucose range were 71.6 ±5.9% during the closed-loop period and 62.9 ±9.0% in the sensor-augmented pump period (adjusted difference, 8.7 percentage points; 95% CI, 7.4, 9.9; P <0.001). The median time spent at glucose level >180 mg/dL was significantly less during the closed-loop period than during the control period (22.9% vs 31.7%; adjusted difference, -8.5 percentage points; 95% CI, -.9.9, -7.1; P <0.001); mean sensor glucose levels (145 ±11.8 mg/dL and 158.1 ±18.5 mg/dL, respectively; P <0.001) and mean glycated hemoglobin levels (6.6 ±0.6% and 7.0 ±0.7%) were significantly lower during the closed-loop period than during treatment with the segmented-sensor pump. There was no difference between treatment periods for percentage of time with glucose <70 mg/dL (P = 0.74). One participant had a serious adverse event (severe hypoglycemia) during their closed-loop treatment period.The authors conclude that a closed-loop system improved glycemic control in young children with type 1 diabetes.Dr Fechner has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Type 1 diabetes is very difficult to manage in the young child. The therapeutic window for insulin is very narrow, with too much insulin resulting in hypoglycemia and too little insulin resulting in hyperglycemia. The last 5 years have seen tremendous advances in the technology available to children with type 1 diabetes. A 2019 study comparing the insulin pump to multiple daily injections showed that the insulin pump was superior to multiple daily injections. (See AAP Grand Rounds. 2019;42[1]:4.) Continuous glucose monitoring has decreased parental anxiety regarding risk of hypoglycemia and diabetic ketoacidosis;1 however, parents still are responsible for making insulin dose adjustments, and glycemic control overall is not improved.2 The results of a 2020 study of 6- to 13-year-olds with type 1 diabetes demonstrated that glucose levels were in the target range for a longer period of time in those randomized to a closed-loop system than those using a sensor-augmented pump. (See AAP Grand Rounds. 2020;44[6]:69.)3 The current researchers compared a hybrid closed-loop insulin delivery system to sensor-augmented pump therapy in younger children with type I diabetes.The strengths of the current study are the randomized, crossover design using the same algorithm with the closed-loop functionality either abled or disabled; each therapy was 16 weeks, which allowed a meaningful glycated hemoglobin to be obtained. There were no restrictions on previous episodes of hypoglycemia and diabetic ketoacidosis, and the study included a very young children with diabetes, who are more vulnerable to hypo- and hyperglycemia. Weaknesses of this study include underrepresentation of ethnic minorities and a patient population not representative of the typical type 1 diabetes population, as the average glycated hemoglobin level was 7.3% at baseline.4 Decreased patient compliance outside of the confines of a study may be reflected in poorer glucose control regardless of the insulin delivery system used.Hybrid closed-loop insulin therapy in young children with type 1 diabetes has the potential to significantly improve long-term outcomes through improved glycemic control.

Closed‐loop control of type 1 diabetes in young children

Journal of Paediatrics and Child HealthVolume 58, Issue 4 p. 734-734 Heads UpFree Access Closed-loop control of type 1 diabetes in young children First published: 26 February 2022 https://doi.org/10.1111/jpc.15929 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Management of type 1 diabetes in young children is difficult because of their unpredictable eating habits, variable insulin requirements and parents' fear of hypoglycaemia. Sensor-augmented pump therapy decreases hypoglycaemia and ketoacidosis in this age-group but has not been shown to improve glycaemic control. Hybrid closed-loop systems (i.e. artificial pancreas) in which an algorithm adjusts insulin delivery based on real-time sensor glucose levels have been used in adolescents. European researchers randomised 74 children aged 1–7 years, mean 5.6 (standard deviation = 1.6) years, to receive insulin via either a closed-loop system or sensor-augmented pump therapy (control) for 16 weeks; they then crossed over to the other treatment for 16 weeks in a multicentre, randomised, cross-over trial.1 The closed-loop period was significantly superior to standard pump therapy in terms of time with glucose levels in the target range (72 vs. 63%, P < 0.001, which equated to a clinically significant 125 min/day), time spent in a hyperglycaemic state, difference in glycated haemoglobin level and difference in mean sensor glucose level (Fig. 1). The time spent in a hypoglycaemic state was similar between treatments, but one child had a severe hypoglycaemic episode during the closed-loop period. A hybrid closed-loop system significantly improved glycaemic control in young children with type 1 diabetes. Fig. 1Open in figure viewerPowerPoint Sensor glucose levels. (), Closed-loop insulin delivery (), interquartile range (IQR)); (), sensor-augmented pump therapy (), IQR); (), target glucose range (N.B. 70 mg/dL = 3.9 mmol/L; 180 mg/dL = 10 mmol/L). Reference 1Ware J, Allen JM, Boughton CK et al. Randomized trial of closed-loop control in very young children with type 1 diabetes. N. Engl. J. Med. 2022; 386: 209– 19. CrossrefCASPubMedWeb of Science®Google Scholar Reviewers: David Isaacs, david.isaacs@health.nsw.gov.au, Children's Hospital at Westmead, Sydney; Lara Graves, lara.graves@health.nsw.gov.au, Children's Hospital at Westmead, Sydney Volume58, Issue4April 2022Pages 734-734 FiguresReferencesRelatedInformation

Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status.

Purpose The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method Sixty-two parent-child dyads of children with normal hearing (NH) and 64 of children who are DHH (3-8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals-Fifth Edition Following Directions subscale (6-8 years)/Clinical Evaluation of Language Fundamentals Preschool-Second Edition Concepts and Following Directions subscale (3-5 years). Follow-up analyses comparing subgroups of children who used hearing aids (n = 29) or cochlear implants (CIs; n = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH.

The Short-Term Impact of Animation on the Executive Function of Children Aged 4 to 7.

Research has shown that animation plays an important role in the development of children’s executive function (EF), and the development of EF components, inhibitory control, working memory, and cognitive flexibility, is asynchronous. Thus, this study explores the developmental trajectories and animation features (fantasy and pacing) that influence each EF component, by examining 218 children aged 4–7. Pretest information, mainly the childhood EF inventory, was provided by parents: child’s age, age of first exposure to animation, animation viewing time on weekdays and weekends, family income, and parents’ education. The children in each age group were randomly divided into four groups to watch animations comprised of different animation features. After watching, their EF were measured by a day-night task, backward digit-span task, and flexible item-selection task. The results showed that the children’s inhibitory control, working memory and cognitive flexibility levels all improved with age. Highly fantastical animations weakened children’s performance on each subsequent EF task. Pacing had no effect on any of the components of children’s EF. An interactive effect on inhibitory control was only found with fantasy in younger children; specifically, high-fantastical animations had a more pronounced short-lived weakening effect on inhibitory control in younger children (4–6 years) compared with low-fantastical animations. Future research should explore the long-term impact of content rather than the form of animation on younger children’s EF.