Development Of Behavior Problems Research Articles

A pilot randomized controlled trial of Internet-delivered parent training for parents of teenagers.

Adolescents with externalizing behaviors are at risk for multiple social and health impairments that may persist into adulthood. Although empirically supported treatments are available for teenagers with severe externalizing behavior and their families, only a few parenting programs have been evaluated for adolescents with subclinical levels of behavior problems. In the present randomized controlled trial (N = 75), we examined the feasibility and efficacy of the Parent-Web, a new Internet-based parenting program for parents of teenagers. Participants reported high satisfaction with the program, 74% completed all five modules and dropout was only 14%. Generalized linear mixed models showed short-term (8 weeks) improvements in parent-reported teenager externalizing behaviors, family conflicts, and family warmth compared to a waitlist control condition. Receiving the Parent-Web was also associated with more improvements in parent-reported teenage emotional symptoms and peer problems, as well as parental stress and depression. No differences regarding parenting behaviors between the two groups were found. Those in the intervention group maintained their posttreatment gains on primary outcomes at the follow-up assessment, 6- to 9-months after the program. Although limited by relying solely on parent report, and by a relatively small sample size, we conclude that our study contributes some preliminary evidence for the utility of supporting parents of adolescents at risk of developing behavior problems through an Internet-based intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Identifying child temperament risk factors from 2 to 8 years of age: validation of a brief temperament screening tool in the US, Europe, and China

Despite ample evidence linking particular child temperament characteristics to behavior disorders later in life, there is currently a lack of temperament measures that can be used early, easily, and widely for screening purposes. To redress this gap, the current research aimed at developing a very brief scale of child temperament characteristics that have been found to predict behavior problems over the long term, are represented across models of temperament, and have the potential to exhibit measurement invariance over different countries and childhood periods. The new scale was derived from the Integrative Child Temperament Inventory, a 30-item measure to assess five well-established temperament dimensions, and examined in three studies with samples of children aged between 2 and 8 years across five countries: The United States, the United Kingdom, China, Germany, and Spain (N = 13,425; boys 55.96%). The studies included tests of measurements invariance, of convergent validity with established measures of temperament, and of criterion validity with measures of behavior problems. The scale exhibited full metric invariance and partial scalar invariance across age groups (toddlerhood, preschool, school age) and countries. Test–retest reliability, interrater reliability across teachers, and convergent and criterion validity were adequate. Preliminary data on the measure’s clinical utility suggest a favorable balance between brevity and screening accuracy. Altogether, this study suggests that early childhood temperament characteristics placing children at risk for developing behavior problems much later in life can be quickly, effectively, and commensurably assessed across different countries and age groups.

Impact of Parent-Child Relationship and Gender on Trajectories of Children Internalizing Problems

Background: Parenting and parental-child relationship may lead children to develop behavior problems that can affect many aspects of their later life, such as happiness, health, intelligence and mental illness. This study aimed to examine the impact of parent-child relationship and gender on the development of internalizing behavior problems (IBP) in children. Methods: Childhood and Adolescent Behaviors in Long-term Evolution (CABLE) is a longitudinal healthy-lifestyle research for which 18 elementary schools were randomly selected respectively in Taipei and Hsinchu in Taiwan. Data were collected on family interactions, lifestyle, problem behaviors and physical health. Data on gender, parent-child relations, and internalizing problem behaviors from four waves of follow-up were analyzed in this paper: 2003 (9 year olds), 2006 (12 year olds), 2009 (15 year olds) and 2012 (18 year olds). A latent growth model (LGM) was used to examine the impact of parental-child relationship and gender on the trajectory of children's IBP. Results: Results show that IBP is more severe (r = 0.21, p < 0.01) and their growth rate faster (r = 0.15, p < 0.01) in girls than in boys. Results from latent growth model show that parent-child relationship is negatively related to the IBP intercept (r = -0.59, p < 0.01) and is positively related to the IBP slope (r = 0.18, p < 0.01). Conclusions: The findings suggest that girls are more susceptible to IBP in puberty, and better parent-child relationship can have a protective influence although the protective impact reduced through time. Health professionals should be sensitive to gender, family functioning and provide positive parenting programs for children at risk for IBP. Funding Statement: National Health Research Institutes and Health Promotion Administration, Ministry of Health and Welfare Taiwan, grant number HP-090-SG-03. Declaration of Interests: The authors have no conflicts of interest relevant to this article to disclose. Ethics Approval Statement: This study protocol was reviewed and approved by the human protection committee of the National Health Research Institutes Taiwan.

Gender differences in occurrence of behavioral and emotional problems at the lower grades of elementary school: Association with developmental and behavioral characteristics at 5 years

AimWe examined whether developmental status and behavioral problems at age five were related to the occurrence of behavioral and emotional problems in the lower grades of elementary school among non-clinical children who did not receive specialized support for developmental problems in early childhood. MethodsThe participants were 367 (non-clinical: 325) second- and third-grade elementary school children. The mean age at follow-up was 7.63 (SD = 0.62). Parents completed a questionnaire about their children’s developmental status and behavioral problems during a community health check-up for 5-year-olds. Behavioral and emotional problems at school age were assessed using the Strengths and Difficulties Questionnaire (SDQ). The association between developmental and behavioral characteristics at age five and each of the SDQ subscales at school age was analyzed with logistic regression. ResultsHyperactivity/inattention, conduct problems, and emotional problems at school age were associated with developmental and behavioral factors in 5-year-olds. The problem of hyperactivity/inattention at school age was associated with hyperactivity/inattention in both genders, and significant gender differences were identified. The relationship with hyperactivity at the age of five was significant for boys, whereas the relationship with inattention was only significant for girls. Emotional problems were significantly associated with social behaviors and developmental status at five years of age only in girls. ConclusionsIt is necessary for clinicians and teachers to consider the relation of developmental and behavioral characteristics to the background of behavioral and emotional problems at school age and to be aware of gender differences.

Early identification of children with developmental delay and behavioural problems according to parents concerns in the Republic of Serbia

ABSTRACT The main goal of this research was to describe the type and level of parents’ concerns about child development and behaviour according to the PEDS test (Parents’ Evaluation of Developmental Status). The sample included 289 parents of children from three to seven years of age, from two preschool institutions in Serbia. A significantly high correlation was determined between parents’ general concerns and expressed concerns with regard to behaviour (χ 2 = 17.86, df = 2, p < .001) and getting along with others (χ 2 = 22.57, df = 2, p < .000). A marginally significant correlation was determined between parents’ general concerns and manifested concerns with regard to fine motor skills (χ 2 = 5.90, df = 2, p = .052), as well as expressive language (χ 2 = 5.858, df = 2, p = .053). According to the criteria of PEDS test, this research identified 56.4% of children whose development needed to be monitored, 27.7% of children who needed to be referred for detailed diagnostic procedures, and 1.7% who needed to be included in treatment or special education support.

Zachowania o charakterze destrukcyjnym w okresie średniego dzieciństwa: norma czy patologia?

&lt;p&gt;W okresie średniego dzieciństwa często pojawiają się takie zachowania, jak upór, nieposłuszeństwo, buntowniczość i napady złości, które mogą zostać uznane za problemowe. Ważne jest ustalenie, czy niepokojące problemy są jedynie mocniej zaznaczającymi się, lecz typowymi cechami rozwoju dziecka, przejściowym efektem frustracji związanej z pokonywaniem kryzysów rozwojowych czy też ich przezwyciężenie wymaga specjalistycznej pomocy. Dzieci, u których obserwuje się słabe kompetencje emocjonalne, znajdują się w grupie ryzyka rozwoju klinicznych symptomów zaburzeń zachowania. Wpływ na ich kształtowanie mają zarówno czynniki biologiczne, jak i środowiskowe. Wśród nich podkreślana jest jakość relacji między dziećmi i rodzicami, a także interakcji dziecko – nauczyciel. Szczególnie niekorzystne są oddziaływania nasycone negatywnymi emocjami, oparte na przymusie i karaniu. Prowadzą one do ograniczenia rozwoju kompetencji emocjonalnych dziecka, niezbędnych do prawidłowego regulowania relacji społecznych oraz kontroli własnego działania. Zidentyfikowanie występujących w tym okresie rozwojowym zachowań problemowych, mających wartość prognostyczną dla diagnozy zaburzeń zachowania u dzieci w wieku szkolnym, pozwala na podjęcie właściwych oddziaływań pomocowych.&lt;/p&gt;

Very low-level prenatal mercury exposure and behaviors in children: the HOME Study

BackgroundMercury is toxic to the developing brain, but the lowest concentration associated with the development of behavior problems is unclear. The purpose of this study was to examine the association between very low-level mercury exposure during fetal development and behavior problems in children.MethodsWe used data from 389 mothers and children in a prospective pregnancy and birth cohort study. We defined mean prenatal mercury concentration as the mean of total whole blood mercury concentrations in maternal samples collected at 16- and 26-weeks of gestation, delivery, and neonatal cord blood samples. We assessed parent-reported child behavior up to five times from two to 8 years of age using the Behavioral Assessment System for Children (BASC-2). At 8 years of age, we assessed self-reported child anxiety using the Spence Children’s Anxiety Scale (SCAS). We used multiple linear mixed models and linear regression models to estimate the association between mean prenatal mercury concentrations and child behavior and anxiety, respectively.ResultsThe median prenatal total blood mercury concentrations was 0.67 μg/L. Overall, we did not find statistically significant associations between mean prenatal mercury concentrations and behavior problems scores, but a 2-fold increase in mercury concentrations at 16-weeks gestation was associated with 0.83 point (95% CI: 0.05, 1.62) higher BASC-2 anxiety scores. Maternal and cord blood mercury concentrations at delivery were associated with parent-reported anxiety at 8 years.ConclusionWe found limited evidence of an association between very-low level prenatal mercury exposure and behaviors in children, with an exception of anxiety.

Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home Investigations for Children with Elevated Blood Lead Levels - North Carolina, 2011-2018.

The number of pediatric cases of elevated blood lead levels (BLLs) are decreasing in North Carolina. However, one county reported an increase in the number of children with confirmed BLLs ≥5 μg/dL (CDC reference value, https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm), from 27 in 2013 to 44 in 2017. Many children with elevated BLLs in this county lived in new housing, but samples of spices, herbal remedies, and ceremonial powders from their homes contained high levels of lead. Children with chronic lead exposure might suffer developmental delays and behavioral problems (https://www.cdc.gov/nceh/lead/). In 1978, lead was banned from house paint in the United States (1); however, children might consume spices and herbal remedies daily. To describe the problem of lead in spices, herbal remedies, and ceremonial powders, the North Carolina Childhood Lead Poisoning Prevention Program (NCCLPPP) retrospectively examined properties where spices, herbal remedies, and ceremonial powders were sampled that were investigated during January 2011-January 2018, in response to confirmed elevated BLLs among children. NCCLPPP identified 59 properties (6.0% of all 983 properties where home lead investigations had been conducted) that were investigated in response to elevated BLLs in 61 children. More than one fourth (28.8%) of the spices, herbal remedies, and ceremonial powders sampled from these homes contained ≥1 mg/kg lead. NCCLPPP developed a survey to measure child-specific consumption of these products and record product details for reporting to the Food and Drug Administration (FDA). Lead contamination of spices, herbal remedies, and ceremonial powders might represent an important route of childhood lead exposure, highlighting the need to increase product safety. Setting a national maximum allowable limit for lead in spices and herbal remedies might further reduce the risk for lead exposure from these substances.

Characterization of autism spectrum disorder and neurodevelopmental profiles in youth with XYY syndrome

BackgroundXYY syndrome is a sex chromosome aneuploidy that occurs in ~ 1/850 male births and is associated with increased risk for neurodevelopmental difficulties. However, the profile of neurodevelopmental impairments, including symptoms of autism spectrum disorder (ASD) in XYY remains poorly understood. This gap in knowledge has persisted in part due to lack of access to patient cohorts with dense and homogeneous phenotypic data.MethodsWe evaluated a single-center cohort of 64 individuals with XYY aged 5–25 years, using a standardized battery of cognitive and behavioral assessments spanning developmental milestones, IQ, adaptive behavior, academic achievement, behavioral problems, and gold-standard diagnostic instruments for ASD. Our goals were to (i) detail the neurodevelopmental profile of XYY with a focus on ASD diagnostic rates and symptom profiles, (ii) screen phenotypes for potential ascertainment bias effects by contrasting pre- vs. postnatally diagnosed XYY subgroups, and (iii) define major modules of phenotypic variation using graph-theoretical analysis.ResultsAlthough there was marked inter-individual variability, the average profile was characterized by some degree of developmental delay, and decreased IQ and adaptive behavior. Impairments were most pronounced for language and socio-communicative functioning. The rate of ASD was 14%, and these individuals exhibited autism symptom profiles resembling those observed in ASD without XYY. Most neurodevelopmental dimensions showed milder impairment among pre- vs. postnatally diagnosed individuals, with clinically meaningful differences in verbal IQ. Feature network analysis revealed three reliably separable modules comprising (i) cognition and academic achievement, (ii) broad domain psychopathology and adaptive behavior, and (iii) ASD-related features.ConclusionsBy adding granularity to our understanding of neurodevelopmental difficulties in XYY, these findings assist targeted clinical assessment of newly identified cases, motivate greater provision of specialized multidisciplinary support, and inform future efforts to integrate behavioral phenotypes in XYY with neurobiology.Trial registrationsClinicalTrials.gov NCT00001246, “89-M-0006: Brain Imaging of Childhood Onset Psychiatric Disorders, Endocrine Disorders and Healthy Controls.”

Validation de la version française d’une échelle évaluant les pratiques disciplinaires de parents d’enfants d’âge scolaire

Several decades of research have emphasized the importance of parenting in the development of behavioral problems in children. Prevention and intervention for these difficulties require the assessment of parental practices with reliable measures. This study investigated the psychometric properties of the French version of the Parenting Scale (PS; Arnold et al., 1993). The original version of this scale has shown its usefulness by allowing the identification of the parents whose strategies of discipline are counterproductive, and by quantifying the effects of certain parenting programs. The study included 464 mothers and 347 fathers of elementary school-aged children (between the age of 4 and 13) from Switzerland and Belgium. Parents completed the PS and a measure of child behavior, the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). Eight different factorial structures were identified in the literature and tested with Confirmatory Factor Analyses (CFA). The results indicate that the two-factor model — laxness and over-reactivity — proposed by Irvine et al. (1999) best fitted the data. Indeed, it led to the lowest values of RMSEA and SRMR (1999). Furthermore the TLI and CFI indices were greater than .90, supporting a satisfactory fit of the data. Results from multi-group CFA analyses indicated that this factor structure did not vary across child sex and age, or parental sex. In this French version, laxness and over-reactivity had good internal consistency when analyzing either the total sample, or when separating the data according to the sex of the parents or the child's age group. It was possible to propose normative values of laxness and over-reactivity for mothers and fathers, as well as according to the age of the child, which will be useful for clinicians assessing parenting discipline practices of their clients. The results indicated that mothers rated themselves as more over-reactive than fathers (t(809) = 2.89, P < .01, d = .21), but the effect size was small. The difference was non-significant for laxness. The sex and age of the child, as well as the parents’ age did not affect over-reactivity and laxness. However, a weak link was found between education level and over-reactivity, but only for fathers (r = .19, P < .01). The association between the two factors and the child's adjustment were also evaluated. The highest correlation appeared to be between over-reactivity and the Total Score on the SDQ (rs = .28, p < .001). Correlations between over-reactivity and externalized problems (behavior and hyperactivity) were higher than those obtained with internalized problems. As for laxness, the correlations were lower: the highest one was with behavioral disorders (rs = .15, p < .001). Over the entire sample (R2 = .09, β = .27, P < .001) and in fathers (R2 = .10, β = .32, P < .001), over-reactivity was the best predictor of the child's difficulties regardless of the sex of the child. In mothers, both factors predicted the child's difficulties (R2 = .08, P < .001), with over-reactivity explaining more variance of total SDQ (β = .22, P < .001) than laxness (β = .14, P < .05). Over-reactivity appears to correspond to the construct of “coercive discipline” theorized and intensively studied by Patterson and colleagues (1982), which represents parents’ tendencies to criticize their child and to engage in severe disciplinary interactions. In summary, the Parenting Scale provides a quick and inexpensive measure of dysfunctional discipline practices. In contrast to more comprehensive measures of parental attitudes and beliefs, the PS items are specific enough to target concrete behaviors regarding parenting interventions. The PS can therefore be particularly useful in planning cognitive and behavioral therapy, as well as in evaluating the effects of treatment.

A "Smart" Way of Addressing Food Insecurity in the Digital Age.

* Abbreviations: app — : application FI — : food insecurity SNAP — : Supplemental Nutrition Assistance Program USDA — : US Department of Agriculture WIC — : Supplemental Nutrition Program for Women, Infants, and Children Maya is a 4-year-old girl who is presenting to our office for her well-child check. A familiar mark on her social screening questionnaire reveals that her family is worried that their food budget will run out before the end of the month. As we enter the room, we catch Maya’s mother in a yawn; she apologizes because she came straight from an overnight shift. Maya and her sister, both with juice-stained lips, are immersed in a video that is playing on their mother’s smartphone as we discuss growth charts and inhalers. Finally, we turn to Maya’s dietary history and the potential reality of food insecurity (FI). As our conversation starts, the phone rings, interrupting the video and our conversation. The family’s ride is out front, and they cannot wait. As they are rushing out the door, all we can do is provide them with a list of local food pantries. We are left dissatisfied. With recent advances in technology, how might we have more effectively and efficiently addressed this family’s FI? One in 6 American families experience FI, an inadequate access to food because of a lack of money or other resources.1 As pediatricians, we must identify and appropriately respond to FI.2 Although screening can help identify some children with FI, others may present more insidiously, with developmental delays, behavioral problems, or frequent hospitalizations, the effects of which may carry into adulthood.3 Pediatric trainees, who are often on the frontline providing primary care to at-risk families, are in a unique position to identify and respond to the needs … Address correspondence to Michelle Phan, MD, Pediatric Residency Program, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: michelle.phan{at}cchmc.org

Behavioral Problems and Psychosocial Strengths: Unique Factors Contributing to the Behavioral Profile of Youth With Down Syndrome.

This study aimed to describe problem behaviors and psychosocial strengths, examine the problem-strength interrelations, and evaluate profiles of problems and strengths in youth with Down syndrome (DS). The community-based sample consisted of 67 parents of children with DS aged between 4 and 19 years. Parents reported about the developmental age (Vineland screener), behavioral problems (Child Behavior Checklist), and psychosocial strengths (Behavioral and Emotional Rating Scale) of their child. Results indicate that attention, social, and thought problems were most prevalent, whereas family involvement and receiving/expressing affection were identified as strengths. A confirmatory factor analysis identified problems and strengths as distinct, yet related, variables. Moreover, a cluster analysis of problems and strengths identified four different profiles. Implications for interventions are discussed.

Identification of two 14q32 deletions involving DICER1 associated with the development of DICER1-related tumors

DICER1 encodes an RNase III endonuclease protein that regulates the production of small non-coding RNAs. Germline mutations in DICER1 are associated with an autosomal dominant hereditary cancer predisposition syndrome that confers an increased risk for the development of several rare childhood and adult-onset tumors, the most frequent of which include pleuropulmonary blastoma, ovarian sex cord-stromal tumors, cystic nephroma, and thyroid gland neoplasia. The majority of reported germline DICER1 mutations are truncating sequence-level alterations, suggesting that a loss-of-function type mechanism drives tumor formation in DICER1 syndrome. However, reports of patients with germline DICER1 whole gene deletions are limited, and thus far, only two have reported an association with tumor development. Here we report the clinical findings of three patients from two unrelated families with 14q32 deletions that encompass the DICER1 locus. The deletion identified in Family I is 1.4 Mb and was initially identified in a 6-year-old male referred for developmental delay, hypotonia, macrocephaly, obesity, and behavioral problems. Subsequent testing revealed that this deletion was inherited from his mother, who had a clinical history that included bilateral multinodular goiter and papillary thyroid carcinoma. The second deletion is 5.0 Mb and was identified in a 15-year-old female who presented with autism, coarse facial features, Sertoli-Leydig cell tumor, and Wilms’ tumor. These findings provide additional supportive evidence that germline deletion of DICER1 confers an increased risk for DICER1-related tumor development, and provide new insight into the clinical significance of deletions involving the 14q32 region.

Maternal variants in NLRP and other maternal effect proteins are associated with multilocus imprinting disturbance in offspring

BackgroundGenomic imprinting results from the resistance of germline epigenetic marks to reprogramming in the early embryo for a small number of mammalian genes. Genetic, epigenetic or environmental insults that prevent...

Production and characterization of CSSI003 (2961) human induced pluripotent stem cells (iPSCs) carrying a novel puntiform mutation in RAI1 gene, Causative of Smith–Magenis syndrome

Smith-Magenis syndrome (SMS) is a complex genetic disorder characterized by developmental delay, behavioural problems and circadian rhythm dysregulation. About 90% of SMS cases are due to a 17p11.2 deletion containing retinoic acid induced1 (RAI1) gene, 10% are due to heterozygous mutations affecting RAI1 coding region. Little is known about RAI1 role.

A Comparison of Cats (Felis silvestris catus) Housed in Groups and Single Cages at a Shelter: A Retrospective Matched Cohort Study.

Simple SummaryWhen cats are relinquished to shelters, they frequently experience a great deal of stress. Shelters often try to control certain aspects of their environment, such as housing, to help them relax. Some cats are placed in small group rooms upon entry, whereas others are placed in single cages. There are tradeoffs to both systems. We wanted to compare the experience and outcomes of cats placed in single housing and group housing in shelters. We found that their experiences while at the shelter were similar, however single-housed cats were moved to the isolation unit more frequently than group-housed cats, which reduced their visibility to the public by pulling them off the adoption floor. Single-housed cats were also sent to the offsite location more frequently, which means they spent more time in transport than group-housed cats. Both groups were adopted at approximately the same rate and after similar lengths of time. However, the rate of return was high, especially in group-housed cats, and live release rate after return was lower than after a cat’s initial stay. More research is needed to know why this is happening and how to reduce returns after adoption.The merits of various housing options for domestic cats in shelters have been debated. However, comparisons are difficult to interpret because cats are typically not able to be randomly assigned to different housing conditions. In the current study, we attempted to address some of these issues by creating a retrospective matched cohort of cats in two housing types. Cats in group housing (GH) were matched with cats in single housing (SH) that were the same age, sex, breed, coat color, and size. Altogether we were able to find a match for 110 GH cats. We compared these two groups on several measures related to their experience at the shelter such as moves and the development of behavioral problems. We also compared these groups on outcomes including length of stay, live release, and returns after adoption. We found that while the frequency of moves was similar in both groups, SH cats were more likely to be moved to offsite facilities than GH cats. SH cats also spent a smaller proportion of time on the adoption floor. Length of stay and, live release and returns after adoption did not significantly differ across groups, however GH cats were two times as likely to be returned after adoption. Future research should look at the behavioral impacts of shelter decision-making regarding moving and management of cats in different housing systems.

Mindfulness-Based Stress Reduction for Parents of Children With Developmental Delays: A Follow-Up Study

ABSTRACTParents of children with developmental delays (DD) consistently report higher levels of stress compared to parents of typically developing children. Elevated parenting stress is concerning, not only because of the associated poorer physical and mental health outcomes for the parents but also because of its role in the development of behavior problems and subsequent psychopathology in their children. A growing body of research suggests that Mindfulness-Based Stress Reduction (MBSR) is effective in reducing parenting stress and child behavior problems among families of children with DD; however, there is a shortage of studies examining whether the effects of MBSR in this population are maintained in the longer term. In the current study, we used a waitlist-control design to examine whether MBSR directly improved parental mental health (i.e., parenting stress, depression, and satisfaction with life) and indirectly reduced child externalizing and internalizing behaviors. Eighty parents of children with DD between the ages of 2.5 and 5 (M = 4.18, SD = 1.01) were randomly assigned to an immediate treatment group or a waitlist-control group. Results indicated that parents who received MBSR reported significantly greater improvements in mental health outcomes as well as reduced child behaviors related to attention and withdrawn behaviors compared to parents in the control group. Further, changes seen through MBSR were maintained at a 6-month follow-up assessment. These findings suggest that improvements in parent and child outcomes through MBSR may have longer term benefits for families of children with DD.

Association of maternal depression with children's attention deficit hyperactivity disorder.

Family problems are considered to be the main risk factor leading to the development of behavi oural problems during childhood and adolescence as well. A well documented fact in the current literature is that psychopathology of any kind in parents may influence behaviour, personality and appearance of psychopathology in their children. The permanent interaction between children's psychopathology or any kind of developmental disorder on one hand and parental psychopathology on the other, is considered to be one of the most important fields of research during the last decades. The aim of the present study was to review research concerning the relationship between maternal depressive disorder and children's attention deficit hyperactivity disorder (ADHD) among members of the same family, the influence that each disorder has in the appearance and development of the other, and the way that the mother-child relationship is influenced by both. We conducted an electronic search through PubMed to detect articles concerning the association of maternal depressive disorder and children's ADHD among the members of the same family published in English from January 1980 to December 2015. The choice was strictly limited to articles concerning exclusively emotional disorders in mothers and ADHD in their children. This process concluded with the electronic research of bibliographic citations of the identified articles, or related articles, in order to locate additional sources. Considering as a fact the interaction between this developmental disorder, ADHD, and mother's psychological profile which is maternal depression for the present research, we report the following: among the 27 articles found, 24 concerned the influence of the mother's depression to the child's ADHD, and the remaining 3 concerned their genetic association. There were important limitations found as well. Despite the fact that all the studies included a control group, many of them did have a follow-up and were short-term studies. Their results were mostly heterogenous and therefore their meta-analysis proved impossible. There was evidence concerning the association between the two disorders as both maternal depressive disorder and children's ADHD influence each other through multiple psychosocial and biological factors. Nevertheless, more data is needed from well structured, homogenous studies, especially in the field of genetics, in order to document this association.

Validation of autism spectrum disorder diagnoses recorded in the Clinical Practice Research Datalink, 1990-2014.

BackgroundPrior studies have reported that the validity of autism spectrum disorder (ASD) diagnoses recorded in the Clinical Practice Research Datalink (CPRD) was high; however, diagnostic criteria and screening practices have changed since the last study was published in 2004.Objectives1) To calculate the positive predictive value (PPV) of ASD diagnoses recorded in the CPRD compared to original medical records and 2) to describe characteristics of cases and use of clinical codes that support the ASD diagnosis as recorded in the electronic data by general practitioners over time.MethodsWe identified children with a code for ASD (autism spectrum disorder, autism, Asperger’s, or pervasive developmental disorder) in the CPRD from 1990 to 2014. We evaluated presence of codes in the electronic medical record indicating the presence of developmental delay, speech delay, behavioral problems, and other supporting clinical codes (e.g., therapy, referrals, etc.). We also evaluated changes in recording of these clinical codes over time. We compared the information present in the electronic medical record to original medical records for a sample of cases and calculated PPVs of ASD diagnoses recorded in the CPRD.ResultsWe identified 2154 children with a code for ASD. The mean age at diagnosis was 5.8 years, and 84% of cases were male. The majority (78.4%) had 1 ASD diagnosis code in their electronic medical record. Approximately half of the cases had a code indicating behavioral problem, developmental delay, or speech delay, and 24.7% had a code indicating specialist referral or visit. After review of original medical records, the PPV of ASD diagnoses recorded in the CPRD was 91.9%.ConclusionThe results of this study suggest that ASD diagnoses recorded in the CPRD are reliable and can be used with confidence to study ASD.

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OBJECTIVES/SPECIFIC AIMS: (1) To assess the prevalence of mental health symptomatology (depressive symptoms, anxiety symptoms, PTSD symptoms, and problematic alcohol use) and psychosocial risk factors for mental health disorders (low social support, immigration stress, acculturation, and marital/partner discord), and their association with immigration status, health care access and contextual risk factors in Spanish-speaking parents of young children (ages 0–5) who attended a well-child visit. (2) To explore acceptability of screening for and discussing parental distress in the pediatric primary care setting, and parental acceptability of a group well-visit format to address both psychosocial risk factors and mental health symptoms in this population. METHODS/STUDY POPULATION: Latino immigrant parents (n=100) of children ages 0–5 attending well-child visits at Johns Hopkins Bayview Children’s Medical Practice were surveyed between October 2015 and February 2016. The verbally administered survey included the Woman Abuse Screening Tool (WAST), AUDIT-C, Primary Care Post-Traumatic Stress Disorder (PC-PTSD) Screener, California Health Interview Survey (CHIS), National Latino and Asian American Study (NLAAS), Appraisal Support Subscale from Interpersonal Support Evaluation List (ISEL), Personal Health Questionnaire Depression Scale (PHQ-8), and Generalized Anxiety Disorder Scale (GAD-2). These questionnaires have been used in large regional or national surveys and most have been validated with US Latino populations. Positive screens were defined as PHQ-8&gt;5 (mild depression or greater), GAD-2&gt;3, AUDIT-C&gt;3 for women and &gt;4 for men, and PC-PTSD&gt;3. Descriptive information and comparisons were obtained by χ2 and Student t-test. Study protocol will allow review of childrens’ pediatric records (n=100). From this sample, parents were separately recruited to participate in in-depth interviews (n=11 of 20 planned have been completed) further exploring both sources of parental distress, acceptability of screening for parental mental health symptoms in the primary care pediatric setting, and acceptability of a potential group-based well-visit model in the pediatric setting. RESULTS/ANTICIPATED RESULTS: Survey participants were 93.0% women, and predominantly&lt;35 years of age. The vast majority (94.0%) were undocumented, recently arrived (&lt;15 years ago) and reported poor or very poor English proficiency (75.0%). Most (84.7%) reported living with a partner or spouse (84.7%), and 58% reported partner relationship strain. In all, 71% reported poor social support. The prevalence of “screen positive” mental health symptoms was highest for depression (55%) and PTSD (35%), followed by anxiety (29%) and alcohol risk use (25%). Having depression was significantly higher (68.4%) (p&lt;0.02) in participants with less education (&lt;6 grade). Partner relationship strain was associated with a higher prevalence of depressive symptoms (59.3%) (p&lt;0.03). Immigration stress (feeling guilty for leaving family and friends) was also significantly associated with depressive symptoms (58.1%) and PTSD (43.5%) (p&lt;0.03). More than half of the participants (60.0%) with depression were not covered by any health insurance and 56.3% of those with depression reported not having been seen by a health care provider in the past 12 months. A high prevalence of symptoms was found in those with poor appraised social support: alcohol risk use (76.0%), depression (69.1%), anxiety (69.0%), and PTSD (68.6%). Among participants, those aged&lt;30 years old and those with more children reported poorer appraised social support. Data from child medical records (including BMI, presence of feeding problems, referrals for social work, or mental health services) has been extracted but not yet linked to parent survey or interview results. Preliminary review of In Depth Interviews suggests that the most common reported source of stress among participants was related to finances, followed by documentation/legal status difficulties, access to childcare, and limited English proficiency. Some mothers also mentioned interpersonal violence and lack of access to healthcare as stressors. All mothers expressed an interest in a pediatric primary care based parent focused the majority of which indicated that a group based intervention would be acceptable, some mothers indicated they preferred a one-to-one intervention if mental health were to be discussed. Mothers seem preferential to social worker-led interventions compared with pediatrician-led, but most mothers were indifferent. Finally, mothers expressed low support from the Latino community in Baltimore. DISCUSSION/SIGNIFICANCE OF IMPACT: Results from this study suggest that this population of parents is experiencing a relatively high rate of mental health symptoms, low perceived social support, and limited access to their own source of care. This suggests that an intervention delivered within a primary care pediatric setting would have the potential to reach parents who might not otherwise interact with their own providers, and that there are an array of problems that could be targeted. Intervening with parents of young children has the potential to affect multiple child outcomes. A group intervention may target poor social support, though this format is not universally preferred. Next steps for this project include assessing the acceptability of and preference for various content components (ie, depression, parenting stress, legal issues) and linking parent data with child data (including developmental screening results, weight, feeding problems, and behavior problems).