Disorders In Toddlers Research Articles

LNK/SH2B3 As a Novel Driver in Juvenile Myelomonocytic Leukemia

Introduction Juvenile myelomonocytic leukemia (JMML) is a rare and aggressive myelodysplastic/myeloproliferative disorder in toddlers. Ninety-five percent of patients have mutations detected in the Ras/MAPK signaling pathway including CBL, KRAS, NF1, NRAS, RRAS, RRAS2, and PTPN11. Oncogenic fusion proteins leading to hyperactive Ras signaling and other mutations in genes encoding for proteins upstream the Ras pathway have also been described. One of these upstream proteins is LNK which is encoded by SH2B3. Loss of function mutations in SH2B3 result in abnormal proliferation of hematopoietic cells due to cytokine hypersensitivity and activation of JAK/STAT signaling. Mutations in SH2B3 have been detected in a variety of hematologic malignancies, specifically in myeloproliferative neoplasms in adults. We previously identified secondary mutations in SH2B3 in JMML. Here we report a case series of four JMML patients with initiating mutations in SH2B3. We also show that SH2B3 mutant induced pluripotent stem cell (iPSC)-derived JMML like hematopoietic progenitor cells (HPC) are sensitive to JAK inhibitors including ruxolitinib. Patients and Methods Genomic DNA from peripheral blood, bone marrow or buccal swabs was extracted using standard protocols. DNA samples were sequenced using a custom amplicon-based targeted sequencing approach. Ficoll-purified mononuclear cells from bone marrow of JMML patients and control samples were reprogrammed by using Sendai virus expressing doxycycline-regulated OCT4, KLF4, MYC, and SOX2. Control and JMML iPSCs were differentiated to HPCs by culturing in serum-free media with sequential combinations of growth factors to support multipotent hematopoietic progenitor formation. The half-maximal inhibitory concentration (IC50) for each kinase inhibitor was determined by performing Cell Titer Glo assays (Promega). Results Clinical characteristics of patients with SH2B3 mutant JMML described in this study are highlighted in Table 1. iPSC-derived JMML-like HPCs with different mutational backgrounds were analyzed in cell proliferation assays after exposure to multiple different JAK inhibitors (ruxolitinib, momelotinib, tofacitinib). HPCs with alterations in SH2B3 were more sensitive to chemical JAK inhibition compared to HPCs not harboring mutations in SH2B3. This finding was observed for all JAK inhibitors but was most prominent with ruxolitinib (Figure 1). Patient 3 received ruxolitinib monotherapy after being refractory to 6-mercaptopurine. Treatment resulted in resolution of splenomegaly but no reduction in the variant allele frequency of SH2B3. The patient is now alive more than one year after hematopoietic stem cell transplantation (HSCT). Discussion In a previous study of 100 patients with JMML we first identified seven patients with secondary SH2B3 mutations. Here, we report four additional patients with JMML that appear to be driven by initiating mutations in SH2B3 (Table 1). The mutations identified here result in a truncated protein (patient 1, 3 and 4) or affect the SH2 domain (patient 2). Interestingly, copy neutral loss of heterozygosity of SH2B3 in patient 1, also known as uniparental isodisomy, is a mechanism that has been observed in other genes (e.g. CBL and NF1) in JMML. Since in vitro data showed that loss of LNK results in increased JAK/STAT signaling, we hypothesized that this cohort of patients may benefit from JAK inhibitor therapy. Our data from iPSC-derived JMML like HPCs shows, that those cells with an additional SH2B3 mutation are more sensitive to JAK inhibitors, specifically ruxolitinib, a JAK1/2 inhibitor that is already approved or under investigation in multiple clinical trials. In summary, we expand the list of initiating mutations in JMML to include SH2B3 and raise the possibility of targeting the JAK pathway in these patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Literature Review: Daun Kelor (Moringa oleifera) sebagai Makanan Sehat Pelengkap Nutrisi 1000 Hari Pertama Kehidupan

Stunting is a growth disorder in toddlers as a result of chronic malnutrition so the child's height does not match their age based on the index of height for age (TB/U) with limits (z-score) is less than -2 Standard Deviation. The impact of stunting causes irreversible disruptions to the physical development of children, which causes a decrease in children's cognitive and motor skills, as well as increased susceptibility to suffering from a disease. One way to overcome malnutrition that occurs in children under five needs to be supplemented with supplementary feeding (PMT). Providing balanced nutrition in the first 1,000 days of life (HPK) can meet the needs of macro and micronutrients to avoid or reduce the risk of stunting. High amounts of protein, iron, calcium, and carotenoids are important for the growth and development of children, especially in preventing stunted growth and malnutrition of protein energy. Moringa leaves are reported to have quite a few nutrients, namely, 10 times the vitamin A found in carrots, 17 times calcium milk, 9 times the protein of yogurt, and carotenoids which are more than oranges, carrots, and melons. Moringa oleifera can be used to treat malnutrition and strengthen complementary foods with local plants that are rich in protein and micronutrients. Processed Moringa leaves can be consumed in dry or wet form and mixed in other foodstuffs with minimal costs. This menu can be a complementary food to fulfill the nutritional needs of 1000 HPK.

Media Edukasi Tumbuh Kembang Bayi 0 – 12 Bulan di Wilayah Kerja Puskesmas Tangerang Selatan

The motor development of children in Indonesia is relatively low, based on the Center for Nutrition Research and Development of the Ministry of Health of the Republic of Indonesia in 2012, the results of the Denver Development Screening Test (DDST) II survey found that the prevalence of fine and gross motor disorders in toddlers was 25%, or every 2 out of 1,000 toddlers had motor developmental disorders. Based on Riskesdas 2013 there were 14 million children who experienced emotional development disorders. Toddler period is an important because this period is a critical for memory development to get to know something, so the right stimulus is needed so that the potential of children develops optimally.The purpose of this research is to develop and design educational media for the growth and development of children aged 0 – 12 months. This research was conducted in 2 stages. The first stage is to analyze the understanding of the mother's condition and needs regarding information on growth and development of babies aged 0-12 months, and the compilation of an educational media that can be used to provide a good and easy-to-understand understanding according to the mother's needs, the second stage is the stage of testing the information media . The sample of this research is mothers who have babies aged 0 – 12 months, the test carried out is T-Test Dependent. The results of the study, most of the respondents had a high school education background (52.9%), most of the respondents had more than one child (76.5%) with good socio-economic conditions (70.6%). The results of the statistical test obtained a P Value of 0.001 > (0.05) meaning that there was a significant difference in mother's knowledge about infant growth and development before and after being given the child's PANTASI educational media.

Achievement of Height and Weight Based on Family Characteristics as Early Detection of Nutritional Disorders in Toddlers

Achievement of optimal height and weight of toddlers in their growth is very necessary to improve and determine the quality of human resources in the future. Many factors affect this achievement, one of which is external factors, namely family characteristics (mother's age, family income, mother's employment status, mother's education and number of children). This study aims to determine the achievement of children's height and weight based on family characteristics (mother's age, family income, mother's employment status, mother's education and number of children).This type of research is an analytic survey, with a cross sectional observation design. The sampling technique used was Total Sampling. The sample size in this study was 45 respondents. This research was conducted in January-March 2022. Statistical analysis used in this study was the Pearson Chi-square test.Based on the results of statistical tests, the correlation coefficient table shows that the mother's age, p value = 0.242, mother's education level, p = 0.018, number of children, p = 0.552, mother's work status, p = 0.183, and family income, p = 0.022. The conclusion in this study is that there is a relationship between mother's education level and family income with the achievement of toddler height and weight, there is no relationship between maternal age, number of children and mother's work status with achievement of toddler height and weight. It is recommended to mothers who have toddlers to pay more attention and monitor the growth process of their children.

Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits.

ObjectiveEarly screening contributes to the early detection of children with autism spectrum disorder (ASD). We conducted a longitudinal ASD screening study in a large community setting. The study was designed to investigate the diagnostic rate of ASD screening and determine the effectiveness of ASD screening model in a community-based sample.MethodsWe enrolled children who attended 18- and 24-month well-child care visits in Shanghai Xuhui District. Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Binomial Observation Test (BOT) were selected as screening instruments. Screen-positive children were referred to a tertiary diagnostic center for comprehensive ASD diagnostic evaluation. Screen-negative children received well-child checkups and follow-up every 3–6 months until age three and were referred if they were suspected of having ASD.ResultsA total of 11,190 toddlers were screened, and 36 screen-positive toddlers were diagnosed with ASD. The mean age at diagnosis for these children was 23.1 ± 4.55 months, diagnosed 20 months earlier than ASD children not screened. The diagnostic rate of ASD was 0.32% (95% CI: 0.23–0.45%) in this community-based sample. In addition, 12 screen-negative children were diagnosed with ASD during subsequent well-child visit and follow-up. The average diagnostic rate of ASD rose to 0.43% (95% CI: 0.32–0.57%) when toddlers were followed up to 3 years old. The positive predictive values (PPVs) of M-CHAT-R/F, M-CHAT-R high risk, and BOT for ASD were 0.31, 0.43, and 0.38 respectively.ConclusionOur findings provide reliable data for estimating the rate of ASD detection and identifying the validity of community-based screening model. M-CHAT-R/F combined with BOT can be an effective tool for early detection of ASD. This community-based screening model is worth replicating.

Sensory Based Feeding Intervention for Toddlers With Food Refusal: A Randomized Controlled Trial.

ObjectiveTo investigate the effect of sensory-based feeding treatment for toddlers with food refusal compared with only providing nutrition education.MethodsThirty-two toddlers with food refusal were randomly assigned to an intervention group or the control group. Toddlers in the intervention group received the sensory-based feeding intervention and the duration was for 1 hour for 5 days per week for 4 weeks, and then 1 hour, once a week for 8 weeks. Subjects in both the intervention and control groups received nutritional education once every 4 weeks for 12 weeks. The participants were evaluated at their entry into the study and 12 weeks later based on height, weight, behavior at mealtime using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and sensory processing ability using the Infant/Toddler Sensory Profile.ResultsSixteen toddlers were included in each group. Two subjects in the intervention group and four toddlers in the control group were excluded from the final analysis. Significant improvements in child or parent subscales of the BPFAS were observed in the intervention group. In contrast, there were no significant improvements in any BPFAS scores in the control group.ConclusionSensory-based feeding intervention was effective for improving mealtime behavior in toddlers with food refusal. Therefore, a sensory-based feeding intervention could be considered as an intervention approach to address feeding disorders in toddlers.

The Characteristic of Toddlers Reproductive Health in Posyandu Matahari, Blimbing, Malang, East Java, Indonesia

Background & Objective: The screening of reproductive health plays an essential role of early detectionof reproductive health disorder. There was a study which suggested that there was at least one congenitaldisorder every 100 live births. The Congenital reproductive disorder are mostly found in type of hypospadias,enlarged clitoris, micropenis, fusion of labia majora, and genital ambiguity. Data collected in Saiful AnwarGeneral Hospital revealed that period of 2012-2017 there were 109 hypospadias cases, 64 undescendedtesticle cases, and 80 cases of testicular torsion. However, for the Disorders of Sex Development cases, therewere found 12 cases from period of 2015-2017, with mean age was school age (8-14 years old). Unfortunately,there was no data of congenital reproductive disorder in toddlers, thus we conducted screening of toddlersreproductive health in PosyanduMatahari which located in Malang, East Java, Indonesia in order to find outthe number of incidence of toddlers congenital reproductive disorder and held the early detection.Materials & Methods: This is observational descriptive study. Screening was held in PosyanduMatahariwhich located in GedungSerbagunaRw. 14, Bunulrejo, Jodipan, Blimbing, Malang, in October 27, 2018. Itused method of physical examination (age, weight, height, external genital examination), and if it was foundsuspicious of disease or disorder of toddler congential reproductive health, thus it would be given referral toappropriate health careResults: This screening event involved 46 toddlers (1-5 years old). From 46 toddlers, there were 14 toddlers(30.43%), 10 toddlers suffered from Phimosis (21.74%), 1 toddler with Hydrocele (2.17%), dan 3 toddlerssuffered from UDT (6.52), who were referred to urology clinic in Saiful Anwar General Hospital to undergofurther examination and treatment.Conclusion:The incidence of toddlers reproductive disorder of this event was 30,43%, showed that thisage group (1-5 years old) had significant amount of congenital reproductive disorder and screening playedimportant role for early detection and improving parental knowledge to prevent the delay of treatment forreproductive disorder.

Improving Early Identification and Access to Diagnosis of Autism Spectrum Disorder in Toddlers in a Culturally Diverse Community with the Rapid Interactive screening Test for Autism in Toddlers

The objective of this study was to test a screening model that employs the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T), in an underserved community to improve ASD detection. We collaborated with a large Early Intervention (EI) program and trained 4 providers reliably on the RITA-T. Toddlers received the Modified Checklist for Autism in Toddlers (MCHAT-R/F), the RITA-T, developmental and autism testing, and a best-estimate clinical diagnosis. Eighty-One toddlers were enrolled: 57 with ASD and 24 with Developmental Delay (DD) non-ASD. Wait-time for diagnosis was on average 6 weeks. The RITA-T correlated highly with autism measures and EI staff integrated this model easily. The RITA-T significantly improved the identification and wait time for ASD in this underserved community.

Family navigation to increase evaluation for autism spectrum disorder in toddlers: Screening and Linkage to Services for Autism pragmatic randomized trial.

Young children with autism spectrum disorder can benefit from early detection and intervention to moderate autism spectrum disorder's effect on their development. Routine screening with standardized instruments facilitates early identification. However, many screen-positive children do not receive referrals for evaluation, complete diagnostic evaluations, or engage in services. This is especially true for children of color and those from less educated or low-income families. The Screening and Linkage to Services for Autism trial evaluated the effect of family navigation on referral and evaluation for autism spectrum disorder in screen-positive toddlers. The trial was conducted in an urban, low-income population. It was designed to test "real-world" implementation of family navigation. We randomly assigned 275 children aged 16-30 months with an initial positive autism spectrum disorder screen to receive navigation if indicated or usual care. Navigation increased the number of at-risk toddlers who were evaluated for autism spectrum disorder. It also improved the quality of autism spectrum disorder screening in primary care clinics. However, many children failed to receive indicated referrals for evaluation. Navigation did not improve referral rates. Furthermore, nearly half of families who were potentially eligible for navigation could not be contacted. Other ways of structuring the navigation program may be necessary to improve families' access to and acceptance of navigation, especially in the setting of financial, cultural, and linguistic barriers. Our trial nevertheless showed that family navigation may be an important tool for reducing systemic inequalities in the early identification and treatment of young children with autism spectrum disorder.

T-STAT for detecting autism spectrum disorder in toddlers aged 18-24 months.

The benefits of early intervention for young children with autism spectrum disorder highlight the importance of early diagnosis. Reliable diagnoses of autism spectrum disorder can be made before 24 months of age. However, many children are diagnosed with autism spectrum disorder at a later age. Delayed diagnosis can occur for children with less severe symptoms and lead to missed opportunities for early intervention. This current study was executed to examine the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds in detecting autism spectrum disorder in toddlers between 18 and 24 months of age. One strength of this study was the inclusion of toddlers with autism spectrum disorder or mild-autism spectrum disorder using the strict and relaxed Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism spectrum disorder simultaneously. The results of this study supported that diagnosis of toddlers with autism spectrum disorder could be made reliable before 24 months of age. And the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds was a Level 2 autism-specific screening tool for toddlers aged from 18 to 24 months in Taiwan.

Adherence to screening and referral guidelines for autism spectrum disorder in toddlers in pediatric primary care.

ObjectivesAlthough the American Academy of Pediatrics recommends screening for autism spectrum disorder (ASD) for all young children, disparities in ASD diagnosis and intervention in minority children persist. One potential contributor to disparities could be whether physicians take different actions after an initial positive screen based on patient demographics. This study estimated factors associated with physicians completing the follow-up interview for the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT-F), and referring children to diagnostic services, audiology, and Early Intervention (EI) immediately after a positive screen.MethodsChildren seen in a large primary care network that has implemented universal ASD screening were included if they screened positive on the M-CHAT parent questionnaire during a 16–30 month well child visit (N = 2882). Demographics, screening results, and referrals were extracted from the electronic health record.ResultsChildren from lower-income families or on public insurance were more likely to have been administered the follow-up interview. Among children who screened positive, 26% were already in EI, 31% were newly referred to EI, 11% were referred each to audiology and for comprehensive ASD evaluation. 40.2% received at least one recommended referral; 3.7% received all recommended referrals. In adjusted multivariable models, male sex, white versus black race, living in an English-speaking household, and having public insurance were associated with new EI referral. Male sex, black versus white race, and lower household income were associated with referral to audiology. Being from an English-speaking family, white versus Asian race, and lower household income were associated with referral for ASD evaluation. A concurrent positive screen for general developmental concerns was associated with each referral.ConclusionsWe found low rates of follow-up interview completion and referral after positive ASD screen, with variations in referral by sex, language, socio-economic status, and race. Understanding pediatrician decision-making about ASD screening is critical to improving care and reducing disparities.

Machine Learning and Technology in Diagnostic Research: The Case Study of Cognitive Disorders among Toddlers

This study tries to research the use of technology, specifically machine learning, in the diagnosis of cognitive mental disorders in toddlers based on the child’s biological history right from the birth. The study will also present some distinct symptoms for observation, that point to the onset of such disorders and can assist in the assessment for early diagnosis. Solutions to most of those problems can be achieved with proper and dedicated study of the individual as well as the use of progressive technology that can help in the accurate, efficient and early diagnosis of such disorders. Another important aspect this study highlights is the need for awareness about these disorders and the solutions in the society.

Systematic Review of Level 1 and Level 2 Screening Tools for Autism Spectrum Disorders in Toddlers.

The present study provides a systematic review of level 1 and level 2 screening tools for the early detection of autism under 24 months of age and an evaluation of the psychometric and measurement properties of their studies. Methods: Seven databases (e.g., Scopus, EBSCOhost Research Database) were screened and experts in the autism spectrum disorders (ASD) field were questioned; Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and Consensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist were applied. Results: the study included 52 papers and 16 measures; most of them were questionnaires, and the Modified-CHecklist for Autism in Toddler (M-CHAT) was the most extensively tested. The measures’ strengths (analytical evaluation of methodological quality according to COSMIN) and limitations (in term of Negative Predictive Value, Positive Predictive Value, sensitivity, and specificity) were described; the quality of the studies, assessed with the application of the COSMIN checklist, highlighted the necessity of further validation studies for all the measures. According to COSMIN results, the M-CHAT, First Years Inventory (FYI), and Quantitative-CHecklist for Autism in Toddler (Q-CHAT) seem to be promising measures that may be applied systematically by health professionals in the future.

Physiologic Leg Bowing is not a Physiologic Condition but Instead is Associated with Vitamin D Disorders in Toddlers.

When children around 2-year-old show leg bowing without lower-limb radiographic abnormalities for rickets, the leg bowing is classified as "physiologic" genu varum without conducting a blood test. However, it has recently been suggested that toddlers who are diagnosed with physiologic genu varum may in fact have some form of bone metabolic disorder. In this 1:2 case-control study, blood samples were obtained from 33 toddlers with genu varum without radiographic abnormalities for rickets and 66 age- and gender-matched healthy children. Serum alkaline phosphatase (sALP), intact parathyroid hormone (siPTH), 25-hydroxy vitamin D [s25(OH)D], calcium (sCa), and inorganic phosphate (sP) were measured. s25(OH)D of the subjects with genu varum (24.8 ng/ml) were significantly lower than those of the control (33.6 ng/ml) (p < 0.001). The frequency of vitamin D insufficiency/deficiency (< 20ng/ml) of the subjects with genu varum (39%) was significantly higher than that in the control (14%) (p = 0.004) (odds ratio by vitamin D insufficiency/deficiency: 4.1 [1.5-11.1, p = 0.004]). sCa in subjects with genu varum (10.2ng/ml) were significantly higher than in control (9.8ng/ml) (p < 0.001), as were sALP (1057IU/l) and siPTH (28.4pg/ml) (740IU/l and 8.8pg/ml in control, respectively; p < 0.001). siPTH levels were associated with s25(OH)D levels in subjects with genu varum (r = - 0.57, p < 0.001), while no association was observed in the control (r = 0.11, p = 0.36). Genu varum without radiographic abnormalities of rickets was associated with both vitamin D and bone-metabolic disorders in toddlers, indicating that physiologic genu varum is not a physiologic condition in toddlers.

Sleep disorders in childhood

Sleep disorders have reached epidemic rates in the modern world. It is important to note that they can affect children as well as adults. Sleep is of the utmost importance for the maintenance of body homeostasis. Many disease processes affecting sleep have been associated with numerous symptoms, including cognitive impairment, fatigue as well as a wide range of behavioral, hormonal and metabolic derangements. Sleep disorders in childhood can be classified by age of incidence (in infants, toddlers, school-age children or adolescents) and by the exact nature of the symptoms. They are classified in insomnias, hypersomnias, parasomnias, circadian rhythm disorders and respiratory disorders which affect sleep. Parasomnias are the most common sleep disorders in toddlers, with night terrors, nightmares and sleepwalking being the most common. Respiratory disorders are the most important in older children, especially obstructive sleep apnea syndrome. All sleep disorders are clinically manifested with symptoms of sleep deprivation. Their management always involves improvement of sleep hygiene, though in some cases (such as obstructive sleep apnea) specific medical treatment is also available and warranted. A three-way relationship of trust, compassion and cooperation between child, family and healthcare professional is a prerequisite for the effective management of childhood sleep disorders. Nursing staff are the main factor cultivating that relationship in the context of inpatient care.

Prevalence of sleep problems and its relation to sleeping habits in toddlers

Background: Sleep problems in children have serious physical and psychological consequences such as obesity, aggression and attention deficit disorder in toddlers. The aim of the present study was to determine the prevalence of sleep problems and its relation with sleeping habits of toddlers in 2017.&#x0D; Methods: By random sampling from rural families of Razan city of Hamadan province, 120 mothers of 12- to 36-month-old children were selected and data collection tools included contextual questions, medical history and 33-question questionnaire of children's sleep habits (CSHQ) completed. Data were analyzed by SPSS software version 23, independent t-test, chi-square, Pearson correlation coefficient and multiple linear regression.&#x0D; Results: The mean age of the children was 22.82±7.53 months and 55% of them were boys and the prevalence of sleep problems was 70.8% (95% confidence interval: 71.9-69.7). The average sleep duration of the children was 11 hours and more than 60% of the children went to bed after 23 o'clock. Results show that age is an important factor in most dimensions of CSHQ and age predicts daytime sleepiness (β = -0.263), nocturnal wakefulness (β = -0.113) and duration, Sleep time (β = -0.108) and sleep resistance (β = 0.194) respectively. Also, parents' education and child's current weight were predictors of subscales of CSHQ questionnaire (P &lt;0.05). In addition, there was a positive and significant correlation between sleep duration with infant sleep anxiety (r = 0.527) and resistance to sleep (r = 0.473) as well as nocturnal wakefulness with parasomnia (r = 0.416) (P &lt;0.001).&#x0D; Conclusion: Given the alarming prevalence of sleep problems in toddlers in the present study and the impact of some changeable factors on children's sleep health, designing interventions aimed at educating mothers to improve healthy sleep habits in toddlers is necessary.

Prevalence of sleep problems and its relation to sleeping habits in toddlers

Background: Sleep problems in children have serious physical and psychological consequences such as obesity, aggression and attention deficit disorder in toddlers. The aim of the present study was to determine the prevalence of sleep problems and its relation with sleeping habits of toddlers in 2017.&#x0D; Methods: By random sampling from rural families of Razan city of Hamadan province, 120 mothers of 12- to 36-month-old children were selected and data collection tools included contextual questions, medical history and 33-question questionnaire of children's sleep habits (CSHQ) completed. Data were analyzed by SPSS software version 23, independent t-test, chi-square, Pearson correlation coefficient and multiple linear regression.&#x0D; Results: The mean age of the children was 22.82±7.53 months and 55% of them were boys and the prevalence of sleep problems was 70.8% (95% confidence interval: 71.9-69.7). The average sleep duration of the children was 11 hours and more than 60% of the children went to bed after 23 o'clock. Results show that age is an important factor in most dimensions of CSHQ and age predicts daytime sleepiness (β = -0.263), nocturnal wakefulness (β = -0.113) and duration, Sleep time (β = -0.108) and sleep resistance (β = 0.194) respectively. Also, parents' education and child's current weight were predictors of subscales of CSHQ questionnaire (P &lt;0.05). In addition, there was a positive and significant correlation between sleep duration with infant sleep anxiety (r = 0.527) and resistance to sleep (r = 0.473) as well as nocturnal wakefulness with parasomnia (r = 0.416) (P &lt;0.001).&#x0D; Conclusion: Given the alarming prevalence of sleep problems in toddlers in the present study and the impact of some changeable factors on children's sleep health, designing interventions aimed at educating mothers to improve healthy sleep habits in toddlers is necessary.

Pregnancy and cord vitamin D status and symptoms of autism spectrum disorders in toddlers: An Odense child cohort study

IntroductionVitamin D deficiency is widespread globally in pregnant women and is suggested to contribute to offspring risk of symptoms of autism spectrum disorders (ASD), but findings are inconsistent.ObjectivesTo investigate whether low prenatal 25OHD exposure and 25OHD status in early life increase risk of early symptoms of ASD.AimsTo investigate early signs of ASD.MethodsFrom the prospective birth cohort, Odense child cohort (n = 2.549), Denmark, we included singletons with their mothers with available serum concentrations of 25OHD at early pregnancy (n = 1.231), late pregnancy (n = 1.361), and birth (n = 2.082). ASD symptoms were rated by parents on the pervasive developmental problem (PDP) scale of the Child behavior checklist for ages 1½-5 (CBCL 1½-5). Associations between 25OHD and PDP score were analyzed by multiple linear and logistic regression models. A priori included covariates were gestational age, child gender, birth weight, season of birth, parity, parental psychiatric diagnoses, maternal age, smoking habits, alcohol consumption, education level, vitamin D supplementation, and pre-gestational BMI.ResultsMeans (SD) of 25OHD for early pregnancy, late pregnancy, and cord were 65.5 (21.5), 78.7 (27.0), and 47.0 (21.7) nmol/L, respectively. PDP data were obtained at a mean (SD) of 2.7 (0.6) years of age. Data from the regression analyses are pending.ConclusionsIn this well-off cohort with relatively high levels of cord 25OHD, power calculations allows us to detect a true change of 0.02 PDP scores per 10 nmol/L change in 25OHD. Further studies will clarify whether early PDP scores track later ASD diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Network over-connectivity differentiates autism spectrum disorder from other developmental disorders in toddlers: A diffusion MRI study.

Advanced connectivity studies in toddlers with Autism Spectrum Disorder (ASD) are increasing and consistently reporting a disruption of brain connectivity. However, most of these studies compare ASD and typically developing subjects, thus providing little information on the specificity of the abnormalities detected in comparison with other developmental disorders (other-DD). We recruited subjects aged below 36 months who received a clinical diagnosis of Neurodevelopmental Disorder (32 ASD and 16 other-DD including intellectual disability and language disorder) according to DSM-IV TR. Structural and diffusion MRI were acquired to perform whole brain probabilistic and anatomically constrained tractography. Network connectivity matrices were built encoding the number of streamlines (DNUM ) and the tract-averaged fractional anisotropy (DFA ) values connecting each pair of cortical and subcortical regions. Network Based Statistics (NBS) was finally applied on the connectivity matrices to evaluate the network differences between the ASD and other-DD groups. The network differences resulted in an over-connectivity pattern (i.e., higher DNUM and DFA values) in the ASD group with a significance of P < 0.05. No contra-comparison results were found. The over-connectivity pattern in ASD occurred in networks primarily involving the fronto-temporal nodes, known to be crucial for social-skill development and basal ganglia, related to restricted and repetitive behaviours in ASD. To our knowledge, this is the first network-based diffusion study comparing toddlers with ASD and those with other-DD. Results indicate the detection of different connectivity patterns in ASD and other-DD at an age when clinical differential diagnosis is often challenging. Hum Brain Mapp 38:2333-2344, 2017. © 2017 Wiley Periodicals, Inc.

Diagnostic stability of autism spectrum disorder in toddlers prospectively identified in a community-based setting: Behavioural characteristics and predictors of change over time.

Autism spectrum disorder diagnoses in toddlers have been established as accurate and stable across time in high-risk siblings and clinic-referred samples. Few studies have investigated diagnostic stability in children prospective identified in community-based settings. Furthermore, there is a dearth of evidence on the individual behaviours that predict diagnostic change over time. The stability and change of autism spectrum disorder diagnoses were investigated from 24 to 48 months in 77 children drawn from the Social Attention and Communication Study. Diagnostic stability was high, with 88.3% overall stability and 85.5% autism spectrum disorder stability. The behavioural markers at 24 months that contributed to diagnostic shift off the autism spectrum by 48 months included better eye contact, more directed vocalisations, the integration of gaze and directed vocalisations/gestures and higher non-verbal developmental quotient. These four variables correctly predicted 88.7% of children into the autism spectrum disorder-stable and autism spectrum disorder-crossover groups overall, with excellent prediction for the stable group (96.2%) and modest prediction for the crossover group (44.4%). Furthermore, non-verbal developmental quotient at 24 months accounted for the significant improvement across time in 'Social Affect' scores on the Autism Diagnostic Observation Schedule for both groups and was the only unique predictor of diagnostic crossover. These findings contribute to the body of evidence on the feasibility of diagnoses at earlier ages to facilitate children's access to interventions to promote positive developmental outcomes.