Early Identification Of At-risk Children Research Articles

The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors

BackgroundDouble burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0–59 months in Ethiopia.MethodsPooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0–59 months were included in the study. Height-for-age z-scores (HAZ) less than − 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below − 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO.ResultsThe prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94–2.85)] in 2005 to 0.87% [95%CI: (0.07–1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13–1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01–2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19–5.88)], and lived in families with 1–4 household members [AOR: 1.52, 95%CI: (1.02–2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42–7.95)].ConclusionThe study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.

Childhood adversity, emergent psychopathology, and adolescent-to-parent violence: Process mining trajectories from police and health service administrative data

AimTo discover developmental risk trajectories for emerging mental health problems among a sample of adolescent family violence offenders to inform service delivery focused on early preventative interventions with children and their families.DesignA retrospective case-series design employing data linkage.SettingAn Australian regional location.ParticipantsAdolescents (born between 1994 and 2006) issued a legal action by the NSW Police Force for an adolescent-to-parent family violence offense (n = 775).ProcedureDiscrete routinely collected episode data in police and health service electronic records for children, and police data for parents, were linked and transformed into longitudinal person-based records from birth to 19 years to identify trajectories for mental health problems.ResultsSixty-three percent (n = 489) of adolescents had contact with a mental health service before age 19. The majority of these adolescents received a diagnosis for a stress or anxiety disorder (n = 200). Trajectory analysis found childhood exposure to parental intimate partner violence and parental drug and/or alcohol use were dominant events in the pathway to receiving a mental health diagnosis. Being a victim of a sexual offense was found to increase the odds of adolescents having a diagnosis for each of the main mental health categories (with the exception of drug or alcohol disorders).ConclusionsPathways to mental health problems were characterized by inter-related adverse childhood events and poly-victimization for many adolescents. Early identification of at-risk children must be a continued focus of child health services in order to reduce and identify early emerging mental health problems.

Severe Developmental Dyscalculia Is Characterized by Core Deficits in Both Symbolic and Nonsymbolic Number Sense

A long-standing debate concerns whether developmental dyscalculia is characterized by core deficits in processing nonsymbolic or symbolic numerical information as well as the role of domain-general difficulties. Heterogeneity in recruitment and diagnostic criteria make it difficult to disentangle this issue. Here, we selected children (n = 58) with severely compromised mathematical skills (2 SD below average) but average domain-general skills from a large sample referred for clinical assessment of learning disabilities. From the same sample, we selected a control group of children (n = 42) matched for IQ, age, and visuospatial memory but with average mathematical skills. Children with dyscalculia showed deficits in both symbolic and nonsymbolic number sense assessed with simple computerized tasks. Performance in the digit-comparison task and the numerosity match-to-sample task reliably separated children with developmental dyscalculia from controls in cross-validated logistic regression (area under the curve = .84). These results support a number-sense-deficit theory and highlight basic numerical abilities that could be targeted for early identification of at-risk children as well as for intervention.

Early identification of at-risk children: service improvement study using immunisation status.

Children who have adverse childhood experiences (ACEs) tend to have more physical and mental health problems when they are adults compared with people who do not have ACEs. Evidence suggests that partial or no immunisation status can be associated with factors (including ACEs) that make children at higher risk of poor outcomes than immunised children. To explore the idea that 'missed immunisations' could be used as a proxy indicator in identifying children at risk of worse outcomes. Service improvement study in seven GP practices in south London, UK. Children aged 0-3 years who were ≥3 months late for immunisations were identified; their computer notes were reviewed during interdisciplinary meetings between health visitors (HVs) and GP practice staff. A bespoke template was used to guide discussions and to record action plans. Evaluation methods included a survey of practitioners and anonymised questionnaires about care management for a sample of children. Issues of concern, including some ACEs (for example, domestic abuse, mental health concerns in parent), were identified in 57% of children. Ninety-four per cent of practitioners found multidisciplinary meetings useful; 62% of practitioners changed the way they thought about providing care to very young children and their families. Of the children discussed during multidisciplinary meetings, 38% subsequently caught up on immunisations. 'Late for immunisations' appears to be a useful indicator for proactively identifying children with issues that make them at risk of poorer outcomes. Integrated working between GPs and HVs is important for ensuring targeted care is provided to families.

Below Average Cognitive Ability-An under Researched Risk Factor for Emotional-Behavioural Difficulties in Childhood.

Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenges. This observational study examines the longitudinal relationship between early cognitive ability and emotional-behavioral difficulties (EBDs) between the age of three and nine. Participants include 7134 children from the population-based cohort study growing up in Ireland. Cognitive ability was measured at age three using the Picture Similarities Scale. A t-score one to two standard deviations below the mean was defined as below average cognitive ability (n = 767). EBDs were measured using the Strengths and Difficulties Questionnaire (SDQ) at three, five, and nine years of age. Generalized linear mixed models and logistic regression were used to examine the relationship. Below average cognitive ability was an independent predictor of higher longitudinal SDQ scores. After adjustment, children with below average cognitive ability were 1.39 times more likely (AOR 1.39, 95% CI 1.17–1.66, p < 0.001) to experience a clinically significant EBD between the ages of three to nine years. This study demonstrates the increased risk of EBDs for children with below average cognitive ability. A scalable method of early identification of at-risk children should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.

Early prediction of encephalopathic transformation in children with benign epilepsy with centro-temporal spikes

BackgroundMost children with Benign epilepsy with centro-temporal spikes (BECTS) undergo remission during late adolescence and do not require treatment. In a small group of patients, the condition may evolve to encephalopathic syndromes including epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), or Landau-Kleffner Syndrome (LKS). Development of prediction models for early identification of at-risk children is of utmost importance. AimTo develop a predictive model of encephalopathic transformation using data-driven approaches, reveal complex interactions to identify potential risk factors. MethodsData were collected from a cohort of 91 patients diagnosed with BECTS treated between the years 2005–2017 at a pediatric neurology institute. Data on the initial presentation was collected based on a novel BECTS ontology and used to discover potential risk factors and to build a predictive model. Statistical and machine learning methods were compared. ResultsA subgroup of 18 children had encephalopathic transformation. The least absolute shrinkage and selection operator (LASSO) regression Model with Elastic Net was able to successfully detect children with ECSWS or LKS. Sensitivity and specificity were 0.83 and 0.44. The most notable risk factors were fronto-temporal and temporo-parietal localization of epileptic foci, semiology of seizure involving dysarthria or somatosensory auras. ConclusionNovel prediction model for early identification of patients with BECTS at risk for ECSWS or LKS. This model can be used as a screening tool and assist physicians to consider special management for children predicted at high-risk. Clinical application of machine learning methods opens new frontiers of personalized patient care and treatment.

Dimension- and context-specific expression of preschoolers' disruptive behaviors associated with prenatal tobacco exposure

ObjectivePrecise phenotypic characterization of prenatal tobacco exposure (PTE)–related disruptive behavior (DB) that integrates nuanced measures of both exposures and outcomes is optimal for elucidating underlying mechanisms. Using this approach, our goals were to identify dimensions of DB most sensitive to PTE prior to school entry and assess contextual variation in these dimensions. MethodsA community obstetric sample of N = 369 women (79.2% lifetime smokers; 70.2% pregnancy smokers) from two Midwestern cities were assessed for PTE using cotinine-calibrated interview-based reports at 16, 28, and 40 weeks of gestation. A subset of n = 244 who completed observational assessments with their 5-year-old children in a subsequent preschool follow-up study constitute the analytic sample. Using two developmentally-meaningful dimensions previously associated with emergent clinical risk for DB—irritability and noncompliance—we assessed children with 2 parent-report scales: the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) and the Early Childhood Inventory (ECI). We also assessed children by direct observation across 3 interactional contexts with the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). We used generalized linear models to examine between-child variability across behavioral dimensions, and mixed effects models to examine directly observed within-child variability by interactional context. ResultsIncreasing PTE predicted increasing impairment in preschoolers' modulation of negative affect (irritability), but not negative behavior (noncompliance) across reported (MAP-DB) and observed (DB-DOS) dimensional measures. Moreover, children's PTE-related irritability was more pronounced when observed with parents than with the examiner. The ECI did not detect PTE-related irritability nor noncompliance. ConclusionsNuanced, dimension- and context-specific characterization of PTE-related DB described can optimize early identification of at-risk children.

Radiologic-pathologic evidence of brain injury: hypoperfusion in the Papez circuit results in poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy.

To provide radiologic-pathologic correlation of brain injury in the Papez circuit in hypoxic-ischemic encephalopathy (HIE) neonates and correlate radiologic findings with long-term neurodevelopmental outcomes. Twenty full-term HIE neonates were evaluated. Cerebral blood flow (CBF) values, obtained through pulsed arterial spin labeling (ASL) perfusion-weighted MRI, were compared by permutation test to identify brain regions with statistically significant perfusion changes between 14 HIE neonates without evidence of developmental delay by Bayley-III (mean age 8.2 ± 7.2days) and 6 HIE neonates with evidence of developmental delay (mean age 13.1 ± 8.0days). Four histopathologic studies on specimens were taken from post-mortem brains of another group of infants (mean age 10 ± 6.8days) with HIE. The infants were not the same ones who had MRIs. Significantly decreased perfusion in Papez circuit was found in HIE neonates with developmental delay compared with HIE neonates without delay. Decreased ASL perfusion values were seen in Papez circuit structures of the fornix (p = 0.002), entorhinal cortex (p = 0.048), amygdala (p = 0.036), hippocampus (p = 0.033), and thalamus (p = 0.036). In autopsy specimens of neonates with HIE, anoxic (eosinophilic) neurons, reactive astrocytes, and white matter rarefaction were observed in these regions, providing pathology correlation to the imaging findings of HIE. The Papez circuit is susceptible to hypoxic-ischemic injury in neonates as demonstrated by perfusion-weighted imaging and histopathology. This sheds new light onto a possible non-familial mechanism of neuropsychiatric disease evolution initiated in the infant period and raises the potential for early identification of at-risk children.

Estimating the population effect of maternal alcohol use disorders on the educational achievement of children

ABSTRACTObjectivesPrevious research has identified that heavy maternal alcohol use impacts on a child’s health and development including poor cognitive and educational outcomes. However, very few studies have used objective measures of heavy alcohol-use and standardised school-based measures. Further, the magnitude of the effect of heavy maternal alcohol use on the educational outcomes of children in Australia is unknown. The primary aim of the project was to examine the association between in-utero and childhood exposure to maternal alcohol use disorder, which provides a proxy for heavy alcohol use, and children’s educational outcomes.&#x0D; ApproachThis Western Australian population cohort study made use of linked administrative data to compare the educational outcomes of a cohort of exposed children born between 1989 and 2007 whose mother had an alcohol related diagnosis recorded on health datasets, with children whose mother did not have a diagnosis. The exposed cohort of mothers was frequency matched on maternal age within Indigenous status, and year of child’s birth with a comparison cohort of mothers without an alcohol-related diagnosis. Records were linked with education records up to 2011, which included the results of standardised state and national testing for children (ages 8-14), and school attendance data (ages 6-18). Mixed multivariate models were used to examine the relationship between exposure, and timing of exposure in relation to pregnancy, and the risk of failure to meet educational benchmarks for reading, writing, spelling, numeracy and school attendance. Separate analyses were run for Indigenous and non-Indigenous children.&#x0D; ResultsA higher proportion of both Indigenous and non-Indigenous exposed children failed to reach minimum standards for all domains of testing compared to those in the unexposed cohort. The risk of failure in the exposed cohort remained significant with adjustment for a set of known confounders and there was no consistent relationship between timing of exposure and academic performance.&#x0D; ConclusionThis project provides a unique view of how maternal alcohol use disorders affect a child’s educational outcomes. The use of linked administrative data overcomes the use of retrospective recall of past behaviour, and self-reports of drinking patterns which may be considered socially unacceptable. Results of this project indicate that children whose mothers have an alcohol use disorder are academically at risk. These results suggest that routine monitoring of maternal alcohol use, early identification of at-risk children and intervention at both the school and family level may assist vulnerable children to reach academic benchmarks.

Learning Disabilities: Opportunities and challenges in Oman.

Learning Disabilities: Opportunities and challenges in Oman.

Πιλοτική διερεύνηση των ψυχομετρικών χαρακτηριστικών μιας κλίμακας για την εκτίμηση γλωσσικών και γνωστικών λειτουργιών από γονείς παιδιών προσχολικής ηλικίας

This pilot study examined the psychometric characteristics of a scale to be used by parents of young children for rating cognitive skills and literacy development. The scale was roughly based on the parent form of “Ratings of Everyday Academic &amp;amp; Cognitive Skills” (REACS) (Lamb, 2008) in an effort to develop a cost-effective tool that could potentially increase the predictive validity of early screening assessments. The original scale had been developed to contain three indexes (academic skills, cognitive skills, self-regulation) related to school functioning subscales (Math, Reading, Writing, Language, Learning, Memory, Problem Solving, Attention, Hyperactivity Control, Impulse Control, and Organization). Raters respond to each item on a 6-point scale: 1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Usually, and 5 = Always and 6= Unknown. For this study we collected 243 forms from parents while individualized testing was conducted with 22 Kindergarten children. A subsample of parents (N=44) completed the scale a second time to investigate reliability of their ratings. Test-retest reliability of the raters' estimations and the internal consistency of the scale were examined, while the validity of the Greek scale was established by inspecting the factor structure through exploratory factor analyses. Associations with child achievement measures (letter names and sounds, phonological awareness, vocabulary, invented spelling, word reading, etc.) were also examined. Study's initial findings regarding the psychometric properties of the scale support our claim that it should be used by parents of young children for rating child's cognitive, language and academic skills. They are also discussed within the context of early identification of at-risk children within the school for providing early intervention programs.

Family-Based Intervention May Help Prevent Anxiety Disorders in Children

Family-Based Intervention May Help Prevent Anxiety Disorders in Children

Posttraumatic stress following acute medical trauma in children: a proposed model of bio-psycho-social processes during the peri-trauma period.

Millions of children worldwide experience acute medical events. Children's responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.

Early prevention of antisocial behavior (ASB): A comparative ethical analysis of psychosocial and biomedical approaches

Scientific research regarding juvenile delinquency increasingly emphasizes the importance of early identification of at-risk children and early preventive interventions. Recent developments in the life sciences give a special boost to this development. The corresponding ethical discussion, however, seems to be characterized by a remarkable discrepancy. Life science approaches toward antisocial behavior (ASB) are frequently confronted by controversial discussions as to their ethical, social and legal implications. By contrast, ethics hardly takes notice of currently existing early ASB prevention practices that largely result from social sciences. This article investigates whether biomedical approaches are indeed ethically more problematic or whether instead this gap in the ethical debate manifests undue “bio-exceptionalism”. To this end, existing ASB prevention practices and potential biomedically informed future developments are presented and discussed. A series of potential drawbacks, as highlighted in bioethics, are reviewed; and whether, when and how far these might also apply to established psychosocial practices will be explored. We conclude that negative ethical implications might result from all kinds of early screening and prevention practices irrespective of their disciplinary origin. Therefore, it is a moral imperative to include not only future biomedical developments in ethical research, but to critically investigate current psychosocial practices as well.

Current concepts in the management of stroke in children with sickle cell disease

Stroke is the most significant complication of sickle cell disease (SCD) in children with the potential for major morbidity and mortality. The recent two decades have witnessed tremendous advancements in understanding the pathophysiology of stroke, risk stratification of children and the role of timely preventative interventions. The aetiopathogenesis, types of stroke and specific risk factors are reviewed here with special emphasis on the role of transcranial Doppler ultrasonogram in the early identification of at-risk children. Published studies on primary and secondary prevention of stroke in children with SCD are analysed with respect to the levels of evidence, in favour of preventative and therapeutic strategies. The roles of the neurologist and the neurosurgeon are highlighted.

Youth crime and justice: Key messages from the Edinburgh Study of Youth Transitions and Crime

Based on findings from the Edinburgh Study of Youth Transitions and Crime, this article challenges the evidence-base which policy-makers have drawn on to justify the evolving models of youth justice across the UK (both in Scotland and England/Wales). It argues that to deliver justice, systems need to address four key facts about youth crime: serious offending is linked to a broad range of vulnerabilities and social adversity; early identification of at-risk children is not an exact science and runs the risk of labelling and stigmatizing; pathways out of offending are facilitated or impeded by critical moments in the early teenage years, in particular school exclusion; and diversionary strategies facilitate the desistance process.The article concludes that the Scottish system should be better placed than most other western systems to deliver justice for children (due to its founding commitment to decriminalization and destigmatization). However, as currently implemented, it appears to be failing many young people.

Childhood Predictors of the Metabolic Syndrome in Middle-Aged Adults: The Muscatine Study

To investigate the association between components of the metabolic syndrome (MetS) measured during childhood/adolescence, and adult MetS. This investigation focused on members of the Muscatine Study Longitudinal Adult Cohort. Predictor variables were risk factor measurements obtained between 1970 and 1981 when cohort members participated in school survey examinations. Risk factor measurements obtained between 1982 and 2008 when cohort members participated in follow-up examinations as young and middle-aged adults were used for MetS classification. 33.0% (29.7% of 474 women; 37.0% of 384 men) of cohort members were classified as having the MetS. The initial MetS classification occurred at ages ranging from 23 to 52 years, with a mean age of 37.2 years (SD = 7.4). Cohort members with the MetS had significantly higher body mass index, systolic blood pressure, and triglycerides at the time they participated in the school survey examinations (P < .0001). Estimated probabilities of remaining MetS free at age 35 for those whose school survey body mass index and triglyceride measurements were both <50th vs >/=75th percentiles were strikingly different (0.94 vs 0.42). BMI is the strongest childhood predictor of adult MetS. Early identification of at-risk children may reduce the burden of atherosclerotic cardiovascular disease.