Non-institutionalized Children Research Articles

Hearing Impairment and School Engagement Outcomes in US Children

Ensuring appropriate school engagement for deaf or hard of hearing (DHH) children in the US is important for improving their long-term outcomes as they grow into adults. To examine the associations between hearing loss (HL), its sequelae (speech and/or language disorders, behavioral and/or conduct problems, and neuropsychiatric and/or learning disorders), and various school engagement measures among school-aged children in the US. This cross-sectional study combined data from the nationally representative 2016-2021 National Survey of Children's Health. A total of 155 178 randomly selected children (weighted, approximately 49 340 700 children) aged 6 to 17 years with a parent or caregiver who responded to an address-based survey by mail or online were included. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population-based estimates representative of all noninstitutionalized school-aged US children and adolescents residing in housing units. Diverse school engagement measures, including extracurricular participation in sports, clubs, paid work, volunteer work, and organized lessons, as well as educational performance variables, including missed school days, not caring about doing well in school, not doing required homework, grade repetition, and parent or guardian contacted by school. Of the estimated 49 340 700 children aged 6 to 17 years (41.1% aged 6-10 years; 51.1% male; 54.7% without underrepresented minority status), an estimated 1.4% (95% CI, 1.2%-1.5%) were reported by their parent or guardian to have deafness or hearing problems. Having DHH status was associated with significantly worse outcomes on 8 of 10 school engagement measures (eg, participation in sports: adjusted odds ratio [AOR], 0.75 [95% CI, 0.60-0.93]; missed school days: AOR, 2.98 [95% CI, 2.21-4.00]), even after adjustment for age, sex, underrepresented minority status, highest educational level of parent or guardian, federal poverty level of the household, and primary language in the household. Moreover, although subgroup analyses of DHH children with and without HL sequelae revealed significant differences (speech and/or language disorder: AOR, 5.83 [95% CI, 4.31-7.89]; behavioral and/or conduct problem: AOR, 2.75 [95% CI, 2.10-3.60]; neuropsychiatric and/or learning disorder: AOR, 3.06 [95% CI, 2.39-3.91]), HL sequelae only partially mediated the associations between these disparities. In this cross-sectional study, DHH status itself may have been the primary factor directly associated with school engagement disparities. These findings suggest the need for greater emphasis on educational accommodations and support for hearing status itself, independent of the presence or absence of HL sequelae.

Academic Performance in Institutionalized and Noninstitutionalized Children: The Role of Cognitive Ability and Negative Lability.

More research is needed to understand the factors that contribute to low academic achievement in institutionalized children. The aim of this study was to investigate the relationship between cognitive and emotion regulation skills and academic performance, by comparing institutionalized and noninstitutionalized Portuguese children. The sample comprised 94 participants (46 institutionalized (22 boys) and 48 noninstitutionalized (23 boys) children), aged between 6 and 10 years, matched for age and sex. We used Raven's Colored Progressive Matrices (RCPM) to measure cognitive abilities. Emotional regulation and negative lability were assessed using the Emotion Regulation Questionnaire (ERC). Academic performance was assessed with the Competence Academic Scale (CAS) of the Portuguese version of the Social Skills Rating System-Teacher Form (SSRS-T). Institutionalized children exhibited poorer academic performance than their noninstitutionalized counterparts (effect size, η2 = 0.174). Cognitive ability (β = 0.28) and negative lability (β = -0.28) were significant predictors of academic performance. In addition to institutionalization, cognitive ability, and the challenges of managing negative emotions may contribute to the observed differences in academic performance. Interventions aimed at fostering cognitive and emotional competencies may play a protective role for institutionalized children facing academic and social difficulties.

Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic

The COVID-19 pandemic has disrupted medical care use. Yet information on how the pandemic has affected pediatric preventive care use in the US is lacking. To examine the prevalence of and risk and protective factors for delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic, further stratified by race and ethnicity to assess associations by groups. This cross-sectional study used data from the 2021 National Survey of Children's Health (NSCH) collected between June 25, 2021, and January 14, 2022. Weighted data from the NSCH survey are representative of the population of noninstitutionalized children aged 0 to 17 years in the US. For this study, race and ethnicity were reported as American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, or multiracial (≥2 races). Data analysis was performed on February 21, 2023. The Andersen behavioral model of health services use was used to assess predisposing factors, enabling factors, and need factors. The main outcome was delayed or missed pediatric preventive care due to the COVID-19 pandemic. Bivariate and multivariable Poisson regression analyses were performed using multiple imputation with chained equations. Of the 50 892 NSCH respondents, 48.9% were female and 51.1% were male; their mean (SD) age was 8.5 (5.3) years. With regard to race and ethnicity, 0.4% were American Indian or Alaska Native, 4.7% were Asian or Pacific Islander, 13.3% were Black, 25.8% were Hispanic, 50.1% were White, and 5.8% were multiracial. More than one-fourth of children (27.6%) delayed or missed preventive care. In multivariable Poisson regression using multiple imputation, Asian or Pacific Islander children (prevalence ratio [PR], 1.16 [95% CI, 1.02-1.32]), Hispanic children (PR, 1.19 [95% CI, 1.09-1.31]), and multiracial children (PR, 1.23 [95% CI, 1.11-1.37]) were more likely to have delayed or missed preventive care compared with non-Hispanic White children. Among non-Hispanic Black children, risk and protective factors included age 6 to 8 years (vs 0-2 years [PR, 1.90 (95% CI, 1.23-2.92)]) and difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.68 (95% CI, 1.35-2.09)]). Among multiracial children, risk and protective factors included age 9 to 11 years (vs 0-2 years [PR, 1.73 (95% CI, 1.16-2.57)]), lower household income (<100% vs ≥400% federal poverty level: 0.52 [0.35-0.79]), and 2 or more vs 0 health conditions (PR, 1.54 [95% CI, 1.14-2.08]). Among non-Hispanic White children, risk and protective factors included older age (9-11 years vs 0-2 years [PR, 2.05 (95% CI, 1.78-2.37)]), 4 or more children vs 1 child in the household (PR, 1.22 [95% CI, 1.07-1.39]), fair or poor vs excellent or very good caregiver health (PR, 1.32 [95% CI, 1.18-1.47]), difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.36 (95% CI, 1.22-1.52)]), good vs excellent or very good perceived child health (PR, 1.19 [95% CI, 1.06-1.34]), and 2 or more vs 0 health conditions (PR, 1.25 [95% CI, 1.12-1.38]). In this study, the prevalence of and risk factors for delayed or missed pediatric preventive care varied by race and ethnicity. These findings may guide targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.

The Relationship Between Temperament Characteristics and Emotion Regulation Abilities in Institutionalized and Noninstitutionalized Children.

This study examined the role of institutionalization and temperament dimensions on emotion regulation and negative lability in school-aged (6-10years) children. Participants were 46 institutionalized (22 boys; 24 girls) and 48 noninstitutionalized children (23 boys; 25 girls), matched in age and sex. Emotion regulation and negative lability were assessed with the Emotion Regulation Checklist (ERC). The School-Age Temperament Inventory (SATI) was used to measure temperament dimensions. No significant between-group differences emerged in temperament dimensions, emotion regulation and negative lability. After controlling for institutionalization status, results indicated that (a) approach/withdrawal (sociability) and persistence positively predicted emotion regulation, (b) negative reactivity positively predicted negative lability, and (c) persistence negatively predicted negative lability. Institutionalization did not predict emotion regulation or negative lability. The protective role that specific temperament characteristics, such as persistence and approach/withdrawal (sociability), may have for at risk populations (e.g., institutionalized) and typically developing (e.g., noninstitutionalized) children is highlighted.

Abstract P459: Socioeconomic Disadvantage and Adverse Childhood Events Associated With Risk of Obesity and Insufficient Sleep in Children

Introduction: Obesity and sleep problems are risk factors for various health problems. Children with both obesity and sleep problems are more likely than children with only one condition to develop cardiometabolic disorders later in life. This study estimates the prevalence of children with obesity and insufficient sleep duration and examines related demographic and social economic factors for their co-occurrence among children in the United States. Methods: Data were from the 2019 and 2020 National Survey of Children’s Health (NSCH). The NSCH provides national and state-level data on the physical and emotional health of non-institutionalized American children 0-17 y of age. For this study, children 10-17 y without missing data in the study variables (N=35678) were included. Age-adjusted, sex-specific body mass index was classified as underweight (&lt;5th percentile); normal weight (5th to &lt;85th percentile); overweight (85th to &lt;95th percentile); or obese (≥95th percentile). Age-appropriate sleep duration was defined according to American Academy of Sleep Medicine guidelines (nighttime sleep for ages 10-12 y=9-12 h; 13-17 y=8-10 h). Children who slept below the minimum recommended duration on an average weeknight in the past week were classified as having insufficient sleep. The main outcome was co-occurrence of obesity and insufficient sleep. Descriptive statistics, chi-square tests and logistic regression were used applying sampling weights to account for non-response and sampling procedures. Results: In NSCH, 16.3% of children had obesity and 34.7 % reported insufficient sleep with 7.4% of children having both conditions. Younger children (age 10-12 y) had higher prevalence of obesity with insufficient sleep (11.3%) compared to older children (age 13-17 y; 5%). Non-Hispanic Black and Hispanic children had higher prevalence of co-occurring obesity and insufficient sleep compared to non-Hispanic white children (11.4% and 11% vs 4.7%, respectively). Children in low-income households had higher prevalence (12.4%) of both obesity and insufficient sleep than higher-income counterparts (2.9%) as did children with parents reporting less than high school education compared to those with more highly educated parents (13.8 vs 5.3%). Children exposed to ≥2 adverse childhood experiences had higher prevalence than those without (10.3 vs 5%). Logistic regression analyses show all these factors were significantly associated with co-occurring obesity and insufficient sleep (p-values &lt;0.001). Conclusion: Combined prevalence of obesity and insufficient sleep duration among children varied by age, race, poverty, exposure to childhood adversity, and parental education. The study findings call attention from policy makers, pediatricians, and researchers to these co-existing health problems in children and develop effective strategies to combat obesity and improve sleep health.

ADVERSE CHILDHOOD EXPERIENCES AMONG DEINITIALIZATION CHILDREN FROM FOSTER CARE

Despite compelling evidence suggesting that foster children are disproportionately exposed to adverse childhood experiences (ACEs), comparatively little research has focused on this vulnerable population of young children. In this research, we evaluate the association between foster care placement and exposure to a variety of ACEs using data from the 2019-2022 Survey of Children's Health, a representative sample of non-institutionalized children aged 0-17 in Azerbaijan. Compared to their peers, children who are adopted from or placed in foster care are more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, exposure to violence, household member mental illness, and household member substance abuse. This finding comes from adjusted logistic regression models.

Oral health needs of U.S. children with developmental disorders: a population-based study

BackgroundChildren with Special Health Care Needs (CSHCN) have higher rates of oral diseases and tooth decay compared with the general population. Children with developmental disorders/ disabilities (DD) are a subset of CSHCN whose oral health has not been specifically addressed. Therefore, this study had two objectives: to describe the oral health needs (OHN) of children with DD compared with children without DD; and to assess barriers to access to care, utilization of dental services, and their association with oral health needs for children with DD.MethodsThis cross-sectional study utilized a sample of 30,530 noninstitutionalized children from the 2018 National Survey of Children’s Health (NSCH). Analysis was conducted using descriptive and inferential statistics.ResultsThe analysis identified 6501 children with DD and 24,029 children without DD. Children with DD had significantly higher prevalence of OHN (20.3% vs. 12.2%, respectively), unmet dental needs (3.5% vs 1.2%), and utilization of any dental visits (86.1% vs 76.1%), (P-value < . 001). The adjusted logistic model identified four factors that contributed to the higher odds of OHN among children with DD: poverty (< 100% of the Federal Poverty Level (AOR = 2.27, CI: 1.46–3.51), being uninsured (AOR = 2.12, 95% CI: 1.14–3.95), a high level of disability (AOR = 1.89, CI: 1.23–2.78), and living in the western United States (AOR = 1.61, CI: 1.09–2.37.ConclusionDespite higher utilization of dental services, children with DD had poorer oral health and more unmet dental needs than children without DD. Advocacy efforts and policy changes are needed to develop affordable access that assesses, as early as possible, children with DD whose conditions impact their ability a great deal so that their potential OHN may be alleviated more effectively.

Swatantra Clinic: A descriptive study on the specialized child mental health service for children in difficult circumstances at a tertiary care center in India.

In India, children in difficult circumstances, like institutionalized children have higher mental health morbidity and complex psychosocial concerns than the non-institutionalized children. To cater to the complex needs of these children referred by the Juvenile Justice System, a specialized service called 'Swatantra Clinic' was initiated by the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neurosciences, India. This article thereby aims to describe the psychosocial characteristics of these children, along with the array of specialized interventions provided during the first year of its inception in June 2018. It was found that majority of these children were girls and were from lower socio-economic, urban background, primarily referred for externalizing or internalizing concerns. The majority of them reported experiences of physical and verbal abuse along with family stressors and almost half of them had a diagnosable psychiatric condition. The nature of the psychosocial services rendered at the clinic mostly comprised of brief, individual and family counseling along with liaison work with various governmental agencies for rehabilitation services. These form the key components of a comprehensive, collaborative, time-bound and holistic care model to cater to the distinct psychosocial issues of this vulnerable population of children in low - middle resource settings. Policy implications are discussed.

Life Effectiveness and Self Efficacy of HIV Infected Children

Globally, only 38% [36–40%] of adults (15 and older) living with HIV and 24% [21–26%] of children living with HIV have access to treatment. As of 2013, 12.9 million people had access to antiretroviral therapy. HIV infection in children is a chronic illness with effect on physical, emotional and social well-being. There is, however dearth of information on assessment of life effectiveness which includes the aspects of Quality of life in HIV infected Indian children [Das S et.al, 2010, Banerjee T, et.al 2010]. The present study was designed to assess the life effectiveness among HIV infected children who were institutionalized and non-institutionalized. The tool assessed the life effectiveness in eight dimensions like: Time Management, Social Competence, Achievement Motivation, Intellectual Flexibility, Task Leadership, Emotional Control, Active Initiative, and Self-Confidence. In this tool higher the score higher the life effectiveness and lesser the score lower the life effectiveness. General Self efficacy scale of 10 items (Matthias Jerusalem & Ralf Schwarzer, 1986) was used to assess a general sense of perceived self-efficacy with the aim in mind to predict coping with daily hassles as well as adaptation after experiencing all kinds of stressful life events. The result revealed that there was a significant difference between the two groups of HIV infected children indicated that the institutionalized children were doing better in all the dimensions of life effectiveness like: Time Management, Social Competence, Achievement Motivation, Intellectual Flexibility, Task Leadership, Emotional Control, Active Initiative, and Self-Confidence when compared with non-institutionalized children. The result also revealed a high significant difference in self efficacy among the two groups of HIV infected children indicating that the institutionalized children were having a better self efficacy when compared to children who were non-institutionalized.

Fostering Social-Emotional Literacy through Art for the Institutionalized Adolescent Girls

There is ample evidence that institutionalization posits several challenges pertaining to the physical, social, emotional and cognitive development of children living in institutions. In spite of being acted on, many institutions continue to function ineffectively augmenting the devastating impact on children. The institutionalized children differ from the non-institutionalized children in that they claim to be less attentive to their own emotions as well as those of others; they do not consider it feasible to actually change an emotion; and they consider the effect of emotions to be more detrimental (Terwogt, Schene & Koops, 1990). Art based learning experiences have the potential to promote young people’s development of social-emotional competencies. A 5 hour programme (covered in two days) with four art activities was conducted in a registered Child Care Institute, Hyderabad on 20 girls who were between the age group of 8 to 12 years. The objective of the art based activities was to foster social-emotional literacy through reflection and discussion. The four activities that were conducted include drawing with two hands, guided visual imagery, peer drawing and change that have been adopted from the book titled as ‘art therapy techniques and applications’ (Buchalter, 2009). Thematic data analysis (deductive approach) was used to analyze the drawings and the feedback received from the participants. Some of the themes that emerged from the drawings created by the girls are openness to learning, taking healthy risks, empathic bonding, stress reduction, mindfulness, emotional awareness, cognitive reappraisal, and acceptance.

The effect of violence in childhood on school success factors in US children

BackgroundA robust literature-base on adverse childhood experiences (ACEs) provides strong evidence on the relationships between social adversity in childhood and the health and well-being of individuals across the lifespan. One form of social adversity, exposure to violence in childhood, is not only harmful to a child's health and well-being, but detrimental to their performance in school. Poor performance in school may affect educational attainment later in life and hinder a child's upward social mobility. We focus on the impact of violence-related ACEs on school success factors to add new evidence on how violence in childhood affects a child's educational progress. ObjectiveTo examine the impact of violence-related ACEs on school success factors, including grade repetition, school absence, and school-home contact. Participants and settingsThis study uses secondary data analysis of a nationally representative survey, the National Survey of Children's Health (NSCH), to study a sample of non-institutionalized children aged 6–17 in the US (n = 35,122). MethodsWe employed binary logistic regression and multinomial logistic regression using 95% confidence intervals to analyze the effect of violence in childhood on three school success factors, controlling for socio-demographic and health status characteristics. ResultsWe found that violence in childhood increases the likelihood of grade repetition (OR = 1.47, 95% CI, 1.12–1.92), school-home contact (OR = 2.20, 95% CI, 1.86–2.60), and school absence greater than one week (OR=1.4, 95%CI,1.08-2.00; OR=1.86, 95%CI, 1.36–2.60), controlling for socio-demographic and health status characteristics. ConclusionsViolence in childhood has a statistically significant negative impact on each of the school success factors included in this study.

Examination of Sleep and Obesity in Children and Adolescents in the United States.

This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US. Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children's Health. US, national. Children ages 10-17 years (n = 34,640). Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts. Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics. An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time. Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime.

Trends in Dietary Supplement Use Among US Adults Between 2009 and 2018

ObjectivesA previous study reported that overall use of dietary supplements among United States (U.S.) adults remained stable from 1999 to 2012. However, little is known about trends over the last ten years. We examined trends in dietary supplement use in recent cycles of the National Health and Nutrition Examination Survey (NHANES). MethodsThe NHANES, a serial cross-sectional study of noninstitutionalized adults and children residing in the U.S., was used to estimate the prevalence of overall dietary supplements use among adults (age ≥ 19 y) between 2009 and 2018 (five continuous 2-year cycles). Information about dietary supplement use was collected in an in-home interview by asking the participants whether they used any dietary supplements in the preceding 30 days. Survey-weighted prevalence was calculated to be nationally representative of the U.S. population. We also evaluated the trends across cycles and conducted subgroup analyses by age, sex, race/ethnicity, education status, body mass index, and self-reported health status. ResultsOver five NHANES cycles, data from 28,415 adults ≥ 19 y were included in current analyses. The sample size ranged from 5,600 to 6,215 across survey cycles. Mean age was 47.2 years. The overall use of any dietary supplements increased between 2009 and 2018 (49.5% in 2009–2010 and 57.4% in 2017–2018, P for trend < 0.001). Use of four or more supplement products also increased from 7.8% to 14.1% between 2009–2010 and 2017–2018 cycles (Ratio = 1.94, 95% Confidence Intervals: 1.52, 2.48, P for trend < 0.001). The observed trend toward increasing was consistent across different age and sex groups, and more pronounced among participants with higher education, higher body mass index, and fair or poor self-reported health status. ConclusionsThe overall use of any dietary supplements among U.S. adults increased during the last ten years. The trend was robust among different population groups. Underlying reasons for these trends warrant further investigation. Funding SourcesThe author(s) received no specific funding for this work.

Children's visual impairment and visual care related to socioeconomic status in Catalonia (Spain).

The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia. The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used. In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession. For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status.

The relationship of emotion regulation and negative lability with socioemotional adjustment in institutionalized and non-institutionalized children.

With this study, we aimed to investigate the contribution of emotion regulation and negative lability to socioemotional adjustment in institutionalized and non-institutionalized children. Ninety-two children aged 6 to 10years (45 placed in residential care after abuse and 47 non-abused, living with their biological families) participated in this study. Emotion Regulation Questionnaire and Strengths and Difficulties Questionnaire were completed by the main caregivers of the institutions and by the elementary teacher, respectively, for the institutionalized and non-institutionalized groups. No differences were observed between institutionalized and non-institutionalized children in emotion regulation, negative lability, and socioemotional adjustment outcomes. Also, no sex and age effects were observed for both groups. Considering the institutionalized children, the length of institutionalization had a significant effect on negative lability, while no effects of the type of maltreatment on emotion regulation and negative lability were observed. Additionally, in institutionalized children, negative lability was negatively associated with peer relationship problems in socioemotional adjustment, whereas in the non-institutionalized children, no significant associations were verified between emotion regulation and negative lability with socioemotional adjustment outcomes. For institutionalized children, emotional lability seems to have a differential impact on specific maladaptive socioemotional outcomes, which emphasizes the importance of analysing these specific risk developmental pathways.

Cumulative adverse childhood experiences and children’s health

Abstract Adverse childhood experiences (ACE), potentially stressful or traumatic experiences that are concentrated among already vulnerable populations such as children of color and economically disadvantaged children, can accumulate throughout childhood. The stress process perspective suggests that ACEs, such as parental incarceration or violence exposure, can have deleterious implications for childhood health. This analysis used data from the 2016 and 2017 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0 to 17 in the United States (N = 71,811), to estimate the association between number of ACEs and children’s health (including three general and 12 specific health indicators). ACEs are common, with nearly half (45.3%) of children exposed to at least one ACE. Exposure to three or more ACEs, compared to no ACE exposure, is positively associated with fair or poor overall health, activity limitations, and recurring school absence, adjusting for an array of child and parent characteristics. Exposure to three or more ACEs is also positively associated with specific indicators of children’s mental (such as depression, anxiety, behavioral or conduct problems) and physical (such as asthma, allergies, headaches) health conditions. These associations exist when restricting the sample to children with similar risks of ACE exposure based on their age. These associations are also similar across child race/ethnicity and gender. Given that ACE exposure is concentrated among already vulnerable children, ACEs may exacerbate existing social disparities in children’s health.

Adverse Childhood Experiences and Mental Health Conditions Among Adolescents

PurposeAdverse childhood experiences (ACEs) have been linked with poor physical and mental health. This study examined adult respondents' (e.g. parental) reports from the 2016–17 National Survey of Children's Health, a nationally representative study of health outcomes and social contexts of U.S. households with noninstitutionalized children. MethodsLogistic regression was used to examine associations between ACEs and reports of current depression, anxiety, conduct/behavioral problems, attention-deficit/hyperactivity disorder, and substance use disorder among youth (n = 29,617; 49% female) aged 12–17 years. ResultsACEs were associated with an increased likelihood of all current mental health diagnoses, particularly for youth exposed to four or more ACEs. ConclusionAlthough data relied on cross-sectional adult reports, results provide evidence of a graded association between ACEs exposure and adolescents' mental health conditions; associations with substance use disorder were particularly marked. Early childhood, multilevel, trauma-informed interventions are needed to prevent negative youth outcomes associated with ACEs.

Household food insufficiency, health status and emergency healthcare utilisation among children with and without special healthcare needs.

To compare exposure to household food insufficiency and the relationship between household food insufficiency and both health status and emergency healthcare utilisation among children with and without special healthcare needs (SHCN). Analysing pooled data from the 2016-2017 iterations of the National Survey of Children's Health, we conducted multivariate logistic regressions on household food insufficiency, health status and emergency healthcare utilisation. We assessed interactions between household food insufficiency and children's SHCN status in our models of health status and utilisation. United States. Parents of a nationally representative sample of non-institutionalised children (aged 0-17 years). Children with SHCN were more likely to experience household food insufficiency (70 v. 56 %), non-excellent health status (67 v. 28 %) and emergency healthcare utilisation (32 v. 18 %) than other children. Household food insufficiency was associated with 37 % (children with SHCN) and 19 % (children without SHCN) reductions in the likelihood of having excellent health. Household food insufficiency was associated with a roughly equal (16-19 %) increase in the likelihood of emergency department utilisation across groups. Compared with other children, children with SHCN have an elevated risk of exposure to household food insufficiency and experiencing greater reductions in health status when exposed.

Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability.

Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.

Crianças institucionalizadas e sintomas depressivos por meio do Rorschach e do CDI

Os sintomas depressivos em crianças podem ser sutis e variados. Este estudo investigou sintomas depressivos em crianças institucionalizadas para a adoção, comparando-as com crianças não institucionalizadas, utilizando para isso o método de Rorschach Sistema Compreensivo e o CDI. Participaram do estudo 84 crianças, com idades entre 7 e 11 anos. Para a análise de dados foram utilizados: o teste t de student, a correlação de Pearson e o d de Cohen. Os resultados revelaram que as crianças institucionalizadas se mostraram com mais baixa autoestima, problemas afetivos, ideações suicidas, dificuldade escolar e dificuldade na relação com o outro quando comparadas com as crianças não institucionalizadas. Esses dados sugerem uma possível síndrome depressiva, sendo aconselhável a investigação clínica mais aprofundada para providenciar diagnóstico e tratamento, especialmente nas crianças institucionalizadas. Além disso, foram observadas associações entre as variáveis do Rorschach e CDI. Implicações desses achados e sugestões de pesquisas futuras são apresentadas ao final.