Outcomes In Toddlers Research Articles

Brain Activity Changes in Toddlers with Autism Following Behavioral Intervention

The Early Start Denver Model (ESDM) is a comprehensive developmental behavioral intervention for improving outcomes of toddlers with autistic spectrum

Long-term Outcomes of Toddlers With Autism Spectrum Disorders Exposed to Short-term Intervention

To examine long-term outcomes of toddlers with autism spectrum disorder (ASD) who received a 6-month early intervention at age 2. Forty-eight toddlers diagnosed with an ASD received a 6-month evidence-based intervention. Cognitive (IQ) and communication ability, as well as severity of autism symptoms, were assessed by using standardized measures at preintervention (Time 1 [T1]; mean [M] age = 27 months), postintervention (T2; M age = 35 months), short-term follow-up (T3; M age = 41 months), and long-term follow-up (T4; M age = 72 months). From pre- to postintervention, significant gains in IQ and Vineland Communication domain standard scores as well as a reduction in ASD severity were achieved (all P < .01). Between T2 and T3, the 6-month period immediately after completion of the intervention, IQ and Communication scores stabilized and ASD severity increased significantly (P < .05). During the long-term follow-up period (T3-T4), IQ and Communication scores significantly increased again, but ASD severity increased significantly as well (all P < .05). For overall trajectory (T1-T4), robust gains were observed for both IQ and communication; ASD severity did not change. Findings highlight the potential for positive long-term outcomes in toddlers with ASD. Additional research is needed to understand the relation between early exposure to uninterrupted intervention and developmental gains, and whether initial reduction in ASD symptom severity can be sustained through targeted intervention.

Promoting First Relationships

We conducted a community-based, randomized control trial with intent-to-treat analyses of Promoting First Relationships (PFR) to improve parenting and toddler outcomes for toddlers in state dependency. Toddlers (10-24 months; N = 210) with a recent placement disruption were randomized to 10-week PFR or a comparison condition. Community agency providers were trained to use PFR in the intervention for caregivers. From baseline to postintervention, observational ratings of caregiver sensitivity improved more in the PFR condition than in the comparison condition, with an effect size for the difference in adjusted means postintervention of d = .41. Caregiver understanding of toddlers' social emotional needs and caregiver reports of child competence also differed by intervention condition postintervention (d = .36 and d = .42) with caregivers in the PFR condition reporting more understanding of toddlers and child competence. Models of PFR effects on within-individual change were significant for caregiver sensitivity and understanding of toddlers. At the 6-month follow-up, only 61% of original sample dyads were still intact and there were no significant differences on caregiver or child outcomes.

Predictors of treatment outcomes in toddlers with autism spectrum disorders

Predictors of treatment outcomes in toddlers with autism spectrum disorders

The Healthy Toddlers Trial Protocol: An Intervention to Reduce Risk Factors for Childhood Obesity in Economically and Educationally Disadvantaged Populations

BackgroundThe number of overweight children in America has doubled to an estimated 10 million in the past 20 years. Establishing healthy dietary behaviors must begin early in childhood and include parents. The Healthy Toddlers intervention focuses on promoting healthy eating habits in 1- to 3-year-old children utilizing the Social Cognitive Theory and a learner-centered approach using Adult Learning principles. This Healthy Toddlers Trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mothers of toddlers. The intervention focuses on: (a) promoting healthy eating behaviors in toddlers while dietary habits are forming; and (b) providing initial evidence for the potential of Healthy Toddlers as a feasible intervention within existing community-based programs.Methods/DesignThis describes the study protocol for a randomized control trial, a multi-state project in Colorado, Michigan, and Wisconsin with economically and educationally disadvantaged mother-toddler dyads; toddlers are between 12 and 36 months. The Healthy Toddlers intervention consists of eight in-home lessons and four reinforcement telephone contacts, focusing on fruit, vegetable, and sweetened beverage consumption and parental behaviors, taught by paraprofessional instructors. Healthy Toddlers uses a randomized, experimental, short-term longitudinal design with intervention and control groups. In-home data collection (anthropometric measurements, feeding observations, questionnaires, 3-day dietary records) occurs at baseline, immediately following the intervention, and 6 months after the intervention. Main toddler outcomes include: a) increased fruit and vegetable consumption and decreased sweetened beverage consumption; and b) improved toddler-eating skills (self-feeding and self-serving). Main parent outcomes include: a) improved psychosocial attributes (knowledge, attitudes, self-efficacy, feeding style) related to child feeding; b) provision of a more positive mealtime physical environment (turning off the TV); and c) creation of a more positive mealtime social environment (sitting down together for meals).DiscussionIf this project is successful, the expected outcomes are that the intervention will be effective in helping toddlers develop healthy eating skills that contribute to improve overall health and development and to the prevention of obesity.Trial registrationCurrent Controlled Trials ACTRN12610000981022

Mediators of the Relationship Between Stable Nonresident Households and Toddler Outcomes

The present study examined the associations between stable nonresidence among never married parents (compared with coresident parents) and outcomes for toddlers using the Early Childhood Longitudinal Survey–Birth Cohort. The authors found small to medium negative associations between stable nonresidence and toddlers’ positive social behavior and small negative associations between stable nonresidence and toddlers’ cognition. The associations between stable nonresidence and positive social behavior and cognition were explained by mothers’ supportiveness during interactions with the child. The findings suggest that toddlers in stable nonresident families are at greater risk for lowered school readiness because of diminished quality of maternal interactions with the child. Implications for practice and policy are discussed.

Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial

Social and communication impairments are core deficits and prognostic indicators of autism. We evaluated the impact of supplementing a comprehensive intervention with a curriculum targeting socially synchronous behavior on social outcomes of toddlers with autism spectrum disorders (ASD). Fifty toddlers with ASD, ages 21 to 33 months, were randomized to one of two six-month interventions: Interpersonal Synchrony or Non-Interpersonal Synchrony. The interventions provided identical intensity (10 hours per week in classroom), student-to-teacher ratio, schedule, home-based parent training (1.5 hours per month), parent education (38 hours), and instructional strategies, except the Interpersonal Synchrony condition provided a supplementary curriculum targeting socially engaged imitation, joint attention, and affect sharing; measures of these were primary outcomes. Assessments were conducted pre-intervention, immediately post-intervention, and, to assess maintenance, at six-month follow-up. Random effects models were used to examine differences between groups over time. Secondary analyses examined gains in expressive language and nonverbal cognition, and time effects during the intervention and follow-up periods. A significant treatment effect was found for socially engaged imitation (p = .02), with more than doubling (17% to 42%) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention. This skill was generalized to unfamiliar contexts and maintained through follow-up. Similar gains were observed for initiation of joint attention and shared positive affect, but between-group differences did not reach statistical significance. A significant time effect was found for all outcomes (p < .001); greatest change occurred during the intervention period, particularly in the Interpersonal Synchrony group. This is the first ASD randomized trial involving toddlers to identify an active ingredient for enhancing socially engaged imitation. Adding social engagement targets to intervention improves short-term outcome at no additional cost to the intervention. The social, language, and cognitive gains in our participants provide evidence for plasticity of these developmental systems in toddlers with ASD. http://www.clinicaltrials.gov/ct2/show/NCT00106210?term = landa&rank = 3.

Prenatal Drug Exposure: Infant and Toddler Outcomes

ABSTRACT This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called “crack baby” preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Improving Outcomes in Toddlers with Autism

A recent CDC retrospective surveillance study suggests that autism spectrum disorder (ASD) afflicts 1% of children in the U.S. In a randomized clinical

Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model

To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

Behavior Problems in Toddlers With and Without Developmental Delays: Comparison of Treatment Outcomes

The purpose of this study is to examine the effectiveness of an in-home parent management program for toddlers with behavior problems and developmental delays by comparing outcomes for a group of toddlers with developmental delays (n = 27) and a group of toddlers without developmental delays (n = 27). The majority of children lived in single parent, low-income homes. Results suggest that the parent management program is equally effective for children with and without developmental delays. Parents from both groups reported clinically significant improvement in their children's behavior and parenting practices. Clinical implications regarding the importance of these findings for improving outcomes for toddlers with behavior problems and developmental delays living in poverty were discussed.

Treatment Outcomes for Toddlers with Behaviour Problems from Families in Poverty

Background: Relatively few treatment studies address mental health issues in very young children. This study examined the effectiveness of a treatment program for toddlers whose behaviour problems were further complicated by living in poverty.Method: An evidence‐based treatment program was adapted for use in the homes of 102 toddlers for an average of 12 weekly sessions.Results: Significant improvements were found for the children’s behaviour problems and their compliance to parent requests.Discussion: The inherent challenges in working with at‐risk families and the challenges in delivering mental health services for very young children living in poverty are discussed.

Language outcomes of toddlers with autism spectrum disorders: a two year follow‐up

Thirty-seven children 15-25 months of age received clinical diagnoses of autism spectrum disorder (ASD) and were re-evaluated two years later. All subjects were judged to have retained a diagnosis of ASD at the follow-up evaluation. Communication scores for the group as a whole during the first visit were significantly lower than nonverbal IQ. However, by the second visit, verbal and nonverbal scores were no longer significantly different. The group was divided into two subgroups, based on expressive language (EL) outcome at the second visit. The two groups were similar in the second year of life in terms of expressive communication skills and autistic symptoms, except for a trend toward more stereotypic and repetitive behavior in the worse outcome group. By the second visit, however, the groups differed significantly on all standard measures of expression and reception, as well as on autistic symptomotology and nonverbal IQ. When assessed during their second year, children who ended up in the better outcome group showed higher average nonverbal cognitive level, receptive language (RL) scores, number of sounds and words produced, use of symbolic play schemes, and response to joint attention bids. Regression analysis revealed that the variables for which significant differences between the two outcome groups in their second year of life were found provided significant prediction of EL outcome at age four. Stepwise regression identified RL and presence of stereotypic and repetitive at the first visit as significantly associated with EL outcome. Implications of these findings for early identification and intervention are discussed.

Human Motor Behavior

Human Motor Behavior

Predictors of Optimal Outcome in Toddlers Diagnosed with Autism Spectrum Disorders

A diagnosis of autism spectrum disorder (ASD) is usually taken to be permanent. In this study, 13 two-year-old children with ASD lost the diagnosis by age 4, at which time they scored within the normal range on standardized measures of cognitive and adaptive functioning. No differences were found in symptom severity, socialization, or communication between children who lost the ASD diagnosis and children who did not, but children with PDD-NOS were significantly more likely than those with full autistic disorder to move off the spectrum. The clearest distinguishing factor was motor skills at age 2. Results support the idea that some toddlers with ASD can lose their diagnosis and suggest that this is difficult to predict.

Brief Report: Newborn Behavior Differs with Decosahexaenoic Acid Levels in Breast Milk

To assess whether natural variations in decosahexaenoic acid (DHA) levels in breast milk would relate to infant neurobehavioral outcomes at the newborn stage following equivocal findings on infant and toddler outcomes of exposure to DHA in formula and breast milk. Breast milk samples from N = 20 mothers were collected 9 days after delivery, while the Brazelton Neonatal Behavioral Assessment Scale (NBAS) was administered on the infant. Milk samples were later analyzed for fatty acids, including DHA. Pearson correlations revealed a positive association between DHA concentrations in breast milk and infants' scores on the NBAS Range of State cluster score, suggesting that DHA is related to the infant's superior ability to maintain optimal arousal. These results suggest that breast milk DHA is beneficial to the neonate's neurobehavioral functioning and call for investigative attention to DHA's role in potentiating optimized intellectual functioning at later stages of development. The findings may also be interpreted as supporting formula supplementation with DHA.

MATERNAL LIMIT-SETTING PATTERNS AND TODDLER DEVELOPMENT OF SELF-CONCEPT AND SOCIAL COMPETENCE

In 126 mother-toddler dyads, the relationships between maternal limit-setting patterns at 12, 24, and 36 months were examined in relation to toddler self-concept and social competence at 3 years. Maternal limit-setting patterns differentiated toddler self-concept and social competence scores, demonstrating effects of socialization as well as cognitive maturation. Less optimal toddler outcomes at 36 months were associated with an inconsistent maternal limit-setting style and an indirect style. Children of mothers with a teaching-based pattern yielded the most positive outcomes. Although a power-based maternal limit-setting style was related to diminished self-regulatory behavior in a concurrent limit-setting context, outcomes for children of power-based mothers in terms of self-concept and social competence were not as negative as expected.

MR findings of bowlegs in toddlers.

Toddlers with severe physiologic tibial bowing are considered to be at risk for the development of Blount's disease. Objective. To correlate MR findings of the knee with the clinical outcome in toddlers with severe physiological tibial bowing. MR findings were evaluated in 22 affected legs of 14 children with severe tibial bowing (mean age 1.9 years). In 18 affected legs, MR findings were compared with the transition of the tibial metaphyseal-diaphyseal angle (MDA) and tibiofemoral angle (TFA) measured serially between 2 and 3 years of age. MR findings of severe tibial bowing comprised undulation of the posteromedial physis of the tibia (3/22), signal alterations in the medial tibial metaphysis (10/22), T2 prolongation in the posteromedial tibial epiphyseal cartilage (14/22) and signal changes in the medial menisci (18/22). The decrease in the TFA was different in the legs with and without increased signal in the epiphyseal cartilage, and the decrease in the MDA was different in the legs with and without physeal undulation. MR imaging findings can predict the retarded resolution of tibial bowing, which may be a risk factor for the development of Blount's disease.

The Impact of Low-risk Prematurity on Maternal Behaviour and Toddler Outcomes

This short-term longitudinal research project was designed to compare the maternal behaviour of mothers whose toddlers had been born preterm with the maternal behaviour of mothers whose toddlers had been born at term; the outcomes for the toddlers were also assessed. Twenty-one toddlers who had been born preterm with low medical risk (1460-2420 grams) were compared with 21 term toddlers who were matched in terms of social class. The heightened maternal responsiveness that had been observed during the first year with preterm infants had disappeared by 12 months, and by 20 months it was the mothers whose infants had been born at term who were more vocally responsive. During the second year, the mothers of preterm toddlers were characterised by more maternal control behaviour than were the mothers of term toddlers. Assessments of cognitive and language performance at the gestationally corrected ages of 12 and 20 months did not differentiate the toddlers who had been born preterm and term. In terms of play skills, reflected during interaction with their mothers at 12 and 20 months, the preterm toddlers were more actively involved than were the term toddlers. Despite the successful adjustment of these low-risk preterm toddlers, maternal behaviour was affected by the circumstances of preterm birth, even after 20 months.

The Impact of Low-risk Prematurity on Maternal Behaviour and Toddler Outcomes

The Impact of Low-risk Prematurity on Maternal Behaviour and Toddler Outcomes