Children's Psychological Outcomes Research Articles

Psychological Outcomes in Children Following Pediatric Intensive Care Unit Hospitalization

Abstract Background Critically ill children may be at risk for developing negative psychological sequel following pediatric intensive care unit (PICU) hospitalization. The highly invasive technological interventions, lack of control over events, the severity of the child’s illness, and high levels of parental distress have been identified as particularly salient factors Aim of the Work To assess the psychological impact of admission to PICU among children and their parents Methods In this cross-sectional study, 100 children admitted to the PICU or ward and their parents completed the Strength and Difficulties Questionnaire (SDQ) and Hospital Anxiety and Depression Scale (HADS) at admission, 6 weeks, and 6 months after discharge. Results The PICU group (n = 50) had significantly higher disease severity scores than the ward group (n = 50) based on mean PRISM (9.5 vs 3.0, p < 0.001) and mean TISS scores (14.98 vs 6.7, p < 0.001). PICU children had a longer mean length of stay (9.8 vs 4.6 days, p < 0.001). At 6 weeks, 38% of PICU children scored in the high or very high risk range on the SDQ total difficulties score compared to 8% of ward children. At 6 months, 28% of PICU children remained at high or very high risk versus 4% of ward children. The SDQ emotional symptoms subscale was most affected. Regarding parental stress, at 6 weeks 12% of PICU parents had abnormal depression scores on the HADS versus 2% of ward parents, while 14% of PICU parents had abnormal anxiety scores versus 4% of ward parents. Multivariate regression found number of previous admissions, severity scores, and invasive procedures predicted SDQ scores at follow-up. Conclusion PICU admission has a significant psychological impact on children and parents lasting at least 6 months. Screening for those at high risk is recommended.

Maternal emotion socialization trajectories in an early-childhood, predominantly White sample.

Several developmental theories identify caregiver emotion socialization (ES) as predicting multiple child psychological outcomes, including anxiety. The present study delineated developmental trajectories of mothers' ES practices, specifically the initial levels and growth across time of their supportive and nonsupportive responses to their young children's emotions. To contextualize the developmental role of these processes, we examined multiple predictors (i.e., maternal emotion dysregulation, child negative emotionality, demographic covariates) and one outcome (i.e., child anxiety) of ES trajectories, as well as how trajectories varied by emotion type-sadness, anger, or worry. We investigated these questions in a community sample of 173 predominantly White, non-Hispanic mother-child dyads who participated at four time points when children were aged 2-5 years, with assessments 1 year apart. Mothers reported on study variables. Results varied by ES type. Mothers' supportive global and emotion-specific ES were highly stable across time and did not relate to predictors, outcomes, or demographic covariates. Mothers endorsed gradual decreases in nonsupportive ES across time, with some variations across emotion type. Nonsupportive responses to worry and sadness each comprised two classes varying by intercept and slope. Nonsupportive worry responses linearly decreased, whereas nonsupportive sadness responses linearly increased. Across global and emotion-specific models, maternal emotion dysregulation, child negative emotionality, and demographic covariates showed unique relations with nonsupportive ES intercept and slope. Trajectories were mostly unrelated to later child anxiety, with the exception of class-specific differences for nonsupportive worry responses. Implications and future directions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parental Accommodations as a Predictor of Child Psychological Outcomes Following a Hurricane

Natural disasters have a lasting impact on the mental health of the children. The effects on children's mental health included posttraumatic stress symptoms, behavioral problems (e.g., disruptive behaviors), depression, and anxiety. Overall, parents have been an important factor in the lasting effects of natural disasters on children's mental health. Although most research has examined overall parental mental health outcomes on childhood outcomes, little research has concentrated on specific parental behaviors that might help children deal with natural disasters. One of those behaviors may be the level of parental accommodations. Considering parental accommodations are often used when a child is upset or distressed, it seems feasible that parental accommodations may also be associated with childhood outcomes after a natural disaster. This study examines the use of parental accommodations in the context of Hurricane Harvey and the associated effects on child outcomes. Participants (N = 129) who were parents, completed an online survey answering questions on their Hurricane Harvey experiences as well as shared about their parenting practices and their perception of their children's outcomes both during and after this time. Overall, parental accommodations were associated with more negative mental health outcomes for children, after a natural disaster. Given these results, it is important that professionals help parents understand how to be supportive of their children during or immediately following a natural disaster, without being overly accommodating to their child's anxiety.

Maternal depression, parenting, and child psychological outcomes in the context of maternal pain.

Parental chronic pain is associated with adverse outcomes in children, but the mechanisms of transmission are largely untested. Mothers with chronic pain (N = 400, Mage = 40.3 years, 90.5% White) and their children (Mage = 10.33 years, 83.3% White, 50.2% female) were recruited in 2016-2018 to test longitudinal pathways of risk transmission from maternal chronic pain to children's psychological symptoms, examining roles of parenting, maternal depression, and child distress tolerance. Maternal pain was associated with positive (β = .28) and pain-specific (β = .10) parenting behaviors. Maternal depression was associated with lower child distress tolerance (β = -.03), which was associated with greater child psychological symptoms (β = -.62). Parenting and maternal pain were not prospectively associated with child outcomes. When considering the dual-generational impacts of chronic pain, physical and psychological functioning should be examined.

Neurodevelopmental outcomes in children conceived by assisted reproductive treatment

IntroductionImpact of assisted reproductive treatment (ART) techniques on the child’s mental development is the focus of numerous studies. Whereas several studies have found potential negative effects on ART children’s psychosocial health, others recognized that the data on the cognitive and psychosocial development of ART children are comforting.ObjectivesHere, we aim to state the current findings concerning psychological outcomes in children conceived by ART.MethodsUsing as key words “assisted reproductive” and as filter “meta-analysis”, we comprehensively reviewed the scientific literature through new meta-analysis during the five last-years resuming the main conclusions of these studies to define principal through psychological conditions in children conceived by diverse ART techniques and approaches.Results Our review showed that since 1978, the date of the first birth using in vitro fertilization technology (IVF), more than 10 million children are conceived by ART. Our research revealed 441 meta-analysis. After a comprehensive analysis of abstracts, only four meta-analysis were selected. Chronologically from 2019 to 2023, the first studies showed that the risk of intellectual disability and autism spectrum diseases (ASD) were higher in intra-cytoplasmic sperm injection (ICSI) children compared to conventional IVF children. The differences in the risk of neurodevelopmental disorders in children born after frozen and fresh embryo transfers were not significant. Analysis of potential cofounder effects such as multiple and preterm birth having a significant correlation with neurodevelopmental disorders suggested that ART is unlikely to cause negative impacts on children’s neurodevelopment. The findings of the most recent meta-analysis showed that the use of ART did not associate with the risk of ASD,ConclusionsGiven the multitude of factors modulating ART, from the indication and parental background to the type of used technique and approach, the results of the studies that investigated the association between ART and neurodevelopmental outcomes remain yet contradictory.Disclosure of InterestNone Declared

Effect of the T-Slim pump with control IQ hybrid closed loop system on physiological and psychological outcomes in children with type 1 diabetes in gloucestershire

Effect of the T-Slim pump with control IQ hybrid closed loop system on physiological and psychological outcomes in children with type 1 diabetes in gloucestershire

Sleep, physical activity, and psychological outcomes in children and adolescents with pediatric onset multiple sclerosis

BackgroundSleep, physical activity (PA) and sedentary behavior (SED) have bidirectional associations with mental health in children. The relationships among sleep, PA, SED, with depressive and fatigue symptoms have not been investigated in Pediatric Onset Multiple Sclerosis (POMS) but are needed to inform sleep and PA behavior change interventions. Objectives(1) To describe sleep quality including: sleep efficiency, latency, total sleep time, number of awakenings, time in bed, and wake after sleep onset using actigraphy in children and adolescents ages 11 to 18 diagnosed with POMS, and to compare these sleep metrics to those of an age- and sex-matched non-MS group (2) To examine the relationship between time spent in sedentary, light (LIPA), moderate and vigorous PA (MVPA), sleep quality, with depression, fatigue, and quality of life in children and adolescents with POMS and an age and sex matched non-MS group. MethodsA cross-sectional study recruited children and adolescents with POMS ages 11 to 18 years followed at a tertiary pediatric hospital (Toronto, Canada) and an age and sex matched non-MS group from the general population. Participants were consented prior to initiation of study procedures. Participants wore an Actiwatch monitor and GT3X accelerometer and completed standardized questionnaires validated to capture data on sleep disturbances, depression, fatigue, and quality of life. Objective sleep data were collected using an Actiwatch including sleep efficiency, total sleep time, number of awakenings, wake after sleep onset (WASO), and sleep latency. A GT3X accelerometer was used to collect PA data including time spent in SED, light (LPA), and moderate to vigorous (MVPA) PA. Correlational analyses and tests of difference were used to compare the groups. Results25 POMS (21F; 16.6 years ±1.1 yrs., median Expanded Disability Status Scale (EDSS) =1.5, IQR=1) and 25 Non-MS (22 F; 16±1.3 yrs.) took part. POMS had higher BMI (T= -5.1, P<0.001) compared to Non-MS. No differences in sleep efficiency (MS mean = 87%, vs. 88%) sleep time (MS Mean = 7.3 hrs. vs. 7.4 hrs.,), WASO (MS mean=37 mins. vs. 36 mins), latency (MS mean=15 mins vs. 11 mins), SED (MS mean =763 mins. vs. 730 mins) or PA (MS, mean LPA = 68 mins. vs 60 mins; MS mean MVPA = 12.7 mins. vs. 12.4 mins). Within POMS, higher sleep efficiency was associated with more SED (SR= 0.4, p = 0.05), while higher sleep efficiency was associated with less SED in Non-MS (SR = -0.7, p< 0.0). In children with POMS, less sleep time, shorter sleep onset latency and more WASO was associated with more SED (SR range = -0.45 to -0.58, P< 0.01). Higher sleep efficiency was associated with less fatigue. Less WASO was associated with lower depression, lower fatigue (SR = 0.67, p<0.01) and better quality of life (SR= -0.6, p<0.01). Greater LPA was associated with lower sleep onset latency (-0.45, p<0.05). ConclusionsChildren with POMS did not differ in Actiwatch monitored sleep quality metrics. However, within the POMS group sleep quality was associated with better fatigue, depression and QOL. Further, total sleep time, WASO and latency associated with time spent SED and LPA, which independently associate with mental health outcome. Longitudinal work should determine the temporal associations between WASO, sleep latency, sleep time, PA, and mental health outcomes and whether reallocation of specific sleep or PA behaviors (time to sleep, total sleep time, sedentary to MVPA) result in improved depression fatigue, or quality of life in children and adolescents with POMS.

COVID-19 Stress in Relation to Parent Emotional Intelligence and Child Mental Health among a Canadian Sample

Due to the unprecedented nature of COVID-19, more studies are needed to examine how parents and children are impacted by the pandemic, and more specifically the role of parental Emotional Intelligence (EI) in the link between COVID-19 stressors and child mental health outcomes. This cross-sectional study investigated the relationships between COVID-19 stressors, parental EI, and child anxiety and depression outcomes. Fifty parents (mean age = 41.98 years; 88% mothers) of children between the ages of 8-11 years old (mean age = 9.46 years; 74% boys) completed online questionnaires assessing COVID-19 stress, parental EI, and child anxiety and depression symptoms. Although no significant results were found between parent COVID-19 stress, parent EI, and child depression symptoms, the results suggest that parental COVID-19 stress was related to child anxiety. Exploratory analyses were conducted examining specific domains of COVID-19 stress, parental EI, and child anxiety and depression symptoms. Findings indicate the resilience of child mood and parental EI to COVID-19 stress among this sample, as well as child anxiety being a potential area of risk during the pandemic. Knowledge of these associations gives insight into areas to prioritize for mental health clinicians in assessment and intervention.&#x0D; &#x0D; Public significance statement: There is a need for more research on parent and child psychological outcomes during COVID-19. This study suggests an association specifically between parental COVID-19 stress and child anxiety, and not with child depressive symptoms. Findings help with better understanding the experiences of families during COVID-19.

Sleep and psychological characteristics of children with cancers and type 1 diabetes and their caregivers

ObjectivesChildren with chronic illnesses and their parents are more at risk to develop sleep problems, which are linked to worse psychological and physical well-being. This study aimed to assess sleep patterns and their connections with psychological outcomes in children with type 1 diabetes (T1D) and cancer and their caregivers, compared to a control sample. In addition, we explored the associations between caregiver and child's sleep quality across the three groups. MethodsWe enrolled 56 children with T1D, 33 children with cancer, and 61 healthy children between 7 and 15, and their respective caregivers. Caregivers filled out an ad-hoc survey assessing their sleep disturbances, parenting stress, general well-being, anxiety, and their children's sleep patterns and psychological adjustments. ResultsChildren with cancer showed lower sleep quality than the other groups. Moreover, worse psychological adjustment was associated with greater sleep disturbances in both clinical groups. As for caregivers, the cancer group reported the worst sleep quality and greater anxiety compared to the other samples. Greater anxiety was also linked to worse sleep quality. Furthermore, greater sleep problems in children were associated with poorer caregivers’ sleep quality in the whole sample and the T1D group. ConclusionsA better understanding of sleep patterns and problems for chronically ill children and their parents is fundamental to provide adequate care for these vulnerable populations. Furthermore, an illness-specific approach may better inform and guide the practitioners in clinical practice.

Parental Cannabis Use, Negative Parenting, and Behavior Problems of Young Children

Introduction: Cannabis use in the United States is increasingly accepted and legal. Rise in use among childbearing aged adults is potentially concerning, as the impacts of parental cannabis use on children are largely unknown, especially for young children. This study examined whether cannabis use is associated with increased risk for negative parenting and child emotional and behavioral problems among the parents of young children. Methods: We conducted a cross-sectional survey of parents and child behavior, recruited through five primary care practices in three states. Parents of children aged 1.5–5 years reported on family demographics, last 6-months cannabis use, negative parenting, parent mental health, parents’ adverse childhood experiences (ACEs), and child emotional/behavioral problems. We conducted hierarchical regressions to determine if parental cannabis use predicts negative parenting and/or child emotional/behavioral problems when controlling for other risk factors. Results: Of 266 responding parents, 34 (13%) reported cannabis use in the last 6 months. Parents who endorsed cannabis use reported significantly more negative parenting, ACEs, anxiety, depression, and child emotional/behavioral problems. Adjusting for the effects of other risk factors, cannabis use significantly predicted more negative parenting, but was not uniquely and significantly associated with child emotional/behavioral problems. Conclusion: Parental cannabis predicted negative parenting, which in turn predicted early childhood emotional/behavioral problems; however, parental cannabis use did not predict child emotional/behavioral problems when other risk factors were considered. Further research is needed to elucidate the nature and direction of relationships between parent cannabis use, negative parenting, child psychological outcomes, and other risk factors.

Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

Animal studies have found that antenatal corticosteroids affect many organs across multiple stages of life. However, the long-term outcomes in human children are not well understood. To conduct a systematic review and meta-analysis of long-term outcomes associated with preterm exposure to antenatal corticosteroids compared with no exposure in all children as well as children with preterm and full-term birth. Academic databases were searched for articles published from January 1, 2000, to October 29, 2021, including Ovid MEDLINE, Ovid Embase, PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, ClinicalTrials.gov, and Google Scholar. References of articles were also searched for relevant studies. Randomized clinical trials (RCTs), quasi-RCTs, and cohort studies that assessed long-term neurodevelopmental, psychological, or other outcomes at 1 year or older in those who had preterm exposure to antenatal corticosteroids were included. No language restrictions were set. Two reviewers independently extracted data using a piloted data extraction form. Data on study population, pregnancy characteristics, exposure to antenatal corticosteroids, and outcomes were collected. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed, and random-effects models were used for the meta-analysis. The primary outcome was an author-defined composite of any adverse neurodevelopmental and/or psychological disorder. The secondary outcomes included specific measures of psychological disorders; neurodevelopmental delay; and anthropometric, metabolic, and cardiorespiratory outcomes. A total of 30 studies met the inclusion criteria, and involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed. Exposure to a single course of antenatal corticosteroids for children with extremely preterm birth was associated with a significant reduction in risk of neurodevelopmental impairment (adjusted odds ratio, 0.69 [95% CI, 0.57-0.84]; I2 = 0%; low certainty). For children with late-preterm birth, exposure to antenatal corticosteroids was associated with a higher risk of investigation for neurocognitive disorders (n = 25 668 children; adjusted hazard ratio [aHR], 1.12 [95% CI, 1.05-1.20]; low certainty). For children with full-term birth, exposure to antenatal corticosteroids was associated with a higher risk of mental or behavioral disorders (n = 641 487 children; aHR, 1.47 [95% CI, 1.36-1.60]; low certainty) as well as proven or suspected neurocognitive disorders (n = 529 205 children; aHR, 1.16 [95% CI, 1.10-1.21]; low certainty). Results of this study showed that exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk of neurodevelopmental impairment in children with extremely preterm birth but a significantly higher risk of adverse neurocognitive and/or psychological outcomes in children with late-preterm and full-term birth, who made up approximately half of those with exposure to antenatal corticosteroids. The findings suggest a need for caution in administering antenatal corticosteroids.

A Virtual Skin-Model-Building Activity Educates Campers With Chronic Skin Disorders and Their Families

A Virtual Skin-Model-Building Activity Educates Campers With Chronic Skin Disorders and Their Families

Prosocial Behavior in Preschoolers: Effects of Early Socialization Experiences With Peers.

Over the last decades, many studies had focused on the psychological outcomes of children who have received early socialization outside of the family context, highlighting that the daycare experience can both positively and negatively influence the child’s social-emotional development. Despite the number of studies conducted, there is a lack of observational research on this topic. The purpose of this study is to investigate whether the early daycare experience can influence the prosocial behaviors that children exhibit during free-play social interactions with peers, focusing on their quantity and quality. In addition, the associations between the enactment of prosocial behaviors and social-emotional and behavioral competence were investigated. 160 preschoolers, 77 of whom had previously attended daycare, participated in the study and were focally observed during two free play sessions with peers. Each prosocial behavior was identified and subsequently classified using a coding scheme designed to consider the self-initiated or required origin of prosocial actions and their underlying motive. Emotion comprehension was measured using a standardized test, while social-emotional and behavioral competence was assessed using a questionnaire filled out by teachers. The main findings showed that children who had attended daycare had higher anger and aggression scores than those who had not, who, in turn, were rated by their teachers as having more internalizing behaviors. These characteristics seemed to account for the differences found in the tendency to act prosocial acts in response to a peer’s request, which was lower in children who had a previous daycare experience. Moreover, early socialization outside of the family context appeared to foster the comprehension of others’ intent to achieve emotional or instrumental personal goals and, at the same time, to reduce conventional/affiliative prosocial acts. Overall, this study suggested that the incidental effects of daycare on prosocial behavior might be canceled due to the peculiar social-emotional and behavioral characteristics of the two groups of children.

Characterisation of neurodevelopmental and psychological outcomes in CHD: a research agenda and recommendations from the cardiac neurodevelopmental outcome collaborative.

The Neurodevelopmental and Psychological Outcomes Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute with the goals of identifying knowledge gaps regarding the neurodevelopmental and psychological outcomes of individuals with CHD and investigations needed to advance science, policy, clinical care, and patient/family outcomes. Accurate characterisation of neurodevelopmental and psychological outcomes in children with CHD will drive improvements in patient and family outcomes through targeted intervention. Decades of research have produced a generalised perspective about neurodevelopmental and psychological outcomes in this heterogeneous population. Future investigations need to shift towards improving methods, measurement, and analyses of outcomes to better inform early identification, prevention, and intervention. Improved definition of underlying developmental, neuropsychological, and social-emotional constructs is needed, with an emphasis on symptom networks and dimensions. Identification of clinically meaningful outcomes that are most important to key stakeholders, including patients, families, schools and providers, is essential, specifically how and which neurodevelopmental differences across the developmental trajectory impact stakeholders. A better understanding of the discontinuity and patterns of neurodevelopment across the lifespan is critical as well, with some areas being more impactful at some ages than others. Finally, the field needs to account for the impact of race/ethnicity, socio-economic status, cultural and linguistic diversity on our measurement, interpretation of data, and approach to intervention and how to improve generalisability to the larger worldwide population of patients and families living with CHD.

Ego Control Mediates the Effect of Maltreatment on Child Depression.

Maltreatment among school-aged children is associated with negative impacts on development and can contribute to the onset of psychological difficulties, including early depressive symptoms. Maltreatment can have devasting consequences, thus it is important to better understand the mechanisms contributing to children's psychological outcomes. Purpose: The objective of this study was to examine children's personality functioning (ego control and ego resiliency) as mediators of the association between substantiated maltreatment and depression. Methods: A total of 300 school-aged children were followed over the course of 3years in the context of a summer camp (168 maltreated children; 132 non-maltreated children). Maltreatment status was determined through cases referred by the Monroe County Department of Social Services, New York. Ego control and ego resiliency at year 2 (T2), as measured by camp counselors using the California Child Q-Set, were tested as mediators. Children's depressive symptoms were self-reported using the Childhood Depression Inventory at year 3 (T3). A parallel mediation model was tested using Mplus. Results: Maltreatment was not directly associated with depression at either time point, but significantly predicted both mediators. Ego undercontrol significantly predicted increased depressive symptoms at T3, while there was no significant prediction by ego resiliency. Conclusions: These findings point to the longitudinal paths to early depressive symptoms in maltreated children and the mediating effect of children's ego control which could be a target for intervention.

He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems.

Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family. Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n=417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study. Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden. Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.

Sleep Problems, Cumulative Risks, and Psychological Functioning in Early Childhood.

Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. 205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created. Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns. Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.

Psychological Outcomes in Children and Early Adolescents With Type 1 Diabetes Following Pediatric Diabetes Summer Camp: A 3-Month Follow-Up Study.

Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp.Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes.Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp.Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.

Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study

Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3-6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children.

Prenatal exposure to gestational diabetes is associated with anxiety and physical inactivity in children during COVID-19.

The coronavirus disease 2019 (COVID-19) is associated with adverse child mental health outcomes and reduced physical activity. Moreover, prenatal exposure to gestational diabetes (GDM) is associated with increased risk for adverse psychological outcomes in children. Assess prenatal exposure to GDM on anxiety levels and physical activity in children during the COVID-19 pandemic. Sixty-five children age 9 to 15 reported their physical activity and anxiety levels using the 24-hours physical activity recall and the State-Trait Anxiety Inventory for Children via phone or video meetings. Prenatal exposure to GDM was obtained from maternal electronic medical records. The 38 GDM-exposed children reported significantly higher anxiety levels and were less likely to engage in any vigorous physical activity (VPA) (5% vs 30%) compared to the 27 GDM-unexposed children. Lower levels of physical activity were significantly associated with higher levels of anxiety. Less engagement in VPA explained 75% of the association between GDM exposure and anxiety levels. Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly amongst GDM-exposed children.