Risk Of Developmental Delay Research Articles

Hearing and Neurodevelopmental Outcomes of Young Infants with Parechovirus-A and Enterovirus Meningitis: Cohort Study in Singapore Children and Literature Review

Abstract Parechovirus-A (PeV-A) and Enterovirus (EV) commonly cause childhood aseptic meningitis. Bacterial meningitis in children has been associated with devastating long-term sequelae. However, developmental outcomes are unclear in Parechovirus meningitis. This study aims to review the clinical findings and developmental outcomes of infants with PeV-A and EV meningitis. We performed a retrospective study of infants aged 90 days or younger being admitted to our hospital with PeV-A meningitis between November 2015 and July 2017, with positive cerebrospinal fluid (CSF) PeV-A PCR and negative blood and CSF bacterial cultures. Hearing and neurodevelopmental outcomes were compared with a previous cohort of infants aged 90 days or younger with EV meningitis admitted from January 2015 to December 2015. A total of 161 infants were included in our study, of which 68 infants (42.2%) had PeV-A meningitis and 93 infants (57.8%) had EV meningitis. We assessed their developmental outcome at 6 months, 1 year, and 2 years post-meningitis. At 2 years post-meningitis, three infants with PeV-A meningitis had developmental delay (5.5%), whereas none with EV meningitis had developmental delay. One patient had speech delay and autism spectrum disorder, while two had mild speech delay. When compared with our cohort of EV meningitis ≤90 days old, children with PeV-A meningitis ≤90 days old were more likely to have developmental delay 2 years post-meningitis (odds ratio 2.4, 95% confidence interval 2.0–3.0, p = 0.043). None of the patients with PeV-A or EV meningitis had sensorineural hearing loss or neurological sequelae, such as cortical blindness, oropharyngeal dysphagia, hydrocephalus, epilepsy, or cerebral palsy. Infants with PeV-A meningitis had a significant risk of developmental delay 2 years post-meningitis compared with those with EV meningitis. It is important to follow-up the developmental milestones of infants diagnosed with PeV-A meningitis for at least 2 years; and when they develop developmental delay, to ensure that they receive appropriate intervention.

Relationships between dietary diversity and early childhood developmental outcomes in rural China.

The period from birth to 2years of age is highly sensitive with respect to the relationship between nutrition and neurodevelopment, but data regarding the association between dietary diversity and early childhood neurodevelopment are limited. We sought to examine the association of two feeding indicators—minimum dietary diversity (MDD) and minimum meal frequency (MMF)—with the neurodevelopment of children aged 6–23 months, using data from a cross‐sectional survey conducted in six rural counties in China. Data on 1,534 children were analysed using logistic regression to explore the associations between dietary diversity and early neurodevelopment, with adjustments for the age, sex and prematurity of the child; the age, sex and educational level of the caregiver; and family size, income and simulative care practices and resources. We found that 32.4% of children had suspected developmental delays based on the Chinese version of the Ages and Stages Questionnaires Version 3, whereas 77.0% and 39.2% failed to meet the MDD and MMF, respectively. Meeting the MDD was associated with a 39% lower risk of developmental delays (AOR = 0.61, 95% CI [0.43, 0.86]). There was a significant association between MDD and reduced likelihood of developmental delays in gross motor, fine motor, problem‐solving and personal social subscales, whereas MMF was only associated with a lower risk of developmental delays in the gross motor subscale (AOR = 0.63, 95% CI [0.42, 0.94]). We observed an inverse dose–response relationship between the number of food groups consumed and the risk of developmental delays (P < .001).

Cognitive, language and motor development of infants exposed to risk and protective factors

IntroductionRisk factors are biological or environmental characteristics increasing the likelihood of delays in child development. Meanwhile, protective factors are conditions that can minimize risks and favor the acquisition of skills. Infants with risk indicators for hearing loss (RIHL) tend to live in less stimulating environments which may lead to lower cognitive, language, and motor development. ObjectiveTo compare the cognitive, language, and motor development of infants under the influence of risk and protective factors. MethodA cross-sectional observational study in which 259 infants aged 8–10 months were assessed for cognitive, language, and motor development using the Bayley Scales of Infant and Toddler Development - Third Edition (BSITD-III). The groups were formed according to the presence or absence of RIHL and the quality of the resources, being: SG-AE (Study Group with Adequate Environment), SG-IE (Study Group with Inadequate Environment), CG-AE (Compared Group with Adequate Environment)) and CG-IE (Compared Group with Inadequate Environment). Affordances were assessed using the questionnaire Affordances in the Home Environment for the Motor Development - Infant Scale (AHEMD-IS). The groups were compared using the Chi-square test or the Kruskal-Wallis test, followed by Dunn's multiple comparison test. The level of significance adopted was 5%. ResultsInfants from the CG-AE performed better than the other groups in cognition and motor skills. The CG-AE language was statistically superior to the SG-IE. SG-IE showed the highest frequency of delays in all domains. CG-IE and SG-AE showed a similar frequency of delays. Adequate environment associated with the absence of RIHL (CG-AE) leads to better cognitive, language, and motor performances. ConclusionBiological and environmental risk factors have a similar impact on development, but the accumulation of both tends to increase the risks of developmental delay. The absence of RIHL and quality environments worked as protective factors and favored the acquisition of skills.

Clinical features and underlying genetic causes in neonatal encephalopathy: A large cohort study.

This study aimed to investigate the potential genetic causes of neonatal encephalopathy (NE) in a large cohort of Chinese patients. We included 366 neonates with encephalopathy. Whole exome sequencing was performed to assess the potential molecular defects. In this study, 43 patients (11.7%) were identified with pathogenic or likely pathogenic variants and 10 patients (2.7%) carried variants with unknown significance. Compared with patients without genetic findings (28.9%), patients with genetic findings (96.2%) displayed a significant higher incidence of seizure (P = .0009); however, a lower frequency of abnormal magnetic resonance imaging (MRI) results (P < .0001). Epileptic encephalopathy related genes account for nearly half (46.4%) of all genetic defects of NE with seizures. Follow-up results revealed genetic diagnosis, seizure and severe abnormal electroencephalograph results were significantly associated with high risk of developmental delay (P < .05). This study increases the understanding of genetic contribution to NE. Our findings suggest that the full-term NE patients with seizure, the greater the possibility of genetic diseases. However, for newborns especially the preterm babies with abnormal MRI findings, there is smaller possibility of genetic diseases. NE caused from genetic diseases have poor prognosis, and intensive intervention and follow-up is necessary for these newborns.

Toward Predicting Infant Developmental Outcomes From Day-Long Inertial Motion Recordings

As improvements in medicine lower infant mortality rates, more infants with neuromotor challenges survive past birth. The motor, social, and cognitive development of these infants are closely interrelated, and challenges in any of these areas can lead to developmental differences. Thus, analyzing one of these domains - the motion of young infants - can yield insights on developmental progress to help identify individuals who would benefit most from early interventions. In the presented data collection, we gathered day-long inertial motion recordings from N = 12 typically developing (TD) infants and N = 24 infants who were classified as at risk for developmental delays (AR) due to complications at or before birth. As a first research step, we used simple machine learning methods (decision trees, k-nearest neighbors, and support vector machines) to classify infants as TD or AR based on their movement recordings and demographic data. Our next aim was to predict future outcomes for the AR infants using the same simple classifiers trained from the same movement recordings and demographic data. We achieved a 94.4% overall accuracy in classifying infants as TD or AR, and an 89.5% overall accuracy predicting future outcomes for the AR infants. The addition of inertial data was much more important to producing accurate future predictions than identification of current status. This work is an important step toward helping stakeholders to monitor the developmental progress of AR infants and identify infants who may be at the greatest risk for ongoing developmental challenges.

Assessing Risk of Developmental Delay in Small-for-Gestational Age Twins

Assessing Risk of Developmental Delay in Small-for-Gestational Age Twins

The Possible Effects of Breastfeeding on Infant Development at 3 Months: A Case-Control Study.

Objective: To examine the influence of exclusive breastfeeding on infant development among 3-month-old infants in a Chinese population. Methods: Mothers and their 3-month-old infants were recruited from four maternal and child health hospitals from April 2018 to March 2019. Based on the infants' feeding patterns, the mother-infant dyads were divided into two groups: exclusive breastfeeding and formula feeding groups. Infant development was evaluated using the Chinese version of the Ages and Stages Questionnaires, 3rd edition (ASQ-C), and maternal depression, parenting confidence, and infant temperament were also assessed using the relevant scales/questionnaires. Multivariate logistic regression analysis was conducted to explore the effects of feeding patterns on infant development at 3 months. Results: The data from 417 mother-infant dyads were analyzed. For the breastfeeding group and formula feeding group, the risk of developmental delay measured by the ASQ-C was 4.1% (10/244) and 9.3% (16/173) respectively for the communication domain; 5.7% (14/244) and 8.1% (14/173) for problem-solving domain and 6.2% (15/244) and 12.1% (21/173) for personal-social domain, respectively. Compared with exclusive breastfeeding, formula feeding was a risk factor for delayed development of communication (adjusted odd ratio [aOR] = 2.60, 95% confidence interval [CI] = 1.42-4.75) problem-solving (aOR = 1.91, 95% CI = 1.06-3.45), and personal-social skills (aOR = 1.96, 95% CI = 1.12-3.42). Conclusions: Exclusive breastfeeding is important for infant communication, problem solving, and social interaction at the age of 3 months. Formula-fed infants may be at a higher risk of developmental delay than exclusively breast-fed infants. It is necessary to encourage mothers to establish and continuous breastfeeding.

Mastery Motivation in Children at High Risk for Developmental Delays and Implications for Early Interventionists

Abstract Date Presented 03/28/20 This presentation will provide an overview of mastery motivation, examine population metrics of the Dimensions of Mastery Questionnaire (DMQ 18) for children at high risk for developmental delays, and provide recommendations for early interventionists or parents to assist in improving overall ability by encouraging mastery motivation. This research is most applicable to those in early intervention or OTs assessing infants or toddlers in NICU follow-up clinics. Primary Author and Speaker: Lily Gullion Contributing Authors: Patricia Blasco, Sage Saxton

Association between surgical procedures under general anesthesia in infancy and developmental outcomes at 1 year: the Japan Environment and Children\u2019s Study

BackgroundThe neurotoxicity of general anesthesia to the developing human brains is controversial. We assessed the associations between surgery under general anesthesia in infancy and development at age 1 year using the Japan Environment and Children’s Study (JECS), a large-scale birth cohort study.MethodsIn the JECS, 103,062 pregnancies and 104,065 fetuses were enrolled between January 2011 and March 2014. Of the 100,144 registered live births, we excluded preterm or post-term infants, multiple births, and infants with chromosomal anomalies and/or anomalies of the head or brain. Data on surgical procedures under general anesthesia in infancy were collected from self-administered questionnaires by parents at the 1-year follow-up. Developmental delay at age 1 year was assessed using the Japanese translation of the Ages and Stages Questionnaires, Third Edition (J-ASQ-3), comprising five developmental domains.ResultsAmong the 64,141 infants included, 746 infants had surgery under general anesthesia once, 90 twice, and 71 three or more times. The percentage of developmental delay in the five domains of the J-ASQ-3 significantly increased with the number of surgical procedures. After adjusting for potential confounding factors, the risk of developmental delays in all five domains was significantly increased in infants who had surgery under general anesthesia three times or more (adjusted odds ratios: for communication domain 3.32; gross motor domain 4.69; fine motor domain 2.99; problem solving domain 2.47; personal–social domain 2.55).ConclusionsSurgery under general anesthesia in infancy was associated with an increased likelihood of developmental delay in all five domains of the J-ASQ-3, especially the gross motor domain at age 1 year. The neurodevelopment with the growth should be further evaluated among the children who had surgery under general anesthesia.Trial registrationUMIN Clinical Trials Registry (number: UMIN000030786)

Is autism driven by epilepsy in infants with Tuberous Sclerosis Complex?

ObjectiveTo evaluate the relationship between age at seizure onset and neurodevelopmental outcome at age 24 months in infants with TSC, as well as the effect on neurodevelopmental outcome of early versus conventional treatment of epileptic seizures with vigabatrin (80–150 mg/kg/day).MethodsInfants with TSC, aged ≤4 months and without previous seizures were enrolled in a prospective study and closely followed with monthly video EEG and serial standardized neurodevelopmental testing (Bayley Scales of Infant Development and Autism Diagnostic Observation Schedule).ResultsEighty infants were enrolled. At the age of 24 months testing identified risk of Autism Spectrum Disorder (ASD) in 24/80 children (30.0%), and developmental delay (DD) in 26/80 (32.5%). Children with epilepsy (51/80; 63.8%) had a higher risk of ASD (P = 0.02) and DD (P = 0.001). Overall, no child presented with moderate or severe DD at 24 months (developmental quotient < 55). In 20% of children abnormal developmental trajectories were detected before the onset of seizures. Furthermore, 21% of all children with risk of ASD at 24 months had not developed seizures at that timepoint. There was no significant difference between early and conventional treatment with respect to rate of risk of ASD (P = 0.8) or DD (P = 0.9) at 24 months.InterpretationThis study confirms a relationship between epilepsy and risk of ASD/DD. However, in this combined randomized/open label study, early treatment with vigabatrin did not alter the risk of ASD or DD at age 2 years.

Developmental and behavioral outcomes of preschool-aged children with biotinidase deficiency identified by newborn screening.

Biotinidase deficiency (BD) may cause neurological symptoms and developmental problems. However, newborn screening of BD and early biotin treatment prevent the manifestation of the majority of symptoms. This study intended to examine the developmental and behavioral outcomes as well as maternal anxiety and depressive symptoms of preschool-aged children with BD and to compare these with the outcomes of healthy preschool-aged children. In total, 49 children with BD and 23 healthy children are included. All children were screened for developmental and behavioral problems. Moreover anxiety and depressive symptomatology of their mothers were evaluated. Despite the high percentage of developmental delay in BD group, the numbers of children screened positive for a developmental delay were statistically similar in children with BD and healthy children. Among patients with BD, children with risk of developmental delay had more unfavorable socio-demographic features compared to typically developing ones. Behavioral problem scores, maternal anxiety, and depressive symptoms scores of children with BD were not higher than the healthy children.Conclusion: Children with BD were not different from their healthy peers in terms of developmental and behavioral outcomes. Developmental problems of children with BD may be related to the unfavorable socio-demographic features, not the BD itself. What is known: • Biotinidase deficiency (BD) may result in neurological symptoms and developmental problems. • Newborn screening and early biotin supplementation prevent the manifestation of the majority of symptoms. What is new: • Preschool-aged children with BD identified by newborn screening are not different from their healthy peers in terms of developmental and behavioral outcomes. • Maternal anxiety and depressive symptoms scores of children with BD are similar to scores of healthy children.

Intergenerational Effects of Maternal Childhood Experiences on Maternal Parenting and Infant Developmental Progress.

This study evaluated the intergenerational indirect effects of maternal childhood experiences on infant progress in reaching developmental milestones through maternal scaffolding behaviors. We hypothesized that mothers who perceived their own mothers as highly supportive in childhood, even in the context of adverse childhood experiences (ACEs), would be more likely to engage in scaffolding with their infants, which in turn would predict greater infant developmental progress (e.g., less risk for developmental delay). Participants included 295 low-income mothers and their infants who were assessed prenatally and at 6 and 12 months postpartum. Mothers retrospectively reported on their childhood experiences, maternal parenting behaviors were observationally rated at 6 months postpartum, and infant developmental progress (communication, problem-solving, gross motor, fine motor, and personal-social) was assessed at 6 and 12 months postpartum using the Ages and Stages Questionnaire. The results of autoregressive structural equation models indicated that mothers who perceived their own mothers as highly supportive in childhood were more likely to engage in scaffolding behaviors with their infants, who in turn made greater progress (e.g., showed less risk for developmental delay) in reaching developmental milestones from 6 to 12 months postpartum. Follow-up analyses revealed that indirect effects were specific to infant problem-solving and communication skills. Maternal ACEs were not associated with parenting or infant developmental progress. Parenting behaviors in 1 generation influence parenting behaviors in the next, which has implications for infant developmental progress. The results may inform evidence-based preventive interventions for mothers and infants living in contexts of risk.

Hypnagogic Frontal EEG Bursts in Children: Epileptic or Not?

Various EEG patterns emerge in drowsiness. Intermittent bilateral midfrontal slowing (BFS) and hypnogogic frontal predominant sharply contoured waveforms (HFSC), maximal at (Fz, F3-4, and Fp1-2), are often encountered. These do not meet the criteria for epileptiform discharges. The study objective was to determine the clinical significance of BFS and HFSC. Clinical information of children with BFS (n = 49) and HFSC (n = 99) was compared with control subjects with generalized spike-wave (GSW) discharges (n = 102) and normal EEGs (n = 100). HFSC was present in younger children (mean age was 3.5 ± 3.6 years), whereas BFS was present in older children (mean 12.9 ± 4.8 years). Seizures occurred in the normal EEG, BFS, HFSC, and GSW groups, respectively, as follows: 22 (22%), 15 (31%), 42 (43%), and 100 (98%) patients, whereas epilepsy occurred in 17 (17%), 10 (20%), 35 (35%), and 95 (93%) patients. The GSW group had more seizures and epilepsy than the other groups (P < 0.001), but the HFSC group also had more seizures (P < 0.001) and epilepsy (P < 0.003) than the normal EEG group. Seizures and neurodevelopmental and psychiatric comorbidities were similar between the BFS and normal EEG groups. Notably, the HFSC group had more developmental delay than the normal EEG group [33 (33%) versus 18 (18%), P < 0.009] but were similar to the GSW group 22 (22%). Bilateral midfrontal slowing and HFSC have had unclear significance. Our results suggest that HFSC may be a marker of increased risk of seizure, epilepsy, and developmental delay as compared to children with normal EEGs and has similar risk of developmental delay to those with GSW.

Adaptive Behavioral, Social-Emotional, and Neurodevelopmental Outcomes at 2 Years of Age in Hungarian Preterm Infants Based on Bayley III

ABSTRACT Aim This study aimed to assess cognitive, language, and motor development as well as social-emotional and adaptive behavior skills of low birthweight (LBW) children. Methods Our cohort contained 305 two-year-old LBW children. Developmental functioning was assessed by the Bayley Scales of Infant and Toddler Development, 3rd Edition. Results Performance in language, particularly in expressive communication was the poorest. Extremely low birthweight (ELBW) children were found to be at increased risk of developmental delay: 12.73 times in motor (95%CI = 2.8–57.5), 9.81 times in cognitive (95%CI = 3.2–29.6) and 3.91 times in language (95%CI = 1.6–9.4), and social-emotional skills (95%CI = 1.6–9.5). Parents of children with lower birthweight reported poorer social and practical adaptive skills. Self-care domain seemed to be the least developed. Conclusion Additionally, the screening for developmental delays, monitoring the adaptive behavior skills may also be useful – especially among ELBW children – in order to identify the specific areas, situations, and functions that are most in need of interventions. Abbreviations AB: Adaptive Behavior; ABAS-II: Adaptive Behavior Assessment System-II; BPD: Bronchopulmonary Dysplasia; BSID-III: Bayley Scales of Infant Development 3rd Edition; BW: Birthweight; CI: Confidence Interval; CS: Composite Score; ELBW: Extremely Low Birthweight; GA: Gestational Age; IVF: In Vitro Fertilization; IVH: Intraventricular Hemorrhage; LBW: Low Birthweight; NEC: Necrotizing Enterocolitis; OR: Odds Ratio; ROP: Retinopathy of Prematurity; SE: Social-Emotional Development; VLBW: Very Low Birthweight

Exploring the Knowledge and Needs of Early Childhood Development Practitioners from a Low-Resource Community

Early childhood development (ECD) practitioners from low-resource communities may find it challenging to provide developmentally appropriate services to support child development, due to the increased risk of developmental delays. Practitioners rely on their ECD knowledge when delivering ECD services, but many practitioners in South Africa are underqualified. The knowledge and needs of practitioners from low-resource communities should be explored to develop and implement appropriate support services. A combined Knowledge of Infant Development Inventory (KIDI) and KIDI-Preschool (KIDI-P) tool was used to investigate ECD knowledge, and a questionnaire was utilised to determine participants’ needs. The mean score for their ECD knowledge was 47.0%. ECD qualification and experience were not identified as significant contributors for better knowledge scores, but having a high school education (β = 4.702, t = 3.387, p = 0.001), being a parent (β = 3.764, t = 2.091, p = 0.038), training completed 5 or more years ago (β = 4.271, t = 2.142, p = 0.034), and a need for information on developmental milestones (β = 2.399, t = 1.992, p = 0.048) were. The most commonly reported need was related to training and furthering knowledge. The findings provide insight into the knowledge base of ECD practitioners, their needs as well as significant contributors to better ECD knowledge. Implications for practice can be guided by the Nurturing Care Framework (World Health Organization 2019), since the participants and findings from the study can be contextualised within it. ECD practitioners, especially those from low-resource communities, need adequate support in the crucial role they are playing. Further research should be conducted to determine consistency of the findings.

Obstetric, neonatal and child development outcomes following assisted hatching treatment: a retrospective cohort study

Assisted hatching (AH) involves artificial disruption of the zona pellucida prior to embryo transfer. The purpose of this study is to examine the safety of AH technique and its effect on obstetrical, perinatal and neonatal outcomes and risk of developmental delay. This is a retrospective cohort of ART cycles using laser AH technique. The study group consisted of 120 cases of AH cycles resulting in singleton pregnancies and live births compared with 113 control cases. A current phone questionnaire was conducted to assess child development in the first year of life. AH was not associated with increased risk for all obstetrical and perinatal outcomes examined including PPROM, gestational diabetes, hypertensive diseases of pregnancy, delivery by cesarean section, gestational age at delivery, low birth weight (LBW), preterm birth and neonatal Apgar score (p>.05). No significant differences were observed between AH and control group in rates and risk of congenital malformations (5.8 vs. 4.4%, respectively, OR 1.33, 95% CI 0.41–4.34) and developmental delay (19.2 vs. 12.8%, respectively, OR 1.62, 95% CI 0.74–3.52). AH did not increase the risk of obstetrical and neonatal complications in singleton pregnancies, including congenital malformations and child developmental delay. AH may therefore be considered a safe method of ART.

Combined effect of polymorphisms of MTHFR and MTR and arsenic methylation capacity on developmental delay in preschool children in Taiwan.

Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are related to cognitive dysfunction and mental disability. These genes, along with folate and vitamin B12 levels, are regulators of one-carbon metabolism, which synthesizes S-adenosylmethionine (SAM) as a methyl donor for arsenic methylation. The aim of this study was to explore whether polymorphisms of MTHFR and MTR influence arsenic methylation capacity and plasma folate and vitamin B12 levels and if these influences cause developmental delay in preschool children. A total of 178 children with developmental delay and 88 without developmental delay were recruited from August 2010 to March 2014. A high-performance liquid chromatography-hydride generator and atomic absorption spectrometer were used to determine urinary arsenic species. Plasma folate and vitamin B12 concentrations were measured by SimulTRAC-SNB radioassay. Polymorphisms of MTHFR C677T, MTHFR A1298C, and MTR A2756G were examined by polymerase chain reaction and restriction fragment length variation. The results show that MTHFR C677T C/T and T/T genotypes had a lower risk of developmental delay than the C/C genotype (odds ratio [OR] = 0.47; 95% confidence interval, 0.26-0.85). Subjects with the MTHFR C677T C/C genotype had significantly lower plasma folate and vitamin B12 levels than those with the MTHFR C677T C/T and T/T genotype. The MTHFR C677T C/C genotype combined with high total urinary arsenic and poor arsenic methylation capacity indices significantly increased the OR of developmental delay in a dose-response manner. This is the first study to show the combined effect of MTHFR C677T genotype and poor arsenic methylation capacity on developmental delay.

Understanding Gaps in Developmental Screening and Referral.

* Abbreviations: AAP — : American Academy of Pediatrics EI — : early intervention In this issue of Pediatrics , Lipkin et al1 describe trends in pediatrician-reported developmental screening and referral practices between 2002 and 2016. The authors compare data across serial American Academy of Pediatrics (AAP) Periodic Surveys conducted in 2002, 2009, and 2016. They demonstrate that pediatricians’ self-reported use of formal developmental screening tools increased from 21% in 2002 to 63% in 2016 and that referral of patients identified as at risk for developmental delay to early intervention (EI) services increased concomitantly from 41% to 59%. Their data, however, also suggest that in 2016, more pediatricians considered lack of available treatment options to be a barrier to screening than did so in 2002 (21% vs 9%). Although developmental screening, surveillance, and referral to services has long been an important aspect of pediatric primary care, the AAP issued its first policy statement calling for universal developmental screening in 2001.2 The unique sampling frames queried with each Periodic Survey included in the current study preclude a true longitudinal analysis of individual-level practice changes; however, the current study represents an important barometer of screening and referral practices over the nearly 20 years since the AAP’s initial policy … Address correspondence to Mei Elansary, MD, MPhil, Division of General Pediatrics, School of Medicine, Boston University, 801 Albany St, Boston, MA 02118. E-mail: mei.elansary{at}bmc.org

A Meta-Analysis of Peer-Mediated Interventions for Young Children with or at Risk for Developmental Delays: Focused on Single-Case Experimental Design Studies

본 연구에서는 단일대상연구설계를 활용한 또래활용 중재연구들의 효과크기를 분석하고, 또래활용 중재가 발달지체 및 장애위험 유아들을 위한 증거기반교수로서 활용 가능한 지에 대해 탐색하였다. 이를 위해 2000년 이후부터 2019년 12월 31일까지 발표된 국내학술지 논문 중 포함 및 배제기준에 따라 선정된 총 12편의 연구를 대상으로 하였다. 무선효과모형을 통하여 전체 평균효과크기(Tau-U)를 산출하였으며, Meta-ANOVA와 Meta-회귀분석을 활용하여 하위그룹 및 조절변인들에 따른 효과크기를 살펴보았다. 분석 결과는 다음과 같이 요약될 수 있다. 첫째, 또래활용 중재는 사회적 기술, 상호작용, 언어기술, 활동참여를 증진시키는 데에 중간-높은 수준의 효과를 보이는 것으로 나타났다. 둘째, 중재유형들 중, 사회극놀이가 가장 빈번하게 사용되었으나, 협동놀이와 게임의 효과크기가 가장 높게 나타났다. 셋째, 중재환경의 경우, 놀이터에서 진행된 중재가 강한 효과를 보였으며, 교실과 치료실은 상대적으로 낮은 효과크기를 나타냈다. 넷째, 유아의 연령, 성별, 중재의 시간과 횟수 변인들은 효과크기에 유의한 조절변인들로 작용하지 않았다. 이상의 결과들을 바탕으로, 또래활용중재의 효과적인 적용 방향과 향후 연구 과제에 대해 논의하였다.This study aimed to provide information about the effectiveness and research evidence on peer-mediated interventions based on a metal analytic approach as a way to evaluate whether those interventions can be established as evidenced-based and have the potential for classroom use. Among the peer-reviewed journals published from 2000 through 2019, an extensive search process with inclusion and exclusion criteria yielded a total of 12 single case experimental design studies to be included in the current study. Effect sizes(ES) were calculated using a Tau-U formula and a random effect model was employed to estimate the significant ESs. Meta-ANOVA and Meta-Regression were applied to calculate the ESs for sub-groups and mediators. Results can be summarized as below: First, peer-mediated interventions were effective in improving social skills, interactions, communication skills, and activity participation. Second, the social play was most frequently used as an intervention type, but the ESs were higher in collaborative play and games. Third, interventions provided in playgrounds showed the highest ES, and interventions delivered in classrooms and clinical rooms showed relatively low in ESs. Finally, variables such as age, gender, time, and session frequency didn’t impact on the significance of ESs. Based on the results, practical implications and directions for future research were discussed.

Physical Discipline, Deprivation, and Differential Risk of Developmental Delay Across 17 Countries

Parenting behaviors have been studied largely in isolation with regard to child development in cross-national contexts. We examine and compare the relative strength of association between physical discipline and deprivation with risk of children's socioemotional and cognitive developmental delay in a cross-national sample. The sample was drawn from the UNICEF Multiple Indicator Cluster Survey. Analyses used observations with data on parental physical discipline, parenting behaviors associated with deprivation, and child developmental outcomes. The present analysis included 29,792 children aged 36-59 months across 17 countries. Using the Early Child Development Index, risk for cognitive or socioemotional developmental delay was indicated if a child could not accomplish 2 or more items within that specific subdomain. Overall risk for delay was indicated if a child was at risk in either subdomain. Associations among discipline, deprivation, and delay were assessed using multivariable logistic regression. Five of the 7 exposures were associated with risk of overall developmental delay. Physical discipline (odds ratio [OR]= 1.49 [95% CI= 1.39, 1.59]; p< .001) had the largest association with risk for socioemotional delay. Not having books (OR= 1.62 [95% CI= 1.42, 1.84]; p< .001) and not counting with the child (OR= 1.47 [95% CI= 1.32, 1.64]; p< .001) had the largest associations with risk of cognitive delay. The exposures of physical discipline and deprivation measured here have distinct associations with risk of socioemotional and cognitive delay cross-nationally. Programmatic and clinical interventions should seek to act on adversities that are relevant to the targeted delay.