Parent Ratings of Health Insurance Adequacy for Children with Emotional,Behavioral, or Developmental Problems

ObjectiveParents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs.MethodsThis study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association.ResultsAmong all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)—including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%).ConclusionsFuture research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.     

Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics

ObjectivesCompare lifetime earning potential (LEP) for developmental and behavioral pediatrics (DBP) to general pediatrics and other pediatric subspecialties. Evaluate association between LEP for DBP and measures of workforce distribution.MethodsUsing compensation and debt data from 2018 to 2019 and a net present value analysis, we estimated LEP for DBP compared to general pediatrics and other pediatric subspecialties. We evaluated potential effects of eliminating educational debt, shortening length of fellowship training, and implementing loan repayment or forgiveness programs for pediatric subspecialists. We evaluated the association between LEP for DBP and measures of workforce distribution, including distance to subspecialists, percentage of hospital referral regions (HRRs) with a subspecialist, ratio of subspecialists to regional child population, and fellowship fill rates.ResultsLEP was lower for DBP than for general private practice pediatrics ($1.9 million less), general academic pediatrics ($1.1 million less), and all other pediatric subspecialties. LEP of DBP could be improved by shortening fellowship training or implementing loan repayment or forgiveness programs. LEP for subspecialists, including DBP, was associated with distance to subspecialists (-0.5 miles/$100,000 increase in LEP, 95% confidence interval [CI] -0.98 to -0.08), percentage of HRRs with a subspecialist (+1.1%/$100,000 increase in LEP, 95% CI 0.37–1.83), ratio of subspecialists to regional child population (+0.1 subspecialists/100,000 children/$100,000 increase in LEP, 95% CI 0.04–0.17), and average 2014 to 2018 fellowship fill rates (+1% spots filled/$100,000 increase in LEP, 95% CI 0.25–1.65).ConclusionsDBP has the lowest LEP of all pediatric fields and this is associated with DBP workforce shortages. Interventions to improve LEP may promote workforce growth.     

青春期的心理行为问题及对策

青春期是指12～16岁的年龄阶段,是个体从童年期向青年期过渡的阶段,也是心理行为问题的高发阶段.了解青春期常见的心理及行为问题,并根据青春期孩子的特点制定缓解或改善青春期心理行为问题的方法和对策,对其青春期的正常发育十分重要.     

他山之石可以琢玉——美国发育行为儿科学的发展对中国发育行为儿科学的借鉴意义

金星明教授欢迎Mark D.Simms教授来中国上海参加中华医学会儿科学分会发育行为儿科学(Developmental and Behavioral Pediatrics,DBP)学组的成立大会. Simms教授很荣幸受到您的邀请,想表达两个祝贺,一是祝贺中华医学会儿科学分会DBP学组的成立,二是祝贺金教授当选第一任DBP学组组长. 金星明教授说来很巧合,美国DBP是美国儿科学会的第13个亚专业,中国的DBP学组是中华医学会儿科学分会的第13个学组.在美国DBP作为一个亚专业有30多年的发展历史,事实上医学史上一个新的亚专业的逐渐形成是要经过漫长的历史.     

Reading Problems and Antisocial Behaviour: Developmental Trends in Comorbidity

Samples of poor and normal readers were followed through adolescence and into early adulthood to assess continuities in the comorbidity between reading difficulties and disruptive behaviour problems. Reading-disabled boys showed high rates of inattentive-ness in middle childhood, but no excess of teacher-rated behaviour problems at age 14 and no elevated rates of aggression, antisocial personality disorder or officially recorded offending in early adulthood. Increased risks of juvenile offending among specifically retarded-reading boys seemed associated with poor school attendance, rather than reading difficulties per se , Reading problems were associated with some increases in disruptive behaviour in their teens in girls.     

哮喘儿童行为问题与家庭环境关系的研究(英文)

目的：探讨家庭环境与哮喘儿童行为问题的关系,为在儿童哮喘的综合治疗手段中进行心理干预提供理论参考依据。方法：采用家庭环境量表中文版(FES-CV)和Conners儿童行为问卷分别对哮喘儿童50名、正常儿童50名(3～12岁)行为问题及家庭环境进行调查,并对调查结果进行多元回归分析。结果：哮喘儿童行为问题检出率明显高于对照组(36.0％VS12.0％),差异有显著性(P<0.01);影响哮喘儿童行为问题的家庭特征有情感表达、矛盾性、亲密度和知识性。结论：心理家庭因素与儿童哮喘发作有关。提示临床医生在药物治疗同时也要有针对性地开展心理及家庭干预。 [中国当代儿科杂志,2003,5(1):17-19]     

Behavioral Testing in the Context of Reproductive and Developmental Toxicity Screening in the West*

Abstract Methods for assessing animal neurobehavior following prenatal/perinatal exposures have been in use for almost 20 years and screening tests incorporating them are regulated in three settings: in Japanese Segment II and III studies on drugs, European (EEC/UK) Segment I studies on drugs, and American neurotoxicity studies on chemicals. The methods used in the West for assessing behavior in these contexts at present are described in detail. The evolution of the methods over time, the concepts of apical tests and functional domains, the use of positive control agents, what the U.S. Collaborative Study has shown us, and justification for assessing animal behavior in predicting outcome from human exposures are discussed.     

New Approach in Behavioral Teratology—Experimental Study on FAS *

ABSTRACT Fetal alcohol syndrome is known as an effect given by mothers. In connection with this, we so far observed rats from physical, biochemical, histological, and functional standpoints. Recently we observed synaptogenesis in brain together with behavior and learning ability of rats. Ethanol was given to mother rats during pregnancy and nursing periods, and learning ability of their offspring at 12 weeks of age was studied by the radial arm maze method. Also synaptogenesis in the hippocampus CA1 was observed at 2, 7, 14, 21, and 70 days of age by quantitative electron microscopy. The offspring were significantly deficient in learning ability tested with the maze compared with offspring of mother rats not exposed to ethanol. Densities of all synapses in the strata radiatum and lacunosum-moleculare of CA1 in the hippocampus became significantly lower at every time of the observation. Both axo-spinous and axo-shaftic synapses significantly decreased. Thus we found that observations of learning ability agreed with observations of synaptogenesis in the hippocampus CA1 which has important association with memory. This fact suggests that both observations will be of great value in the research in behavioral teratology.     

Methods in Behavioral Teratology Screening: Current Status and New Developments

Abstract In 1975 our laboratory began developing a behavioral teratology screening test battery suitable for use in preclinical safety assessment experiments with rats. The battery involved assessment of physical milestones of development, sensorimotor reflex ontogeny, pre- and postweaning locomotor activity, motor coordination, and tests of learning and memory. Although some of the specific procedures were new, the tests themselves were drawn from the experimental animal psychology, undernutrition, psychopharmacology, and developmental X-ray literatures. The features which distinguished this approach from the past were not to be found in the tests employed, but rather from (1) the effort to objectify and standardize the tests to make them better suited as screening instruments and (2) the evaluation of them collectively and individually for reliability and validity. Reliability was ascertained by replication and validity by evaluation of positive and presumptively negative control test agents. The present paper reviews the rationale for the test battery and some of the positive effects that have been detected with the individual tests. New tests added to and old tests modified in the battery are discussed in the light of the recommendations which have come from the recently completed U.S. Collaborative Behavioral Teratology Study. Particular emphasis is placed on a discussion of the Biel water maze as a test that has been perhaps the most successful instrument for identifying behavioral teratogens to come out of the Cincinnati research effort.     

From Descriptive to Predictive: Linking Early Childhood Developmental and Behavioral Screening Results With Educational Outcomes in Kindergarten

ObjectiveTo assess the predictive value of a pediatric screening tool by linking 2 independent databases: an educational database that includes data from standardized academic assessments administered during kindergarten and a pediatric database that includes screening results.MethodsA database that includes results of the Survey of Well-being of Young Children (SWYC) completed during pediatric visits were linked to an educational database that includes STAR Early Literacy examinations in kindergarten. Linear multilevel regression modeling was used to examine if screening results on the developmental and behavioral sections of the most recently completed SWYC form predicted trends in the percentile rank on the STAR exam over the school year, adjusting for potential confounders.ResultsLinking the 2 databases resulted in a sample of 586 children who were administered at least one SWYC evaluation between 24 and 48 months and completed at least one STAR Early Literacy examination in kindergarten. The sample represents a diverse population with 55% Hispanic children, 25% Non-Hispanic black children, and 91% of children receiving a subsidized lunch. After adjusting for confounders, children with a positive developmental or behavioral screen had significantly lower percentile ranks on the STAR exam.ConclusionsEarly developmental and behavioral screening results predicted performance on the STAR exam in kindergarten. Children with developmental and behavioral concerns may be less ready to enter kindergarten than peers without such concerns. These preliminary findings provide proof-of-principle of the potential utility of developmental screening tools in identifying children with reduced school readiness who may benefit from intervention prior to kindergarten.