Background: The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child-care visits. Early identification facilitates early intervention (EI), which improves developmental outcomes. Historically, Non-Hispanic Black and Hispanic/Latino children in the United States receive autism diagnoses and autism-specific services later than Non-Hispanic White children. Variability in pediatric screening rates may indicate that systemic factors impede screening and referral; enhanced screening across community settings may support autism identification and connection to services. Methods: A feasibility study was conducted with one early learning program (ELP) to determine if screening for autism in ELPs is feasible. ELP teachers and staff received one 90 min training session on screening with the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). They were then tasked with independently screening ELP-enrolled children between 16 and 30 months old. Results: Eighty children were eligible for screening and 79 screenings were completed; 14 screens were positive and 65 were negative. Of the 14 positive screens, eight referrals were made to EI. All eight families completed EI evaluations and were eligible for EI services. One family declined an evaluation. Five positive autism screens were for children already receiving general EI services. Those five screening results were communicated to the child's EI team and an autism-specific evaluation was completed; four of the five children subsequently received autism diagnoses. Conclusions: Our data supports the feasibility of completing autism-specific screenings within an ELP setting.
Abstract The use of multiple technologies in the service of social relations in widely evident. It is not at all clear, however, that we recognize the fundamental changes in social relations that are occurring as a result. Some changes are quite positive, e.g., low cost maintenance of geographically distant but emotionally close relationships. Others can be quite negative, e.g., the lost ability to gauge emotional reactions through face-to-face contact, often resulting in unnecessarily hurtful behaviors. Preliminary data indicate that people selectively use different forms of communication under positive circumstances, e.g. to transmit good news; or negative circumstances, e.g. resolve a dispute/express anger and dependent on the nature or closeness of the relationship e.g., parent, spouse, child. We need to be mindful of the good, the bad, and the ugly of technology; and, its specific effect on the relationships of and with older people.
Various learning disorders affect children without any sensory (vision, hearing), psychiatric, or neurological impairments, even when they have adequate intelligence and a suitable social environment. These children have difficulties in learning to read, write, spell, calculate, express themselves, or concentrate. Objective To demonstrate the importance of the Bells test in young students without visuospatial complaints and to evaluate the test in different levels of schooling, age groups, and genders. Methods Among the one hundred (100) middle school students enrolled in the second year of middle school, sixty (60) students were selected to be tested using the Bells test. This test consists of a sheet containing 315 small drawings, including 35 bells. The participants are required to circle as many bells as possible (the test time is limited to three minutes). Results The percentage of students suspected of having hemineglect is 8.33% or 5/60. Students who forgot their left bells exhibited right hemineglect, while those who forgot their right bells exhibited left hemineglect. Furthermore, 16/60 students surveyed obtained a negative score on the left-right hemineglect calculation, representing 26.66%. Omissions were slightly more frequent on the right side. A statistical analysis revealed a non-significant correlation between the two sexes. Conclusion Identifying neuro-visual disorders in school-aged children, regardless of their age, would allow us to prevent these disorders from impacting learning, treat them in a specific manner, and determine the neurological origin of the disorder in a child experiencing difficulties.
Abstract Social status of the elderly nowadays declines rapidly in China. As anthropologist Margaret Mead considered, post-figurative culture leading in contemporary society and the source of knowledge are from youth. The value of the elderly has been overlooked. However, in Pumi, one of the smallest ethnic minority groups in northwestern Yunnan Province of China, it is common that senior residents have high social status. This study examines the social values the Pumi elderly have by systematic analysis and participation observation methods. Based on data collected in a Pumi village during a 6-month fieldtrip, we conclude that Pumi elderly enjoy a high status in the community. They occupy core positions in all important ceremonies, such as religious activities and other daily activities including hospice. Factors behind the special old-age care phenomenon are Pumi’s history and its culture. The special culture has united the group members together and enhanced individual development with community social capital. It is clear that respecting elderly does not only contribute the transformation of ethnical knowledge but also enhance community cohesiveness. Evaluating the role of the elderly should not only from economic perspective, but also from the holistic perspective of social culture, so as to reconsider the importance of the elderly to our society.
Abstract BACKGROUND Telehealth is an emerging modality that can include patient evaluation, review of test results, and clinical decision-making. Access to care and quality of life are challenges for patients with pediatric brain tumors and their families. Herein we describe the introduction of video visits within our outpatient services led by nurse practitioners and nurse coordinators. METHODS The pediatric neuro-oncology program at University of California, San Francisco - Benioff Children’s Hospital (UCSF) established a robust telehealth practice to improve access to care for children and young adults with brain and spine tumors. Our nursing team identifies appropriate time points to offer video visits in lieu of in-person visits. Families are guided to connect through secure video conferencing. Data was collected retrospectively through electronic medical record schedules, billing records, and UCSF patient satisfaction surveys. RESULTS Since 2015 we have utilized telehealth for over 400 encounters. The service was limited to patients located in California. Introduction of telehealth resulted in savings of 2300 hours of travel by car, over $22,000 in gas, and over 127,000 miles traveled. Surveys indicate patient satisfaction is equal to or better than in-person experiences. Anecdotally, this service allows for face-to-face contact with patients who have significant barriers to travel. Challenges have included technology platforms, native language, provider and patient acceptance, and billing. CONCLUSION Overall, telehealth is feasible as a tool to deliver outpatient care in pediatric neuro-oncology. Implementation of video visits in clinical practice increases access to neuro-oncologic care and improves quality of life for patients and families.
Background/Objectives: Dental caries is the most prevalent chronic disease of childhood, and untreated caries in the primary dentition affects an estimated 514 million children worldwide. Children are the principal target of oral health outreach through school dental screening, community camps, and charitable events for children with special healthcare needs, yet these programmes are evaluated largely by what is most visible: the number of children examined and the photographs disseminated. This measurement substitution dissociates activity from impact, so that children are screened but not treated, counted but not cared for. The objective was to determine what works, for whom, in what contexts, and through what mechanisms in converting children's oral health screening contacts into sustained care, with primary applicability to low- and middle-income, community-outreach-oriented health systems and, in particular, to India and South Asia, while the configurational logic is offered as transferable rather than universal. Methods: A realist synthesis was conducted and reported in accordance with the RAMESES publication standards. An initial programme theory was developed and refined through purposive iterative searching, appraisal of relevance and rigour, and the extraction of Context, Mechanism, and Outcome (CMO) configurations across the diverse literature. Searching ran from initiation to theoretical saturation; complete strategies, dates, and a document-selection flow diagram are provided. Results: Eight configurations were derived, six enabling and two antagonistic, organised around three thematic constellations, Prevent, Promote, and Promulgate, and navigated by a compass of competency-based education. Thirty-six documents were retained as the principal contributors to the final synthesis. The refined theory holds that the intervention is not the camp but the configuration of conditions that allows it to convert into care for the child. Conclusions: Children's oral health outreach should be evaluated as a multi-level health-systems configuration rather than a discrete event; competency-based education is the generative lever that reorients practice from optics to outcomes. The eight configurations are theoretical propositions that require prospective empirical testing through realist evaluation before they are treated as confirmed causal claims.
Purpose The purpose of this study was to identify domains of psychosocial risk specific to school-aged cochlear implant (CI) users and to explain individual differences in psychosocial risk within the CI sample. Method The parent-completed Behavior Assessment System for Children was used to measure psychosocial functioning behaviors in 59 children with CIs and 52 children with hearing 7-19 years of age. Item-level differences between the CI and hearing samples were identified, and a principal components analysis (PCA) was conducted on differentiating items to identify at-risk psychosocial behavioral constructs specific to CI users. Associations between CI-specific risk constructs and audiological, speech-language, and neurocognitive functioning were investigated. Results CI users showed significantly greater psychosocial difficulties compared to their hearing peers on 14 items of the Behavior Assessment System for Children-Second Edition. A PCA on those items identified three domains that represent CI-specific psychosocial risks: communication deficit, social popularity, and executive functioning. Better receptive vocabulary and verbal comprehension were associated with better functioning in all three CI psychosocial risk domains. Better verbal short-term memory was associated with fewer risks related to communication deficit and social popularity, whereas better verbal working memory was associated with stronger executive functioning. Participants with stronger sentence recognition had fewer risks related to communication deficit. Conclusions Children and adolescents with CIs show specific elevated psychosocial risks for problems in social communication and executive functioning. Language abilities broadly influenced all psychosocial risk domains, while other cognitive abilities were more specifically associated with some psychosocial outcomes. Development of measures tailored to assess CI-specific domains of psychosocial risk is needed to inform targeted clinical intervention. Supplemental material https://doi.org/10.23641/asha.32913569.
Purpose To evaluate changes in visual acuity (VA) and stereoacuity in children with amblyopia following monocular or stereopsis training delivered alongside standard clinical care and to examine factors associated with training-related improvements in visual outcomes. Methods Forty-three children with amblyopia (7.3-14.8 years; 37 anisometropic, five strabismic, and one mixed) completed approximately 29 sessions of either monocular training (grating acuity or motion discrimination targeting the amblyopic eye, n = 23) or binocular stereopsis training (dichoptic disparity discrimination, n = 20). All participants continued standard clinical management, including optical correction and prescribed patching. Pre- and post-training assessments included amblyopic-eye VA, interocular acuity difference (IOD), and Randot stereoacuity. Results Both training protocols produced significant task-specific learning. Amblyopic-eye VA improved significantly in both groups, with no evidence of differential effects between training approaches. Stereoacuity also improved in both groups, with significantly greater gains following stereopsis training than monocular training. Exploratory analyses indicated that poorer baseline amblyopic-eye VA was associated with larger VA gains; however, this association did not survive correction for multiple comparisons. Stereoacuity improvement was not significantly associated with baseline VA, IOD, age, or changes in VA. Conclusions Visual training combined with standard clinical care improved amblyopic-eye VA and stereoacuity in children with amblyopia. Although both training approaches yielded comparable gains in VA, stereopsis training produced larger improvements in stereoacuity, supporting its potential role in addressing residual binocular deficits after conventional treatment.
OBJECTIVES/SPECIFIC AIMS: Our overall goals are: 1. To engage, inform and educate children and families on clinical research and increase their understanding of the goals and process of participation in research studies/clinical trials; 2. To Increase participation of children, especially those who are disproportionately underrepresented, in clinical research in the Western New York region and beyond. METHODS/STUDY POPULATION: The University at Buffalo Clinical Translational Science Institute conducted meetings in schools, community coalitions while holding focus groups with children with chronic conditions and their families and community health workers to identify the general perceptions of research. These conversations then informed the development of a children’s activity book about research. Completed in 2017, our “Sofia Learns about Research” activity book presents research in a non-threatening way by presenting a child with asthma who walks through the process of learning about research, being recruited and participating in research. The book explains basic concepts about research coupled with fun games and the possibility to color. Over 1,000 copies of the activity book have been disseminated to second to fourth graders via afterschool programs, community events, and medical practice waiting rooms. Recipients of the book are directed to short surveys to provide feedback on the book and their perception of research. The parents are also given the option to sign-up for the Buffalo Research Registry in order to be contacted about research opportunities. RESULTS/ANTICIPATED RESULTS: Response has been very positive, with parents and community participants saying “It’s not just a storybook. The activities keep kids entertained while learning new concepts.” In children informally polled via a brief questionnaire pre and post story reading at an afterschool program, there was an increase in those interested in participating in a research study. In a recent event sponsored by the CTSI Community Engagement Core and other UB organizations, a group of fifty children from diverse background colored with enthusiasm several activity pages and obtained stickers for their “Research Passport”. In a recent teacher focus group we learned that the book content may fit the Science Curriculum and plan on reading sessions in inner-city schools after approval from the district. A pilot reading activity in a Montessori program revealed that second grade children were able to understand and complete the activities in the book. We are obtaining further feedback form teachers and parents in order to design simple protocol to be submitted for IRB approval to obtain more formal feed-back and outcomes in future readings. In parents and focus groups several respondents have indicated its relevance to older populations and English-language learners as well. The book has recently been translated into Spanish and Arabic through a partnership with the International Institute of Buffalo, which “welcomes, connects and empowers the foreign born”. Some of the book’s images have been modified in order to be sensitive to the readers’ culture and we are in the process of collaborating with the International Institute to disseminate it to their clients. We are in the initial phase of planning a mobile application which we anticipate will significantly enhance dissemination. DISCUSSION/SIGNIFICANCE OF IMPACT: This presentation will describe the development process, the underpinning concepts and our plans and current progress towards a more formal community and school dissemination and evaluation. This project was made possible by Team Science in that the expertise of a millennial pre-medical student and an anthropologist with high community involvement was coupled with that of a senior clinical translational researcher. Moreover, much research and attention was devoted to the creation of images that are culturally inclusive. To this end, with the exception of the cover page, we have intentionally created the book in black and white so that the child may use his/her imagination and color the way he/she sees the protagonists and the environment. Great attention was devoted to names of the protagonists with the names of the two main characters being among the most common in the world in numerous countries. Also, the book lends itself to a mobile application which will allow the reader to change colors and shapes of the protagonists to fit his/her cultural background. We are in the early planning stages and will share our progress as part of this presentation. We have strived to disseminate the book with a broad approach in our community. This phase is being followed by a more formal dissemination phase via libraries, schools and community events. This part of the project exemplifies the challenge between wanting to disseminate the book broadly while obtaining formal feedback and outcomes in compliance with regulations protecting the anonymity and/or confidentiality of children and families. Therefore for this second phase of dissemination IRB approval is being sought in order to collect more quantitative and qualitative data on the impact of the book. We have already conducted a focus group with teachers to overcome the challenges around informed consent, especially in the public school system. Our initial findings suggest this resource will improve knowledge and perception of research among children and their families. To our knowledge most of the materials explaining research to children are geared to older children and are often sponsored by pharmaceutical companies for a specific trial. If successful, this book can have a profound impact in reaching out to children outside of the research and medical environments, with the ultimate goal of increasing the child’s and family’s willingness to participate in clinical research and clinical trials.
Given the increasing prevalence of autism among school-aged children, preschool classrooms need evidence-based interventions to address students' social-communication needs. However, the complex school context presents unique challenges to maintaining a high level of intervention fidelity. We have engaged in an iterative development and testing process of professional development (PD) supports for the Advancing Social-Communication and Play (ASAP) intervention to create a PD model that supports preschool teams in their uptake and intervention fidelity. This pilot cluster randomized control trial included 12 classrooms (42 educators, 43 autistic preschoolers) and compared classrooms that received ASAP with adapted PD supports (ASAP-PD) to ASAP with materials only (ASAP-MO). The PD model supported gains in educators' knowledge of ASAP content and reported use of ASAP procedures when compared to ASAP-MO classrooms; however, there were no group differences in fidelity of implementation during classroom observations, and implementation varied widely across classrooms. There were also no group differences in primary student outcomes, although parents in the ASAP-PD group reported significant changes in child skills from pre- to post-test. Implications for practice and future directions for research are discussed with a focus on the importance of implementation supports to address common challenges in schools.
