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Video Abstract: Physician voices on ECHO Autism India - Evaluation of A Telementoring Model for Autism in a Low-Middle Income Country

Video Author: Koyeli Sengupta
Published on: 01.20.2022
Associated with: Journal of Developmental & Behavioral Pediatrics. ():, January 12, 2022

We assessed the relevance and effectiveness of a telementoring model ECHO Autism in increasing pediatricians' access to best-practice care for children with ASD in Low-Middle Income Countries. Sixty-two physicians across two cohorts (2019-20) participated in the mixed-methods study. We found that participants considered the practices inherent in the ECHO Autism model like reflective discussions, respectful mentoring, having a parent as "expert" as novel, yet beneficial. We also found that participation improved physicians' knowledge, self-efficacy and practice-behaviors in ASD diagnosis and management. We propose ECHO Autism using local ASD experts, as a feasible model for enhancing best-practise ASD care in LMICs.

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Creator: Koyeli Sengupta
Duration: 5:58
We assessed the relevance and effectiveness of a telementoring model ECHO Autism in increasing pediatricians' access to best-practice care for children with ASD in Low-Middle Income Countries. Sixty-two physicians across two cohorts (2019-20) participated in the mixed-methods study. We found that participants considered the practices inherent in the ECHO Autism model like reflective discussions, respectful mentoring, having a parent as "expert" as novel, yet beneficial. We also found that participation improved physicians' knowledge, self-efficacy and practice-behaviors in ASD diagnosis and management. We propose ECHO Autism using local ASD experts, as a feasible model for enhancing best-practise ASD care in LMICs.
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Creator: Rebecca McNally Keehn
Duration: 5:38
In this video abstract, we present clinician and caregiver perspectives regarding telehealth neurodevelopmental evaluation delivered at the onset of the COVID-19 pandemic. Specifically, we describe telehealth neurodevelopmental evaluations, examine associations between child characteristics and diagnostic factors, determine the impact of technology and family barriers, and report on clinician and caregiver satisfaction with telehealth evaluation. Our findings suggest that telehealth holds significant promise for neurodevelopmental assessment both within the context of a global pandemic and beyond.
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Creator: Deanna Lau
Duration: 4:29
A diagnosis of ASD may be reliably made by 24 months old, yet the average age of ASD diagnosis is 4 years, 4 months old. Literature suggests that children with ASD have high rates of coexisting developmental behavioral disorders. Using nationally representative data from the 2011 Survey of Pathways to Diagnosis and Services, we investigated whether receiving a diagnosis of an alternate developmental behavioral disorder before ASD is associated with delays in ASD diagnosis following parental report of concern to healthcare professionals.
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Creator: Talia Losier, Sylvana M Côté
Duration: 03:58
Longitudinal study shows that early center-based childcare and education before school entry is related to higher graduation rates at 20 years. Child care services need to start early and be offered in a structured environment with qualified educators.
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Creator: Jessica L. Riggs, PhD
Duration: 4:54
Young children whose parents experienced childhood adversity are at risk for developmental problems (including social, emotional, and cognitive domains) across the lifespan. Parenting behavior may be a mechanism linking parental adversity and subsequent child language development problems, and is a target for intervention. Utilizing a randomized controlled trial, we demonstrated that a relationship-focused home visiting program, Infant Mental Health Home Visiting (IMH-HV), mitigates impact of maternal ACEs on toddler language. Parental adversity can impact development across generations, but intervention can mitigate this negative effect; IMH-HV and other relational interventions should be available to those at risk.
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Creator: Vivian W. L. Tsang
Duration: 4:30
This study takes an innovative approach to investigate the needs of young patients as they age out of paediatric care. Specifically, this three-phase mixed-methods study directly includes youth as co-researchers (YCR) from the creation of research objectives and implementation to data evaluation and knowledge translation. Challenges exist with siloed transition programs. It is important that comprehensive community support related to the pre-transition, transfer, and post-transition care of young patients be included in order for transition to be successful; a brilliant pre-transition preparation process is futile if post-transition care is unavailable or inadequate.
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Creator: Eric Fombonne
Duration: 9:26
This study, presented by Dr. Eric Fombonne, recruited 1,267 children (472 with autism, 410 with asthma, 385 controls) at several sites. Caregivers completed online standardized measures of psychiatric symptoms, of impairment in child’s functioning, and autism severity. At all ages and in both sexes, caregivers reported significantly much higher rates of psychiatric symptoms, and of impairment levels compared to both comparison groups. Among children with autism, psychiatric problems contributed to impaired functioning as much as autism symptomatology. The study suggests that systematic detection and management of emotional/behavioral problems in youth with autism could substantially improve their functioning and outcome.
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Creator: Suzanne Rybczynski, MD, MSHCM
Duration: 4:56
Suicide risk screening has been recommended for all ages in order to intervene and prevent suicide deaths through appropriate mental health services. Our study describes suicide risk screening in a neurodevelopmental disabilities and rehabilitation pediatric outpatient setting. It is feasible to implement universal suicide risk screening in youth with neurodevelopmental disabilities in outpatient clinic settings. We found our cohort to have a 6.8% rate of positive screenings similar to rates seen in neuro-typical children. As other healthcare institutions implement universal suicide risk screening, it is important that children with neurodevelopmental disabilities always be included in screening protocols.
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Creator: Radhika Raghunathan
Duration: 5:43
The COVID-19 pandemic has affected emotional and behavioral well-being of children and families. In this study, we investigated changes in children’s self-regulation before and during the onset of the COVID-19 pandemic and the impact of pandemic-related life disruptions on children’s behavior. Families who participated in an intergenerational study up to one year prior to the pandemic were recontacted (April 2020 - August 2020, n = 45, 87% Black). We found that children’s self-regulation decreased pre-pandemic to pandemic, particularly for children experiencing more pandemic-related disruptions. Children whose families have been disproportionately impacted by the pandemic may need focused support in school and at home to avoid widening pre-pandemic health disparities.
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Creator: Nancy Cheak-Zamora, Ph.D.
Duration: 3:44
The video details the study, Assessing and Promoting Independence in Young Adults with Autism Spectrum Disorder, including the qualitative methods used in the study, results, and implications.
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Creator: Addam J Wawrzonek
Duration: 5:35
The present study evaluated symptoms of pediatric feeding disorder in a sample of individuals with 3q29 Deletion Syndrome. Previous research has found that individuals with 3q29 deletion syndrome (3q29Del) may experience elevated feeding concerns in early childhood; however, the specificity of these feeding concerns is not well understood. Results suggest individuals with 3q29Del experience increased symptoms of pediatric feeding disorders that may require targeted evaluation and intervention for optimal outcomes.
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Creator: Emily Hanno
Duration: 5:21
The COVID-19 pandemic and associated public health measures have drastically affected life for children and families. In this study we examined changes in children’s behavioral health and families’ well-being at the start of the COVID-19 pandemic. Leveraging longitudinal data on nearly 3,000 children in Massachusetts, we used child fixed effects analyses to compare children’s own outcomes in Spring 2020 to their outcomes in pre-pandemic periods. We found that children’s behavioral health and families’ well-being worsened at the start of the pandemic. These findings underscore the need for family- and child-focused policies to mitigate negative outcomes.
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Creator: Marie-Josée Harbec, Gary Goldfield, Tracie A. Barnett, Linda Pagani
Duration: 5:38
This prospective-longitudinal study assesses the reciprocal relationship between physical activity, including sport participation, and depressive and anxiety symptoms, conceptualized as emotional distress, over time. We used a population-based longitudinal birth cohort design (n = 1438). We found that boys who were not physically active at age 5 years were more likely to experience later emotional distress from ages 6 to 10 years. Boys who experienced less depressive and anxious symptoms from ages 6 to 10 years were also more likely to be more physically active at age 12 years. We underscore male needs for physical activity for health promotion.
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Creator: Colleen Stiles-Shields, PhD
Duration: 4:42
We conducted a national survey to better understand the transition from pediatric to adult healthcare for young adults with Spina Bifida in the United States. Transition status, success, and preparation processes were assessed; correlates of transition status and success were also examined. While the majority of our sample of young adults with Spina Bifida had transitioned to adult healthcare, their reported experiences: 1) implicate potential interventions to improve this process; and 2) highlight the need for additional research about barriers and facilitators to the transition to adult healthcare for young people with Spina Bifida.
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Creator: Benjamin W. Sanders et al.
Duration: 7:32
Coauthors discuss challenges with EI referrals, study approaches, and results to answer the questions "What information is sent in an EI referral?" "Who sends EI referrals?" and "How are they sent?"
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Creator: Tuba Çelen Yoldaş
Duration: 4:08
This study aimed to identify developmental and behavioral problems of preschool-aged children with common chronic rheumatic diseases (Juvenile Idiopathic Arthritis or Familial Mediterranean Fever), to compare the diagnostic categories, and to elucidate the associated factors with these difficulties. Internalizing problem scores were increased and the percentage of children who failed at least in one developmental domain and experienced delays in fine motor and problem-solving domains were higher in children with chronic rheumatic diseases when compared with healthy children. The management of chronic rheumatic diseases in the early years should include the screening of developmental and behavioral problems.
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Creator: William G. Sharp, PhD
Duration: 5:43
Evidence suggest intensive multidisciplinary intervention holds benefit for children with feeding tube dependence complicated by comorbid medical, behavioral and/or developmental conditions; however, much remains unknown regarding factors impacting a patient achieving full oral feeding following intervention. This retrospective review involved 81 patients who completed intensive multidisciplinary intervention between June 2014 and 2019. Fifty-eight patients (72%) weaned from tube feeding at last follow-up; 23 patients (28%) experienced a partial wean. Results suggest improving response to intensive likely necessitates development of treatment adjuncts for patients whose medical and/or developmental conditions complicate wean from tube feeding.
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Creator: Mei Elansary, MD
Duration: 7:42
The purpose of this study was to test associations between maternal stress, maternal mindset, and infant neurodevelopment at 12 months of age. Specifically, we sought to examine the extent to which maternal growth mindsets may serve to attenuate the negative associations between maternal stress and infants’ neurodevelopment. Maternal perceived stress, maternal mindset, and infant electroencephalography (EEG) recordings were collected when infants were 12 months of age. The final analytic sample included 33 dyads. Results revealed no statistically significant main effects of maternal stress or maternal mindset for any of the infant EEG frequency band outcomes. After including interactions between maternal stress and mindset, statistically significant positive interactions were detected for all EEG frequency bands. Simple slope tests revealed significant negative associations between maternal stress and each of the six EEG frequency bands for mothers with more fixed-oriented mindsets. Associations between maternal stress and infant EEG outcomes for mothers with more growth-oriented mindsets did not differ from zero. These findings suggest that infants raised by mothers with growth mindsets may be protected against the neurodevelopmental consequences of higher maternal stress.
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Creator: Roopa Srinivasan
Duration: 6:33
This study aims to (1) adapt the Measure of Processes of Care (MPOC-20) for use in India and (2) evaluate family-centered services for children with disabilities and their caregivers in an urban Indian context. Methods: In this cross-sectional observational study, we translated the MPOC-20 into Hindi. Caregivers of children diagnosed with developmental disabilities who read and/or understood Hindi and had received services for ≥6 months were recruited. The psychometric properties of the Hindi MPOC-20 were assessed using factor analysis followed by reliability analyses. The Hindi MPOC-20 was used to assess caregiver perceptions about the family-centeredness of services delivered between October 2016 and February 2017 at Ummeed Child Development Center. Results: Of the 170 eligible children, 141 (83%) comprised the study sample. Most were boys (66%) with a median age of 67 months. Factor analyses yielded a 4-factor scale with items loading differently from the original measure. The resulting Hindi MPOC-20 had acceptable to good internal consistency (Cronbach’s alpha of scales: 0.71–0.86). On the Hindi MPOC-20, Respectful and Coordinated Care, Enabling Partnership and Providing Specific Information were identified as strengths and Providing General Information as a relative limitation of the service by caregivers across different income and education groups. Conclusion: The Hindi MPOC-20 shows acceptable psychometric properties for use with caregivers of children with disabilities in India. The availability of Hindi MPOC-20 paves the way for the assessment of the family-centeredness of services in India and provides a roadmap for adaptations in other low- and middle-income countries.
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Creator: Luciane R. Piccolo
Duration: 4:41
In this study, we examined 1) whether a reading aloud intervention, Universidade do Bebê (UBB), had impacts on self-regulation, 2) whether effects on child outcomes were mediated by self-regulation, and 3) whether effects of UBB were explained through a sequential pathway of impact including cognitive stimulation in the home, parent-child interactive reading, and self-regulation. Method: We performed a cluster-randomized controlled trial of UBB in childcare centers serving low-income 2-4 year-old children in Northern Brazil. The childcare centers were randomized to receive UBB or standard care (control). Families in UBB could borrow children’s books weekly and participate in monthly workshops focused on reading aloud. Parent-child dyads (n=484, intervention=232, control=252) were evaluated at baseline and nine months later on: child self-regulation, vocabulary, IQ, working memory, and phonological memory; and measures of cognitive stimulation in the home and parent-child interactive reading. Results: The UBB group showed significant higher self-regulation (Cohen’s d=.25), compared to the control group, particularly in the subdomains of Attention (d=.24) and Impulse Control (d=.21). Previously shown impacts of UBB on receptive vocabulary, IQ, and working memory were mediated by self-regulation. Effects of UBB on self-regulation and child outcomes were partially explained through cognitive stimulation in the home and parent-child interactive reading. Conclusion: Selfregulation represents an important mechanism by which reading aloud interventions impact language and cognitive outcomes. Investigators should consider the role of self-regulation when refining interventions seeking to prevent poverty-related disparities.
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