Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti.

Dante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child-Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues' work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children's attachment and self-regulatory capabilities. In the current study, we assessed adolescents' reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.'s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.

DC: 0-5 system in clinical assessment with specialty pediatric populations.

Early childhood mental health (ECMH) programs provide an opportunity to provide specialized mental health services to vulnerable young children and connect them with necessary evidence-based early intervention. However, there is a paucity of descriptive and explorative studies of the clinic protocols in the literature. Even within published work, there is a lack of standardization in clinical models and diagnostic systems limiting comparison and extrapolation. This paper describes how the DC: 0-5 framework guides the development of the model for an ECMH clinic embedded in the context of academic pediatrics. It also highlights the opportunity the DC 0-5 presents for developing the standardized protocols and a mechanism for standardized data collection in clinical settings. The paper demonstrates the utility of using the DC 0-5 in protocol development, assessment and data collection the mental health assessments of 87 children ages 0-6 were reviewed to gather information on history, presenting problems, parent-child relationship, and mental health diagnoses. This paper and associated data underscore the utility and necessity of ECMH clinics while identifying challenges in the field.

Los programas de salud mental en la temprana niñez ofrecen una oportunidad para proveer servicios de salud mental especializados a niños pequeños vulnerables y ponerlos en contacto con la necesaria intervención temprana que se base en la evidencia. Sin embargo, hay escasez de estudios descriptivos y de exploración de los protocolos clínicos en la información impresa. Aun dentro de los trabajos publicados, se da una falta de estandarización en los modelos clínicos y sistemas de diagnóstico, lo cual limita la comparación y la extrapolación. Este ensayo describe cómo el marco de trabajo DC: 0-5 guía el desarrollo del modelo para una clínica de salud mental en la temprana niñez enmarcado dentro del contexto de la pediatría académica. También resalta la oportunidad que DC 0 a 5 presenta para desarrollar los protocolos estandarizados y un mecanismo para la recolección de datos estandarizados en escenarios clínicos. El ensayo demuestra la utilidad de usar el DC 0 a 5 en el desarrollo de protocolos, evaluación y recolección de datos. Se revisaron las evaluaciones de salud mental de 87 niños de edad 0-6 para obtener información acerca del historial, la presentación de problemas, la relación progenitor-niño y la diagnosis de salud mental. Este ensayo y la información asociada subraya la utilidad y necesidad de las clínicas de salud mental en la temprana niñez, al tiempo que identifica los retos en el campo.

Les programmes de santé mentale de la petite enfance offrent une chance d'offrir des services spécialisés de santé mentale à des jeunes enfants vulnérables et de les connecter à une intervention précoce ayant des preuves à l'appui. Cependant, dans les recherches, il existe très peu d'études descriptives et exploratoires des protocoles cliniques. Même au sein du travail qui est publié, nous observons un manque de standardisation dans les modèles cliniques et dans les systèmes diagnostiques, limitant la comparaison et l'extrapolation. Cet article décrit comment la structure DC: 0-5 guide le développement du modèle pour une clinique de santé mentale de la petite enfance ancrée dans le contexte de la pédiatrie académique. L'article met également en lumière l'opportunité que présente la DC 0 à 5 pour le développement de protocoles standardisés et un mécanisme pour une collecte de données standardisée dans des contextes cliniques. Nous démontrons l'utilité de l'utilisation de la DC 0 à 5 dans le développement du protocole, l'évaluation et la collecte de données. Les évaluations de santé mentale de 87 enfants âgés de 0-6 ont été passées en revue afin de récolter des données sur l'histoire, ce qui présente des problèmes, la relation parent-enfant, et les diagnostics de santé mentale. Cet article et les données qui y sont liées soulignent l'utilité et la nécessité des cliniques de santé mentale de la petite enfance tout en identifiant les défis qui se présentent dans ce domaine.

Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) Symptomatology in a High-Risk Clinical Sample.

Attachment relationships are broadly considered foundational to child development as such attachment disorders, reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), pose a severe threat to children's safety and developmental trajectory. This study examined the prevalence of full diagnosis and symptoms of RAD and DSED in a high-risk sample of adopted children (n = 98; mean age: 46.26 months; range: 16.09 months-6.51 years). Consistent with existing literature, a full diagnosis of RAD and DSED was rare, 1% (n = 1) and 8.1% (n = 8), respectively. However, over half of the sample presented with at least one clinically concerning symptom of RAD or DSED. Given the nature of attachment disorders and the level of concern associated with symptoms, these findings emphasize the need for effective mental health screening, sensitivity beyond just a full diagnosis, and early interventions for adopted children.

Regression in Early Childhood Development: An Unintended Outcome of Prolonged Hospitalization?

This brief review outlines a novel case study with targeted literature search. Patient X was a 21-month-old male who was receiving ongoing treatment for stage M MYCN-amplified high-risk neuroblastoma. Patient X's mother was considering refusal of further cancer-directed therapy because of the child's developmental regression noted during his prolonged hospitalization. Given the underlying malleability of the developing brain in early childhood, access to supportive services that facilitate ongoing neurodevelopment in hospitalized young children is of utmost importance; such services further reduce parental stress and likely enhances parental and medical team efficacy of care.

Birthweight moderates the association between chronological age and infants' abilities to respond to cues for joint attention.

Infants born preterm are more likely than ever to survive, but relatively little is known about the factors that influence their subsequent sociocognitive development. Responding to joint attention (RJA) is a pivotal skill that is likely supported by biological preparedness at birth and ex-utero social experience. The goals of this study are to evaluate the relative roles of chronological age, gestation duration, and birthweight for early RJA and examine birthweight as a potential moderator of the associations between chronological age and RJA. This study leveraged a mixed longitudinal design of infants (N = 256, obs = 421) from 8 to 16 months of chronological age. Results show that chronological age and gestation duration both explain unique variation in RJA. Further, birthweight exhibits quadratic relations with RJA. Birthweight moderates the association between chronological age and RJA; infants born heavier demonstrate faster RJA growth compared to those born smaller. Findings suggest that birth weight, an index of nutrient sufficiency in utero and biological preparedness, may constrain or afford early RJA development, consistent with the Developmental Origins of Health and Disease (DoHAD) hypothesis. Findings inform our understanding of the roles of biological preparedness and experience in shaping RJA and help disaggregate potential mechanisms of prematurity-related challenges to social cognitive development.

Case Report: Traumatic Stress and Developmental Regression: An Unintended Consequence of Complex Cardiac Care.

This brief case report outlines a novel approach to supporting the development of a pediatric complex cardiac care patient. Patient X is a 19-month old patient who spent 5.5 months in hospital and underwent multiple surgeries including heart transplantation. This case report explores the impacts of his condition and care on his development and family functioning within the framework of an integrated care model. This case report is uniquely complimented by outpatient neurodevelopmental follow up, dyadic trauma-informed intervention and use of telemedicine allowing for a deeper understanding of the family adaptation that provide novel insight into long-term trajectory beyond discharge. Throughout care Patient X met criteria for both a traumatic stress disorder and global developmental delay. This case study highlights the threat complex care poses to neurodevelopment, pediatric mental health and family dynamics as well as opportunities for intervention.