Black and White Adults' Racial and Gender Stereotypes of Psychopathology Symptoms in Black and White Children.

Adults' judgments of children's behaviors play a critical role in assessment and treatment of childhood psychopathology. Judgments of children's psychiatric symptoms are likely influenced by racial biases, but little is known about the specific racial biases adults hold about children's psychiatric symptoms, which could play a critical role in childhood mental health disparities. This study examined one form of such biases, racial stereotypes, to determine if White and Black adults hold implicit and explicit racial stereotypes about common childhood psychopathology symptoms, and if these stereotypes vary by child gender and disorder type. Participants included 82 self-identified Black men, 84 Black woman, 1 Black transgender individual, 1 Black genderfluid individual, 81 White men, and 85 White women. Analyses of implicit stereotypes revealed that White adults associated psychopathology symptoms more strongly with Black children than did Black adults (p < .001). All adults held stronger implicit racial stereotypes for oppositional defiant disorder, anxiety, and depression than for attention-deficit/hyperactivity disorder (p < .001). For explicit stereotypes, White adults generally associated psychopathology symptoms more with Black children than did Black adults but effects varied across child gender and disorder type. As the first study to examine racial and gender stereotypes across common childhood psychopathology symptoms, these findings point to a need for further investigation of the presence and impact of racial biases in the mental healthcare system for Black youth and to identify interventions to mitigate the impacts of racial biases to inform racial equity in mental healthcare in the United States.

Racial and Ethnic Differences in the Relation Between Parenting and Preschoolers' Externalizing Behaviors.

This study examined racial/ethnic differences in the relations between three dimensions of parenting practices (harsh, lax, and warm parenting) and children's externalizing behaviors across European American, African American, and Latinx families. Participants included 221 mothers who identified as African American (n = 32), Latina (n = 46), or European American (n = 143). Mothers' self-rated and observer-coded harshness, laxness, and warmth, and their ratings of their 3-year-old children's externalizing behaviors (hyperactivity, aggression) were analyzed. Multiple regression analyses indicated some racial/ethnic differences in the relations between harsh and warm parenting, and children's externalizing behaviors. The slopes of the relation between greater harshness and greater aggression and hyperactivity were more positive for European American families than for African American or Latinx families. The slopes of the relation between greater warmth and less aggression were more negative for European American and Latinx families than for African American families. Results indicated no racial/ethnic differences in the relation between laxness and externalizing behaviors. These findings suggest racial/ethnic differences in the relation between some parenting practices and externalizing behaviors, which has important implications in culturally sensitive clinical practice for different racial/ethnic groups. More research is necessary to replicate these findings, and to identify other parenting practices that may be more important in racial/ethnic minority families.

Mediators and moderator of the effects of early exposure to intimate partner violence on children's mental health.

Childhood intimate partner violence (IPV) exposure increases the likelihood of internalizing and externalizing problems. There is substantial variability in children's outcomes following IPV exposure, but the reasons behind this are unclear, particularly among preschool-age children. The current study aimed to examine the direct and indirect effects of IPV on preschoolers' mental health through parent factors (parenting and parental depression), exploring child temperament as a potential moderator of the relation between IPV and child outcomes. Participants were 186 children (85 girls) and their parents living in the United States. Data were initially collected when children were age three, with follow-up at ages four and six. Both parents' baseline IPV perpetration had adverse effects on child outcomes. Mothers' IPV was associated with greater paternal depression, paternal overractivity, and maternal laxness, whereas fathers' IPV was associated with more paternal overreactivity. Only paternal depression mediated the effect of mothers' IPV on child outcomes. Parenting did not mediate nor did child temperament moderate the relation between IPV and child outcomes. Results shed insight into the need to address parental mental health in families experiencing IPV and underline the need for a further exploration of individual- and family-level mechanisms of adjustment following IPV exposure.

Neural Activity and Emotion Socialization as Predictors of Later Emotion Regulation Difficulties in Children With and Without Hyperactivity/Impulsivity.

OBJECTIVE: This study examined emotion socialization and neural activity during frustration as predictors of emotion regulation (ER) difficulties, and the interplay of emotion socialization and neural activity, in children with and without hyperactivity/impulsivity (H/I). METHOD: At Time 1, neural activity (P1, N2, P3) during a frustration task, H/I symptoms, and emotion socialization were assessed in 68 children (aged 4-7 years old). At Time 2 (1.5-2 years later), child-report, maternal-report, and observation measures of ER difficulties were assessed. RESULTS: H/I symptoms moderated the relation between predictors and ER difficulties; there were significant relations for children with high, but not low, levels of H/I. Further, as emotion socialization quality increased, relations between event-related potentials and later ER difficulties became weaker. CONCLUSION: The processes underlying ER difficulties differ for children with H/I symptoms. High quality emotion socialization may have a protective effect for children whose neural patterns indicate risk for later ER difficulties.

Early Development of ADHD and ODD Symptoms from the Toddler to Preschool Years.

OBJECTIVE: ADHD and ODD are commonly co-occurring, but often studied individually. This study evaluated common trajectories of these disorders and explored how they co-develop in early childhood. METHOD: Community parents (N = 273) completed online surveys about their 2-year-old. Children's inattention, hyperactivity/impulsivity, and oppositional defiant disorder symptoms over 2 years were examined using latent class, dual trajectory, and cross-lagged analyses. RESULTS: Most children followed low symptom trajectories. A small portion showed high, moderate, or increasing trajectories. The hyperactive/impulsive domain of ADHD showed a declining symptoms group. Children in high ODD groups were likely to be in high ADHD symptom groups; the converse was true but probabilities were lower. Hyperactive/impulsive symptoms predicted ODD symptoms across time, more than vice versa. CONCLUSION: The study extends the small body of literature assessing early development of ADHD and ODD. Findings suggest that earlier intervention for symptoms of ADHD may mitigate risk of developing ODD.

Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric in-centre haemodialysis unit: a quality improvement project.

BACKGROUND: Intra-dialytic hypotension (IDH) is the most common serious adverse event in paediatric haemodialysis (HD). Repeated IDH results in chronic multi-organ damage and increased mortality. At the Hospital for Sick Children, Toronto, retrospective data from all in-centre HD sessions revealed frequently occurring IDH events (16.5 ± 5.6% of HD sessions per week). Based on literature review and clinical expertise, fluid volume management was selected as a potential modifiable risk factor to decrease IDH. Root causes identified as contributing to IDH were incorporated into a Paediatric haemodialysis fluid volume management (PedHDfluid) program using the Model for Improvement methodology including rapid cycles of change. METHODS: Multiple measures were evaluated including (i) Outcome: IDH events per number of HD sessions per week; (ii) Process: number of changes to estimated dry weight per number of HD sessions per week; (iii) Balancing: time spent on dry weight meeting per week. Data was analysed using statistical process control charts. We aimed to decrease IDH in our dialysis unit to < 10% of HD sessions per week over a 6-month period by implementing a PedHDfluid program, including a multifaceted dry weight assessment protocol, multidisciplinary meetings and electronic health records "Dry Weight Evaluation flow sheet/synopsis". RESULTS: The project resulted in a decline in IDH events from 16.5 ± 5.6% to 8.8 ± 3.3% of HD sessions per week. More frequent dry weight changes and increased awareness of fluid removal goals were noted. CONCLUSIONS: A multidisciplinary approach including regular assessment, guidelines and systematic discussion, with an embedded electronic health record assessment and data gathering tool may sustainably reduce IDH events. A higher resolution version of the Graphical abstract is available as Supplementary information.

Cost Effectiveness and Impact in Quality of Care of a Pediatric Multidisciplinary Stone Clinic.

Herein, we assess the cost-effectiveness of a multidisciplinary clinic for children with urinary stones. The clinic's primary goals were to decrease unnecessary visits, imaging, and costs while optimizing the quality of care. METHODS: Between October 2012 and January 2016, children with complex stone disease, previously treated in urology and/or nephrology clinics, were seen at a triannual pediatric combined stone clinic. We compared the number and cost of ultrasounds, emergency room (ER) visits, and stone surgeries performed before and after each patient's initial evaluation. All patients received satisfaction surveys. RESULTS: Among the 79 patients, 27 were seen at least twice in the combined clinic and followed multiple times in either urology or nephrology clinics. The mean number of ER visits per patient per year significantly decreased from 0.29 ± 0.36 to 0.10 ± 0.15 (P = 0.002). The mean cost of ER visits went from CAD$ 23.44 ± 28.80 to CAD$ 4.14 ± 12.18 (P = 0.002). Likewise, the mean annual number and cost of stone-related surgeries significantly decreased [(0.38 ± 0.63 versus 0.20 ± 0.32 after the MSC started (P = 0.026) and mean annual cost of surgeries went from CAD$ 182.97 ± 301.49 to CAD$ 41.59 ± 110.97 (P = 0.022)]. Among the survey responses returned, 75% of families believed the clinic was time-saving. CONCLUSIONS: Despite a small sample size, the number of ER visits and stone-related operations significantly decreased after the initial combined clinic intervention. Longer-term data will hopefully confirm if the positive findings continue.

Pharmacokinetics of Vancomycin in Pediatric Patients Receiving Intermittent Hemodialysis or Hemodiafiltration.

INTRODUCTION: Vancomycin is a common antibiotic used to treat hemodialysis (HD) or hemodiafiltration (HDF)-related infections in pediatric patients, but optimal dosing remains unknown. This is the first observational study to characterize the pharmacokinetics and evaluate dosing of vancomycin in this population. METHODS: Eligible patients received IV vancomycin 10 mg/kg per dose postdialysis followed by a series of serum vancomycin concentrations collected before, immediately after, 1 hour after, and 4 hours after dialysis. The pharmacokinetic parameters were estimated using 1- and 2-compartment models and a nonlinear least-squares algorithm. RESULTS: Among 42 vancomycin courses in 16 patients, 1 compartment model had the best fit for observed data. The net drug removal was 43 ± 13% (39% for HD and 50% for HDF) from an average 3-hour HD/HDF session. The mean elimination constant was 0.28 h-1 (standard deviation [SD], 0.11 h-1) during the intradialytic period compared with 0.0049 h-1 (SD, 0.004 h-1) when off dialysis. The mean volume of distribution was 0.65 (SD, 0.19) L/kg. Duration of dialysis session and mode of dialysis (HD vs. HDF) were significant predictors of vancomycin pharmacokinetic parameters. Half-life was shorter for HDF compared with HD (2.1 vs. 3.5 hours). CONCLUSIONS: Based on the simulations, an initial vancomycin dose of 10 mg/kg per dose and redosing postdialysis was optimal to achieve a vancomycin concentration range of 5 to 12 mg/L at 4 hours postdialysis and 24-hour area under the curve over minimum inhibitory concentration of ≥400 hours. Therapeutic drug monitoring is necessary to account for residual variability in vancomycin elimination in pediatric patients receiving HD/HDF.

Early Development of Comorbidity Between Symptoms of ADHD and Anxiety.

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that shares a high comorbidity with anxiety disorders. However, the early development of comorbid ADHD and anxiety symptoms is not well-understood. In this study, the bidirectional relation between ADHD and anxiety symptoms was examined by testing two models of the development of ADHD and anxiety comorbidity: an anxiety effects model, which posits that anxiety symptoms contribute to the development of ADHD symptoms, and an ADHD effects model, which posits that ADHD symptoms contribute to the development of anxiety symptoms. Within the ADHD effects model, parenting practices were tested as mediators of this relation. Participants included children who were 3 years old at baseline (n = 258) and their caregivers who reported on their children's ADHD and anxiety symptoms annually for 3 years. The bidirectional relation of parent-reported anxiety and ADHD symptoms was tested using a series of cross-lagged models. Results indicated that ADHD symptoms predicted later anxiety symptoms, but anxiety symptoms did not predict later ADHD symptoms. Parenting practices did not mediate the relation between ADHD and anxiety symptoms within the ADHD effects model. These findings suggest that ADHD-anxiety comorbidity may develop in part because early symptoms of ADHD contribute to the development of anxiety symptoms; future research should be conducted to elucidate the mechanisms of this relation.

Behavioral and Neural Markers of Emotion Competence as Predictors of Later Psychopathology in Children With and Without Hyperactive/Impulsive Symptoms.

Objective: We examined behavioral and neural markers of emotion competence in young children as predictors of psychopathology, and as mediators of the relation between hyperactivity/impulsivity (H/I) and psychopathology. Method: At Time 1 (T1), children (n = 49; ages 4-7 years) with and without H/I symptoms completed a frustration task. Frustration, observed emotion, and neural activity (P1, N2, and P3 event-related potentials) were measured. Symptoms of psychopathology were collected 18 months later (Time 2; T2). Results: T1 lability, negative affect, and frustration predicted T2 depression and aggression symptomatology, controlling for T1 symptoms. Children with difficulty allocating neural resources during and after frustration were at risk for depression, aggression, and anxiety symptoms, controlling for earlier symptoms. P3 amplitudes during recovery mediated the relation between H/I and later depression. Conclusion: Markers of emotion competence contribute to psychopathology symptoms, particularly in children at risk for attention-deficit/hyperactivity disorder (ADHD). Emotion competence skills may be useful intervention targets.

Executive Function and Trajectories of Emotion Dysregulation in Children with Parent-Reported Behavior Problems.

The current study examined whether a variety of dimensions of executive function predicted trajectories of emotion dysregulation among preschool children with behavior problems. This study focused on 199 3-year-old children with parent-reported behavior problems who took part in a larger longitudinal study. Results revealed that response inhibition and working memory were not predictive of later emotion dysregulation. Gender differences emerged for delay aversion and attentional control. Boys who performed better on delay aversion tasks exhibited lower emotion dysregulation related to threat 2 years later, whereas girls who performed better on delay aversion tasks exhibited higher threat-related emotion dysregulation 2 years later. Better performance on a visual attention task significantly predicted decreasing threat-related emotion dysregulation slopes for boys but not for girls. Finally, girls who made more omission errors on a continuous performance task exhibited higher emotion dysregulation related to frustrative-nonreward 2 years later. Results suggest that specific facets of executive function may play an important role in difficulties with emotion dysregulation during the preschool years and that this pattern may differ across boys and girls.

Effects of Sleep Extension on Inhibitory Control in Children With ADHD: A Pilot Study.

Objective: Children with ADHD often have sleep complaints and cognitive deficits. The aim of this pilot study was to determine whether sleep extension improves inhibitory control, a primary cognitive deficit in ADHD. Method: Children with (n = 11) and without (n = 15) ADHD participated in a within-subject sleep extension intervention that targeted nocturnal sleep duration. Sleep was assessed with actigraphy and polysomnography. Inhibitory control was assessed with a Go/No-Go task. Results: For children without ADHD, there was a significant main effect of time, such that morning inhibitory control was 10% greater than evening inhibitory control. However, inhibitory control did not differ between the baseline and extension conditions in this group. For children with ADHD, although morning inhibitory control did not differ from evening inhibitory control, sleep extension improved inhibitory control by 13% overall. Conclusion: These results suggest that a sleep extension intervention improves inhibitory control in children with ADHD.

Racial Differences Between Black Parents' and White Teachers' Perceptions of Attention-Deficit/Hyperactivity Disorder Behavior.

Previous research suggests there may be racial differences in how adults rate children's ADHD behavior. Differences in perceptions of Black parents and White teachers could have implications for ADHD diagnosis of Black children. This study compared ADHD ratings of Black parents to White teachers, and examined factors that may explain racial differences. Participants included 71 Black parents (65 women, 6 men; Mage = 33.92) and 60 White teachers (41 women, 19 men; Mage = 33.60), as well as a comparison group of 65 White parents (49 women, 16 men; Mage = 36.83). Participants watched video clips of children in classrooms and rated ADHD behaviors and ADHD likelihood. They then completed questionnaires regarding beliefs about ADHD stigma, verve (movement expressiveness), experiences with racial discrimination, and racial attitudes. White teachers rated Black boys' ADHD behaviors and their likelihood of having ADHD higher than Black parents. White teachers with more negative racial attitudes toward African Americans gave higher ADHD behavior and likelihood ratings to Black boys than did teachers with less negative racial attitudes. Across all participants, ADHD stigma beliefs and verve were not related to ratings of Black boys. Black parents with more experiences with racial discrimination gave higher ratings to Black boys' ADHD behaviors. Research is necessary to further explain the mechanisms by which discrepancies in ratings of Black boys' ADHD behaviors exist between Black and White adults to inform culturally sensitive assessment and diagnosis of ADHD in Black children.

Neuropsychological Predictors of ODD Symptom Dimensions in Young Children.

Oppositional defiant disorder (ODD) is a commonly diagnosed childhood behavior disorder, yet knowledge of relations between ODD and early neuropsychological functions, particularly independent of attention deficit/hyperactivity disorder (ADHD), is still limited. In addition, studies have not examined neuropsy chological functioning as it relates to the different ODD symptom dimensions. Structural equation modeling was used to investigate how preschool neuropsychological functioning predicted negative affect, oppositional behavior, and antagonistic behavior symptom dimensions of ODD in 224 six-year-old children, oversampled for early behavior problems. Working memory, inhibition, and sustained attention predicted negative affect symptoms of ODD, controlling for ADHD, whereas delay aversion uniquely predicted oppositional behavior, controlling for ADHD. Delay aversion also marginally predicted antagonistic behavior, controlling for ADHD. Results demonstrate that different ODD symptom dimensions may be differentially predicted by different neuropsychological functions. The findings further underscore the importance of future research on ODD to take into account the possible heterogeneity of both symptoms and underlying neuropsychological functioning.

Psychometric Properties of ADHD Symptoms in Toddlers.

The purpose of this study is to examine the psychometric properties of the 18 Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms of attention deficit/hyperactivity disorder (ADHD) in 2-year-old children. ADHD is typically diagnosed in elementary school, but research suggests that many children with ADHD first show symptoms during the toddler years. An important first step in identifying toddlers who are at high risk for developing ADHD is to better understand the properties of DSM symptoms of ADHD in young children. Parents of 2-year-old children (N = 434; 240 boys, 194 girls; M = 29.07 months, SD = 3.42) across the United States were recruited online through Amazon's Mechanical Turk to complete surveys about their children's ADHD symptoms and temperament. Confirmatory factor analysis showed that 2- and 3-factor models fit well. All but one verbal hyperactive/impulsive symptom loaded highly on their respective factors. Relations between ADHD symptoms and temperament traits provided some support for convergent and divergent validity of the symptoms. Finally, item response theory analyses showed that items showed moderate to high levels of discrimination between toddlers with high and low levels of ADHD symptoms. Psychometric properties in 2-year-old children were generally comparable to those in older children, with similar factor structure, good reliability and validity, and good though somewhat lower discrimination, particularly for verbal symptoms. The study provides support for conducting prospective studies to determine whether these symptoms have utility for identifying at-risk toddlers.

A Longitudinal Study of the Relation Between Family Functioning and Preschool ADHD Symptoms.

The present study examined the bidirectional relation between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms across the preschool years. Participants included 197 (110 boys) 3-year-old children (M = 44.14 months, SD = 3.43; 60% White) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Parenting, parent psychopathology, life stress, and child symptoms were assessed annually from ages 3 to 6. Cross-lagged models provided evidence for both parent and child effects for mothers. In particular, greater maternal overreactive parenting and life stress were predictive of more child ADHD symptoms, and greater child ADHD symptoms significantly predicted greater maternal life stress and depressive symptoms and lower warmth, controlling for child oppositional defiant disorder and parent ADHD symtoms. Child effects were evident for fathers' depression and life stress, but these did not remain controlling for paternal ADHD symptoms. Findings suggest that targeting child ADHD symptoms, maternal overreactive parenting, and maternal stress each hold promise for attenuating the negative mutual influence of child ADHD symptoms and family functioning over time.

Child Neurology: Friedreich ataxia with upper motor neuron findings: A case study.

A 16-year-old boy with hypertrophic cardiomyopathy, gait abnormalities, and balance problems was found to have Friedreich ataxia. Though Friedreich ataxia typically renders patients areflexic, this child had upper motor neuron findings of spasticity in both lower extremities, with crossed adductors, and 4+ deep tendon reflexes at the patella and Achilles bilaterally. This unusual presentation of an uncommon genetic disorder led to uncertainty of the patient's true diagnosis until genetic testing confirmed that he had 2 alleles with the Friedreich ataxia mutation.

Reciprocal Relations Between Parenting Behaviors and Conduct Disorder Symptoms in Preschool Children.

Reciprocal relations between children's conduct disorder (CD) symptoms and parenting behaviors were examined across the preschool years. Participants were 199 children (M = 44.26 months, SD = 3.37; 92 girls) and their 199 mothers and 158 fathers. CD symptoms were assessed via structured interviews; parenting was assessed via observational and self-report measures. Fixed effects models were used to assess within-individual changes and traditional cross-lagged models were used to assess between-individual changes; comparisons by sex were also carried out. Increases in maternal overreactivity predicted increases in CD symptoms. During the later preschool years, decreases in maternal warmth predicted increases in CD symptoms and increases in CD symptoms predicted increases in paternal overreactivity. Reciprocal effects were found between girls' CD symptoms and paternal negative affect. Findings suggest maternal and paternal influence on the development of CD symptoms and suggest that CD symptoms influence fathers' parenting during the preschool years.

Positive emotional attention bias in young children with symptoms of ADHD.

Children with attention-deficit/hyperactivity disorder (ADHD) often experience emotional dysregulation. Dysregulation can arise from heightened attention to emotional stimuli. Emotional attention biases are associated with a number of adverse socioemotional outcomes including reward sensitivity and externalizing behaviors. As reward sensitivity and externalizing behaviors are common in children with ADHD, the aim of the current study was to determine whether emotional attention biases are evident in young children with clinically significant ADHD symptoms. To test this, children with (n = 18) and without (n = 15) symptoms of ADHD were tested on a Dot Probe task. Provided recent evidence that emotional attention biases are attenuated by sleep, the task was performed before and after overnight sleep. Children with ADHD symptoms displayed positive, but not negative, attention biases at both time points, whereas typically developing children did not preferentially attend toward or away from positive or negative stimuli. Sleep did not alter attention biases in either group. Collectively, these results indicate that children with ADHD symptoms have stable, positive attention biases.

Longitudinal Associations of Parental Emotion Socialization and Children's Emotion Regulation: The Moderating Role of ADHD Symptomatology.

Theory and research suggest that parents' reactions to children's emotions play a critical role in teaching children effective emotion regulation (ER) skills, but no studies have directly examined the role that parent emotion socialization plays in the development of ER in children with ADHD. Gaining insight into the causes of impaired ER, particularly in youth with ADHD who are known to have poor ER, has important theoretical and translational significance. The present study is the first to longitudinally examine whether emotion socialization predicts later physiological and adult-reported measures of ER in children with and without ADHD. It also sought to determine if these relations are moderated by ADHD symptoms. Participants were 61 children (31 girls, 30 boys; M = 10.67 years, SD = 1.28) with and without clinically significant ADHD symptoms. At Time 1, parent reports of emotion socialization and parent- and teacher-report of child ADHD symptoms were collected. At Time 2, child ER measures were collected based on parent- and teacher-report and physiological reactivity during an impossible puzzle and a social rejection task. Physiological measures included respiratory sinus arrhythmia and skin conductance level (SCL). Supportive parenting practices were associated with better parent-rated emotion regulation skills for all children and greater SCL reactivity for children with high ADHD symptoms. Non-supportive parenting reactions were associated with greater adult-rated emotional lability for children with high ADHD symptoms. Results highlight the importance of considering multiple aspects of ER, including physiological manifestations. Findings suggest that parents' use of adaptive emotion socialization practices may serve as a protective factor for children's ER development and may be particularly critical for youth with ADHD. Our findings support the use of interventions addressing parent emotion socialization to help foster better ER in children.