If Opportunity Knocks: Understanding Contextual Factors' Influence on Cognitive Systems.

Central to the Research Domain Criteria (RDoC) framework is the idea that RDoC constructs, which vary dimensionally by individual, are heavily influenced by contextual factors. Perhaps chief among these contextual factors is structural opportunity - the quality of resources available to a child as they grow. The aim of this study is to understand the impact of access to opportunity during childhood on three central RDoC cognitive systems constructs: language, visual perception, and attention. These constructs were measured using clinical data from psychological evaluations of youth ages 4-18 years (N = 16,523; Mage = 10.57, 62.3% male, 55.3% White). Structural opportunity was measured using the geocoded Child Opportunity Index 2.0 (COI), a composite score reflecting 29 weighted indicators of access to the types of neighborhood conditions that help children thrive. Findings indicate that, controlling for demographic and socioeconomic factors, greater access to opportunity is associated with significantly stronger cognitive skills across all three constructs. However, opportunity uniquely explains the largest proportion of the variance in language skills (8.4%), compared to 5.8% of the variance in visual processing skills and less than 2% of the variance in attention. Further, a moderating effect of age was found on the relation between COI and language skills, suggesting that the longer children remain exposed to lower levels of opportunity, the lower their language skills tend to be. Understanding how opportunity impacts cognitive development allows clinicians to offer better tailored recommendations to support children with cognitive systems deficits, and will support policy recommendations around access to opportunity.

Caregiver perspectives on the continued impact of the COVID-19 pandemic on children with intellectual/developmental disabilities.

The COVID-19 pandemic has significantly impacted caregivers, especially those raising a child with an intellectual/developmental disability (IDD). While research has shown substantial disruption to the family, school, and occupational lives of the IDD community, little is known about the long-term impacts of COVID-19. To address this question, 249 caregivers were surveyed via an online questionnaire, between April and August of 2022 (more than 2 years into the pandemic) about potential impacts of the COVID-19 pandemic on their child's access to health- and school-based therapeutic services, caregiver mental health, and family life. The majority of caregivers reported disruptions in access to and quality of school-based therapeutic services for their child as well as a reduction in educational accommodations in the 2021-2022 academic year. Nearly half of caregivers reported feeling anxious and almost a quarter reported feeling depressed for the majority of their days. More than half of respondents reported decreased social support, and one-fifth reported employment disruptions and decreased access to food. These findings suggest that families of children with IDD are still experiencing ongoing negative impacts of the pandemic, emphasizing the critical need for continued support in the wake of the initial and more obvious disruptions caused by the COVID-19 outbreak.

Pre-appointment online assessment of patient complexity: Towards a personalized model of neuropsychological assessment.

Recent events such as the global pandemic of COVID-19 have challenged neuropsychologists to scale up their capacity to conduct portions of their assessment remotely. While more complex patients will likely continue to require on-site, office-based interaction and assessment, the current emergency-based expansion of online and telehealth evaluation practices may ultimately lay the groundwork for more routine, online assessment of patients with less complex presentations in the future. To this end, the current study evaluated a pre-appointment, online methodology for differentiating referred pediatric patients based upon the scope and severity of their caregiver-reported adaptive, academic, attentional, behavioral, and emotional impairment. Prior to on-site assessment, parents/caregivers of 2197 children (Mean age = 10.0y, range = 4-19y, 62% male) completed an online developmental history form screening for symptoms of adaptive, attentional, learning, affective, and behavioral impairment; 71% of those children eventually underwent assessment. Using latent class analysis, the data supported a reproducible 4-class model consisting of groups of children at increased risk for: 1) severe multi-domain dysfunction; the "High Complexity" group, 30%, 2) behavioral-affective (but not academic) dysregulation; the "Behavioral Focus" group, 13%, 3) academic (but not behavioral-affective) problems; the "Academic and Inattention" group, 37%, and 4) patients with minimal clinical complexity; the "Low Complexity" group, 20%. Comparison of pre-visit classification with day-of-assessment standardized test scores supported the validity of patient subtypes. Moving forward, pre-appointment clarification of patient complexity may support efficient patient triage with regard to assessment modality (e.g., on-site or online) and length of appointment (e.g., comprehensive or targeted).

Caregiver Perspectives on Informed Consent for a Pediatric Learning Healthcare System Model of Care.

BACKGROUND: Data is needed to provide insight into the issue of preference around consent for use of pediatric clinical data for research. This study evaluated caregivers' preferences concerning use of their child's clinical information. METHODS: Caregivers of children (n = 101; response rate 81.5% of n = 124) presenting for psychological evaluation at an urban medical center viewed a video regarding how the information contained in their child's medical record could be used for research. RESULTS: An anonymous survey following the video indicated that: 1) >90% of caregivers felt comfortable with their child's information being used; 2) >90% of caregivers felt their child's privacy would be adequately protected; 3) 98% of caregivers reported themselves to be as or more likely to return to the institution after viewing the video; 4) 60% of caregivers felt no additional consent procedures beyond viewing the video were needed, while 20% preferred an opt-out and 20% preferred a traditional consent procedure. Caregiver demographic variables were largely unrelated to consent preferences. DISCUSSION: Overall, caregivers reported strong support for use of their child's clinical data for research purposes.

Correction to: Interest in Research Participation Among Caregivers of Children with Neurodevelopmental Disorders.

During the publication process, an author "M. Pinkett-Davis", who helped conceptualize and revise this study was accidentally excluded from the authorship list. The revised author group is now: Kalb, L., Jacobson, L., Zisman, C., Mahone, E., Landa, R., Azad, G., Pinkett-Davis, M., Menon, D., Singh, V., Zabel, A., & Pritchard, A. Please use this authorship list when citing this manuscript.

Interest in Research Participation Among Caregivers of Children with Neurodevelopmental Disorders.

The goal of this study was to examine caregiver agreement to hear about local research opportunities by joining a clinical research registry. Data from this cross-sectional study were gathered, between 2014 and 2017, across two outpatient clinics: (1) a multidisciplinary Autism Spectrum Disorder (ASD) clinic (N = 5228) and (2) a general psychology clinic serving youth with, or at risk for, a neurodevelopmental disorder (NDD; N = 5040). Overall, more than 8 in 10 caregivers agreed to join the registry. Several child clinical characteristics, as well as racial and sociodemographic factors, were predictive of parental agreement. Findings suggest caregivers of youth with ASD and NDD are amenable to joining the local research enterprise, however further work is needed to understand why some caregivers decline.

Psychiatric hospitalisation among individuals with intellectual disability referred to the START crisis intervention and prevention program.

BACKGROUND: Little is known about inpatient psychiatric hospitalisation among adults with intellectual disability (ID) in the United States. Greater research is, therefore, required to inform efforts aimed at preventing this costly and restrictive form of care. METHODS: Data were from 3299 individuals with ID (mean age = 31 years; SD = 14 years) who were referred to START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a community-based crisis intervention and prevention programme. A random effects logistic regression model was used to examine the association between 11 factors and caregiver report of psychiatric hospitalisation in the past 12 months. RESULTS: Twenty eight percent of the sample had at least one psychiatric inpatient stay in the prior year. Factors associated with an increased likelihood of prior hospitalisation included: younger age, diagnosis of a psychotic disorder, a score of >30 on the irritability subscale of the Aberrant Behavior Checklist, increasing number of psychiatric diagnoses, less severe ID, Black/AA race and not having a home and community waiver. CONCLUSIONS: Among this high-risk referred group, more than 1 in 4 individuals were hospitalised in the year prior to referral. While results from the analyses will help profile those at risk for hospitalisation, the findings suggest that interventions at the policy level may play an important role in reducing psychiatric hospitalisation.

Methodological considerations when assessing restricted and repetitive behaviors and aggression.

Methodological issues impacting the relationship between aggression and restricted, repetitive, and stereotyped behaviors and interests (RRSBI) were examined in 2648 children and adolescents with autism spectrum disorders (ASD) using a multi-method, multi-informant analysis model to assess the effects of informant, assessment method, and aggression phenotype. Overall, a significant, but small relationship was found between RRSBI and aggression (p < .05). There was significant heterogeneity of estimates with large effect sizes observed when utilizing teacher report and a broad phenotype of aggression. Variance in estimates was attributed to differences in informant and assessment method with two times greater effect attributed to informant. Results suggest strategies to optimize future investigations of the relationship between RRSBI and aggression. Findings also provide the opportunity for the development of targeted interventions for aggression in youth with ASD.

The concentration of offenders in families, and family criminality in the prediction of boys' delinquency.

The main aims of this study were to investigate inter-relationships among offending by three generations of relatives (fathers, mothers, sons, daughters, uncles, aunts, grandfathers and grandmothers) and the concentration of offending in families. This study also investigates how far criminal relatives predict a boy's delinquency. The parents of 1395 Pittsburgh boys aged 8, 11 or 14 reported arrests by all relatives. Parent reports of boys' arrests predicted their later referrals to juvenile court, demonstrating predictive validity. Offenders were highly concentrated in families; if one relative had been arrested, there was a high likelihood that another relative had also been arrested. Arrests of relatives were compared with arrests of the boy, court petitions of the boy, and the boy's reported delinquency (according to the parent, boy and teacher). Arrests of brothers, sisters, fathers, mothers, uncles, aunts, grandfathers and grandmothers all predicted the boy's delinquency. The most important relative was the father; arrests of the father predicted the boy's delinquency independently of all other arrested relatives. Studies of explanatory variables suggested that having a young mother, living in a bad neighbourhood, and low guilt of the boy may be links in the causal chain between arrested fathers and delinquent boys.

Physical fighting in childhood as a risk factor for later mental health problems.

OBJECTIVE: The prevalence, persistence, and desistance of boys' physical fighting was examined over a 7-year period. The importance of persistent physical fighting compared with other risk factors in the prediction of later mental health problems was explored. METHOD: One hundred seventy-seven boys, aged 7 to 12 years, who had been referred to clinics for mental health problems were followed up annually for 7 years, with the boys, their parents, and teachers as informants. RESULTS: Agreement among different informants about the boys' fighting tended to be low. The prevalence of fighting over time remained quite similar for different age cohorts. Almost 9 of 10 fighters in year 1 continued to fight in one or more successive years, and about one third of the boys could be classified as persistent fighters. Only 13.1% of the boys desisted in fighting. Boys who desisted, compared with those who persisted, had higher intelligence and their mothers scored lower on measures of antisocial personality disorder. At year 7, persistent fighting was significantly associated with impairment. The prevalence of psychiatric diagnoses in year 7 was 3 times higher for persistent fighters than for nonfighters. Using regression analyses with several control variables, conduct disorder was best predicted by earlier oppositional defiant disorder in year 1 and persistent fighting. Global impairment was best predicted by oppositional defiant disorder in year 1, persistent fighting, and low IQ. Finally, the number of diagnoses at year 7 was best predicted by persistent fighting. CONCLUSION: Physical fighting constitutes a significant mental health risk in referred boys.