Objective: To determine the frequency of missed dental appointments among children with a cleft lip and/or palate (CL/P). Design: A prospective study of failed appointments over a 12-month period. Setting: Three different CL/P clinics within a British dental hospital. Patients: Forty-five CL/P children (mean age of 8.8 years) and 45 age-matched, gender-matched, and postal code–matched noncleft patients. Main outcome measures: The overall percentage of missed appointments at three different clinics by CL/P patients and the difference in attendance rates at the pediatric dentistry clinic between CL/P and non-CL/P children. Results: Pediatric dentistry had the highest rate of missed appointments (22.4%), followed by the multidisciplinary cleft clinic (9.2%) and the orthodontic clinic (8.8%). CL/P patients missed a significantly greater proportion of their pediatric dentistry appointments than noncleft children (22.4% versus 11.9%). Patients with a bilateral CL/P were significantly more likely to miss an appointment than patients with a unilateral CL/P. Age, gender, medical history, and distance traveled had no significant effect on attendance rates. Conclusions: Further work is needed to identify risk factors for poor attendance and to develop strategies to reduce the frequency of missed appointments in this vulnerable group.

Parental influences are important for a child’s behavior, overall adjustment, as well as cognitive/language development. New research is exploring how relationships with parents can influence a child’s neurobiological functioning and development. In this systematic review, our first aim is to describe how the caregiving environment influences these aspects of child development. The second and main aim is to review and recommend that the concept (and measurement) of “emotional availability” may provide a new window in this continued exploration. Emotional availability (EA) refers to the capacity of a dyad to share an emotionally healthy relationship. The EA Scales assess this construct using a multi-dimensional framework, with a method to measure the affect and behavior of both the child and adult partner (caregiver). In this review, we first provide an overview of child development research, with regards to stress physiology, neuroendocrine system, genetics and epigenetics, and brain mechanisms. We then summarize the results of specific EA research in these areas, and propose a theoretical model integrating these constructs. Finally, we offer areas for future research in this area.

Adverse childhood experiences (ACEs) heighten the risk for adult obesity and cardiometabolic disease, but physiological factors underlying this connection are not well understood. We determined if ACEs were associated with physiological stress response and insulin resistance in adolescents at risk for adult obesity. Participants were 90 adolescents 12.0–17.5 years (50% female, 30% Hispanic/Latinx), at risk for adult obesity by virtue of above‐average body mass index (BMI; kg/m2 ≥ 70th percentile) or parental obesity (BMI ≥ 30 kg/m2). ACEs were determined as presence (vs. absence) based upon the Schedule for Affective Disorders and Schizophrenia for School‐Aged Children. Physiological stress response was measured as heart rate/blood pressure response to the Trier Social Stress Test. Homeostatic model assessment of insulin resistance was determined from fasting glucose/insulin. Sixty‐one percent of adolescents reported positive ACE history. The presence of ACEs predicted greater heart rate (p < .001) and diastolic blood pressure (p = .02) response to stress, controlling for age, sex, race/ethnicity, puberty, and BMI standard score. Systolic blood pressure and insulin resistance did not differ by ACE history (p‐values > .08). Findings suggest heightened sympathetic stress response in adolescence could be explanatory in how ACEs increase the risk for later cardiometabolic disease. Future studies should characterize ACEs in relationship to day‐to‐day variations in adolescents’ stress physiology and glucose homeostasis.

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Background: Depressive symptoms often manifest in adolescence and predict worsening insulin sensitivity, a key precursor in the path to β-cell failure and type 2 diabetes (T2D). Objective: To assess the efficacy of a six-week cognitive-behavioral group versus six-week health education group for improving insulin sensitivity and preserving β-cell function in adolescent girls at-risk for T2D with depressive symptoms and evaluate mechanisms underlying the association between depression and insulin dynamics. Design: Randomized controlled trial of N=150 12–17-year-old girls with overweight/obesity (body mass index [BMI; kg/m2] ≥85th percentile), elevated depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D] total score >20), and diabetes family history. Methods: Girls at-risk for T2D with elevated depressive symptoms are recruited from the Denver-metropolitan area and randomized to participate in one of two six-week interventions. The cognitive-behavioral group is a depression prevention program involving psycho-education, restructuring negative thoughts, and behavioral activation. The health education group is a didactic control that provides knowledge about healthy living. Participants are assessed at baseline, immediate post-intervention, and one-year follow-up. Primary outcomes are insulin sensitivity and β-cell function from oral glucose tolerance tests. Secondary outcomes are disinhibited eating, physical activity, sleep, and cortisol. Summary: Results from this adequately powered randomized controlled trial will determine whether decreasing depressive symptoms with a behavioral health program preventatively alters insulin sensitivity and β-cell function trajectories in adolescents at-risk for T2D. Results from the MIND Project will add to knowledge of the contribution of depressive symptoms to T2D risk.

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