Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay

Bagner, Daniel M.; Berkovits, Michelle D.; Coxe, Stefany; Frech, Natalie; Garcia, Dainelys; Golik, Alexandra; Heflin, Brynna H.; Heymann, Perrine; Hong, Natalie; Sanchez, Amanda L.; Wilson, Maria K.; Comer, Jonathan S.

doi:10.1001/jamapediatrics.2022.5204

Cited by 12 publications

(11 citation statements)

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“…Results underscore that caregivers dealing with hardship can protect their children from the negative effects of stress, particularly when caregivers are provided access to effective interventions designed to enhance parenting. maintained improvements in observed positive and negative-parenting behaviors for this population (Bagner et al, 2023). Thus, we hypothesized that increased levels of observed positive parenting and decreased levels of observed negative parenting (assessed using two time points of observational data) would buffer the association between early-life adversity exposure (i.e., a cumulative risk index inclusive of parent, family, and neighborhood-level factors) and epigenetic age acceleration assessed 1.5 years later in a sample of young children with developmental delays.…”

Section: Statement Of Relevancementioning

confidence: 58%

“…Children were excluded (a) if they were receiving medication for behavior problems; (b) if the children or their caregiver had deafness or blindness; (c) if the children demonstrated severe social-communication deficits (i.e., caregiver report on Social Responsiveness Scale-Second Edition T-Score > 75); and (d) if the primary caregiver's standard score was less than 4 on the vocabulary subtest of the Wechsler Abbreviated Scale of Intelligence-Second Edition (for English speakers) or the Escala de Inteligencia Wechsler Para Adultos-Third Edition (for Spanish speakers). For further details, refer to Bagner et al (2023) and see Figure S1 in the Supplemental Material available online for the primary RCT's CONSORT diagram.…”

Section: Methodsmentioning

confidence: 99%

“…The current study recruited from a randomized controlled trial (RCT) of a telehealth-based behavioral parenting intervention (Bagner et al, 2023) to evaluate whether increases in positive parenting (e.g., praise, engagement, warmth) and decreases in negative parenting (e.g., criticism, hostility) buffered the impact of adversity exposure on epigenetic age acceleration among majority Latinx preschoolers with developmental delays. The main outcomes of the primary RCT were that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements in observed positive and negative-parenting behaviors for this population (Bagner et al, 2023).…”

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confidence: 99%

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Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

Sullivan,

Bozack,

Cardenas

et al. 2023

Psychol Sci

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This study examined whether children exposed to adversity would exhibit lower epigenetic age acceleration in the context of improved parenting. Children with developmental delays and externalizing behavior problems ( N = 62; Mage = 36.26 months; 70.97% boys, 29.03% girls; 71% Latinx, 22.6% Black) were drawn from a larger randomized controlled trial (RCT), which randomized them to receive Internet-delivered parent–child interaction therapy (iPCIT; n = 30) or community referrals as usual (RAU; n = 32). Epigenetic age acceleration was estimated with the pediatric buccal epigenetic clock, using saliva. Adversity was assessed using parent, family, and neighborhood-level cumulative-risk indicators. Adversity interacted with Time 2 (T2) observations of positive and negative-parenting practices to predict epigenetic age acceleration 1.5 years later, regardless of treatment assignment. Children exposed to more adversity displayed lower epigenetic age acceleration when parents evidenced increased positive ( b = −0.15, p = .001) and decreased negative ( b = −0.12, p = .01) parenting practices.

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Section: Statement Of Relevancementioning

confidence: 58%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

Sullivan,

Bozack,

Cardenas

et al. 2023

Psychol Sci

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“…Risk and protective factors identified here can be ascertained prenatally, at birth, and prior to postnatal discharge to the home community to individualize family supports. 71 , 72 When initiated earlier, behavioral and emotional interventions are more effective, 73 , 74 , 75 , 76 , 77 with potential to prevent escalation among children with borderline symptoms. Toward the goal of disrupting persisting dysregulation and facilitating resilience, the cumulative risks and behavioral indicators identified inform best practices and future research.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

et al. 2023

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ImportanceEmotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.ObjectiveTo characterize children’s emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood.Design, Setting, and ParticipantsThis cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022.ExposuresStandardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities.Main Outcomes and MeasuresChild Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression).ResultsThe sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks’ gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P &lt; .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P &lt; .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005).Conclusions and RelevanceIn this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.

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“…In the Original Investigation titled “Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial,” published online January 9, 2023, the Results section of the Abstract and article body incorrectly listed children’s age in years instead of months. This article has been corrected online.…”

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confidence: 99%

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2023

JAMA Pediatr

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be very challenging to conduct large-scale randomized trials, given the ample evidence supporting the benefit of COVID-19 vaccination.Finally, our article could not extensively assess the most effective timing and dose of vaccination since only a few studies reported the difference in the maternal or neonatal protective effects among the first, second, and third trimesters. In our original article, 1 vaccination during the second or third trimester was associated with lower incidences of preterm birth and small for gestational age. However, it was compared with unvaccinated individuals instead of those vaccinated during the first trimester. Therefore, it is difficult to determine the best time to receive vaccinations to protect children. Nevertheless, even if it were proven that getting vaccinated later in pregnancy compared with earlier was more effective in reducing neonatal outcomes, that would not necessarily dictate the best timing to be vaccinated because unvaccinated individuals would have to remain having higher risks of SARS-CoV-2 infection while waiting for the second or third trimester. Under current consensus, it can be recommended that pregnant individuals or those of reproductive age be vaccinated against COVID-19.Overall, we agree that our meta-analysis has several limitations to be acknowledged. However, our findings would promote vaccinating pregnant individuals who have not received one yet due to concerns for the safety and efficacy of COVID-19 vaccines. Future investigations on the optimal dose and timing of COVID-19 vaccination, including the ones for the Omicron subvariant, for pregnant individuals, are warranted.

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Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay

Cited by 12 publications

References 59 publications

Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

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