Angela LaRosa

Evidence-based health promotion programs for schools and communities.

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children.

Sleep-Disordered Breathing in Down Syndrome

OSA is associated with significant adverse outcomes with far-reaching health-care implications. OSA is much more common and severe in patients with Down syndrome (DS) than in the general population, yet there is a striking lack of literature in this area. In this review article, we have summarized the current state of knowledge and presented the available data on OSA in DS. The higher prevalence and severity of OSA in patients with DS may be related to unique upper airway anatomic features as well as increased risk for obesity, hypothyroidism, gastroesophageal reflux disease, and generalized hypotonia. Although many of the manifestations of OSA in patients with DS are similar to those seen in the general population, the relative morbidity is significantly higher. For individuals with DS who already face cognitive challenges, the added impact of OSA on cognitive function may hinder their ability to function independently and reach their full potential. Screening and evaluation for OSA should be done in children and adults with DS. Treatment of OSA in DS involves the use of CPAP, upper airway surgery, and dental appliances, along with weight-reduction strategies, nasal steroids, and oral leukotriene modifiers as adjunctive treatments. The treatment plan should be individualized for each patient with DS, taking into account age, comorbid conditions, and barriers to treatment adherence. Future research should aim to better characterize OSA, further evaluate neurocognitive outcomes, and evaluate the efficacy of treatments in patients with DS.

Neuronal exosomes reveal Alzheimer's disease biomarkers in Down syndrome

Individuals with Down syndrome (DS) exhibit Alzheimers disease (AD) neuropathology and dementia early in life. Blood biomarkers of AD neuropathology would be valuable, as non‐AD intellectual disabilities of DS and AD dementia overlap clinically. We hypothesized that elevations of amyloid β (Aβ) peptides and phosphorylated‐tau in neuronal exosomes may document preclinical AD.

Understanding Developmental-Behavioral Screening Measures

1. Kevin P. Marks, MD*,† 2. Angela C. LaRosa, MD‡ 1. *Department of Pediatrics, PeaceHealth Medical Group, Eugene, OR. 2. †Division of General Pediatrics, School of Medicine, Oregon Health & Science University, Portland, OR. 3. ‡Department of Genetics and Developmental-Behavioral Pediatrics, Medical University South Carolina, Charleston, SC. * Abbreviations: ASQ: : Ages and Stages Questionnaire ASQ-3: : Ages & Stages Questionnaire, Third Edition ASD: : autism spectrum disorder ECSE: : early childhood special education EI: : early intervention M-CHAT: : Modified Checklist for Autism in Toddlers NPV: : negative predictive value PEDS: : Parents’ Evaluation of Developmental Status PEDS:DM: : Parents’ Evaluation of Developmental Status–Developmental Milestones PPV: : positive predictive value With nearly half of pediatricians still not using standardized screening tools, primary care clinicians should know that the periodic use of general developmental and social-emotional screening tools has been proven to identify promptly two to six times more children (age 0–5 years) with suspected delays than a clinician’s unstructured surveillance alone. After completing this article, readers should be able to: 1. Recognize the many methods available to detect a wide spectrum of developmental and behavioral conditions with screening tools, and the screening schedule recommended by the AAP. 2. Recognize that universal, periodic screening with psychometrically sound developmental-behavioral instruments greatly enhances a clinician’s ability to detect, refer, and monitor children who have evolving developmental and behavioral problems. A pediatric provider’s impression has good specificity but poor sensitivity and thus has difficulty identifying the less obvious delays. 3. Know that children who have false-positive screens (screening test concerning but subsequently ineligible for early intervention or early childhood special education services) are a high-risk group in need of close monitoring and other community services such as evidence-based parenting programs and Head Start. 4. Know the main limitations of applying standardized screening tools into a primary care setting. 5. Be aware that screening measures which adhere to core psychometric and feasibility standards are more likely to perform consistently well and be found sustainable in a primary care setting. Developmental and behavioral problems are among the most common conditions of childhood and adolescence; 15% of children have a developmental disability and 21% have a mental health disorder. If intervention is instituted before kindergarten entrance, many problems can be prevented and the large majority can be ameliorated. In the United States, …

Ameliorating attention problems in children with sickle cell disease: a pilot study of methylphenidate.

Objective: This pilot study examined whether methylphenidate (MPH) was effective in enhancing cognitive performance and attention for children with sickle cell disease (SCD) with cerebrovascular complications who evidence attention problems. Methods: In this multisite, pilot study, we evaluated 2 separate double-blind controlled clinical trials, including a laboratory trial of the short-term efficacy of MPH, with the second study a 3-week home/school crossover trial evaluating the efficacy of MPH. The laboratory trial included 14 participants between the age of 7 and 16 years. Assessments included measures of sustained attention, reaction time, executive functions, and verbal memory. The home/school trial included 20 participants. The outcome measures were parent and teacher ratings of attention. The first study compared MPH with placebo, while the second trial compared placebo, low-dose (LD) MPH, and moderate-dose MPH. Results: In the laboratory trial, significant effects were revealed for measures of memory and inhibitory control. Parent and teacher reports from the home/school trial indicate that moderate-dose MPH produced superior improvement in attention relative to the placebo and LD MPH. Conclusions: Stimulant medication positively impacted select measures of memory and inhibitory control in some children with SCD. Attention, as rated by parent and teachers, was improved for a greater number of children and adolescents on higher doses of MPH relative to LD MPH and placebo. Stimulant medication may provide an effective intervention for some children with SCD and cerebrovascular complications who demonstrate attention problems.

Parental depressive symptoms: relationship to child development, parenting, health, and results on parent-reported screening tools.

OBJECTIVE To determine whether parents with depressive symptoms can accurately complete parent-reported developmental screens, and to explore effects of parental depressive symptoms on perceptions of childrens health and parenting behaviors. STUDY DESIGN A total of 382 parent-child (ages 0 to 2 years) dyads from pediatric sites across 17 U.S. states were evaluated with the directly administered and parent-reported Brigance Infant Toddler Screen, the Brigance Parent-Child Interactions Scale, a child development and health rating scale, and a caretaker depression screen. Groups were compared by parental status by depression screening. RESULTS Fifteen percent of parents had positive scores on screening for depression. Parents with a positive screen result for depression were twice as likely to rate their children as below average or average and to perceive health problems in their children. Their children were 1.7 times more likely to perform below Brigance Screen cutoffs. Parents with a positive screen result for depression were as accurate as parents with a negative screen result for depression in identifying delayed or average development but were significantly less likely to rate their above-average children as such and reported fewer positive parenting practices. CONCLUSION Parents with a positive depression screen result were as accurate in identifying developmental problems as parents with a negative depression screen result. Parental depressive symptoms are negatively associated with parenting behaviors, parental perspective on health and development, and child outcomes, which supports screening for depression and intervening promptly.

Down syndrome and pediatric obstructive sleep apnea surgery: A national cohort: Down Syndrome and Pediatric OSA Surgery

To analyze the trend of sleep surgeries in pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA), and to compare this to nonsyndromic (NS) children with OSA.

Tonsillectomy in Children with Down Syndrome: A National Cohort of Inpatients

Objective To describe the cost, length of stay, and incidence of postoperative hemorrhage associated with Down syndrome (DS) patients undergoing tonsillectomy in a national sample of inpatient children. Study Design This study uses a national cross-sectional cohort to analyze children with and without DS undergoing tonsillectomy with or without adenoidectomy. Setting 2012 Healthcare Cost and Utilization Project Kids’ Inpatient Database. Subjects and Methods The database was analyzed for postoperative hemorrhage and respiratory compromise, length of stay, and total charges of hospital stay. These outcomes were compared between patients with DS vs patients without DS. Results In total, 7512 patients were identified who underwent tonsillectomy: 7159 patients without DS and 353 patients with DS. The non-DS group was younger with a median age of 3 years (range, 0-18) compared with a DS median age of 4 years (range, 0-20), P = .004. The DS group had a significant increase in postoperative hemorrhage compared with non-DS (10 [2.8%] vs 87 [1.2%], respectively), P = .024. However, the DS and non-DS groups were comparable for respiratory complications (5 [1.4%] vs 106 [1.5%], respectively), P = .922. Median length of stay was significantly increased in the DS group (1 [interquartile range (IQR), 1-3]) compared with the non-DS group (1 [IQR, 1-2]), P < .001. Median charges for hospital stay totaled

The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood

17,451 (IQR,

Developmental delay: Timely identification and assessment

11,901-