Kristina E. Patrick

Cortical Changes Across the Autism Lifespan

Although it is widely accepted that autism spectrum disorder (ASD) involves neuroanatomical abnormalities and atypical neurodevelopmental patterns, there is little consensus regarding the precise pattern of neuroanatomical differences or how these differences relate to autism symptomology. Furthermore, there is limited research related to neuroanatomical correlates of autism symptomology in individuals with ASD and the studies that do exist primarily include small samples. This study was the first to investigate gray matter (GM) changes throughout the ASD lifespan, using voxel‐based morphometry to determine whether significant differences exist in the GM volumes of a large sample of individuals with ASD compared to age‐ and IQ‐matched typical controls. We examined GM volume across the lifespan in 531 individuals diagnosed with ASD and 571 neurotypical controls, aged 7–64. We compared groups and correlated GM with age and autism severity in the ASD group. Findings suggest bilateral decreased GM volume for individuals with ASD in regions extending from the thalamus to the cerebellum, anterior medial temporal lobes, and orbitofrontal regions. Higher autism severity was associated with decreased GM volumes in prefrontal cortex, inferior parietal and temporal regions, and temporal poles. Similar relationships were found between GM volume and age. ASD diagnosis and severity were not associated with increased GM volumes in any region. Autism Res 2015, 8: 379–385.

Sleep Differences by Race in Preschool Children: The Roles of Parenting Behaviors and Socioeconomic Status.

Background and Objective: This study aimed to examine whether socioeconomic variables (SES) and parenting behaviors mediate differences in sleep problems between Black and White preschool-aged children. Method: Parents of 191 preschool-aged children (53% male; 77% White) completed questionnaires regarding SES and sleep behaviors. Parenting behaviors and SES were analyzed as mediators of differences in sleep problems between Black and White children. Results: Parent behaviors related to bedtime routine and independence mediated the relationship between race and parent-reported bedtime difficulty, parent confidence managing sleep, and sleep onset latency. SES mediated the relationship between race and sleep onset latency. Conclusions: Sleep differences between Black and White preschool children were primarily mediated by parent behaviors rather than socioeconomic variables. Results may reflect differences in cultural practices and provide important information for treatment and parent-directed intervention regarding improving sleep in young children.

Clinical Utility of the Colorado Learning Difficulties Questionnaire

BACKGROUND AND OBJECTIVE: Behavioral disorders are highly comorbid with childhood learning disabilities (LDs), and accurate identification of LDs is vital for guiding appropriate interventions. However, it is difficult to conduct comprehensive assessment of academic skills within the context of primary care visits, lending utility to screening of academic skills via informant reports. The current study evaluated the clinical utility of a parent-reported screening measure in identifying children with learning difficulties. METHODS: Participants included 440 children (66.7% male), ages 5.25 to 17.83 years (mean = 10.32 years, SD = 3.06 years), referred for neuropsychological assessment. Academic difficulties were screened by parent report using the Colorado Learning Difficulties Questionnaire (CLDQ). Reading and math skills were assessed via individually administered academic achievement measures. Sensitivity, specificity, classification accuracy, and conditional probabilities were calculated to evaluate the efficacy of the CLDQ in predicting academic impairment. RESULTS: Correlations between the CLDQ reading scale and reading achievement measures ranged from −0.35 to −0.65 and from −0.24 to −0.46 between the CLDQ math scale and math achievement measures (all P < .01). Sensitivity was good for both reading and math scales, whereas specificity was low. Taking into account the high base rate of reading and math LDs within our sample, the conditional probability of true negatives (96.2% reading, 85.1% math) was higher than for true positives (40.5% reading, 37.9% math). CONCLUSIONS: Overall, the CLDQ may more accurately predict children without LDs than children with LDs. As such, the absence of parent-reported difficulties may be adequate to rule out an overt LD, whereas elevated scores likely indicate the need for more comprehensive assessment.

Individual and socio-demographic factors related to presenting problem and diagnostic impressions at a pediatric sleep clinic

OBJECTIVE Individual and socio-demographic factors have been found to be associated with sleep disturbances in children. Few studies have examined these factors among children presenting for care at pediatric sleep clinics. This study examined individual and socio-demographic factors in association with presenting problems and diagnostic impressions for new patients at an interdisciplinary pediatric sleep clinic. METHODS Data were collected from electronic medical records of 207 consecutive patients (54% male, 59% White, Meanage = 7.73, SD = 5.62). RESULTS Older age, female gender, and White race were associated with higher likelihood of presenting with difficulty falling asleep; younger age, male gender, and Black race were associated with higher likelihood of presenting with obstructive sleep apnea (OSA)-related concerns. Older age was associated with diagnostic impressions of inadequate sleep hygiene, insufficient sleep, circadian rhythm disorder/delayed sleep phase disorder, periodic limb movement disorder/restless legs syndrome, and insomnia, while younger age was associated with provisional OSA and behavioral insomnia of childhood (BIC) diagnoses. Male gender was associated with provisional OSA. White race was associated with BIC. Age-based analyses were also conducted to further understand the findings within a developmental context. CONCLUSIONS Age- and gender-related findings converged with prevalence literature on pediatric sleep disorders. Race was only associated with presenting concern and BIC, and one association for neighborhood disadvantage was found within the age-based analysis. Results suggest a potential service delivery gap, with racial/ethnic minority youth being less likely to present for sleep services, despite prevalence data on the increased likelihood of sleep disturbances among these youth.

Selective reminding of prospective memory in Multiple Sclerosis

ABSTRACT Objective: Multiple sclerosis (MS) is associated with prospective memory (PM) deficits, which may increase the risk of poor functional/health outcomes such as medication non-adherence. This study examined the potential benefits of selective reminding to enhance PM functioning in persons with MS. Method: Twenty-one participants with MS and 22 healthy adults (HA) underwent a neuropsychological battery including a Selective Reminding PM (SRPM) experimental procedure. Participants were randomly assigned to either: (1) a selective reminding condition in which participants learn (to criterion) eight prospective memory tasks in a Selective Reminding format; or (2) a single trial encoding condition (1T). Results: A significant interaction was demonstrated, with MS participants receiving greater benefit than HAs from the SR procedure in terms of PM performance. Across diagnostic groups, participants in the SR conditions (vs. 1T conditions) demonstrated significantly better PM performance. Individuals with MS were impaired relative to HAs in the 1T condition, but performance was statistically comparable in the SR condition. Conclusions: This preliminary study suggests that selective reminding can be used to enhance PM cue detection and retrieval in MS. The extent to which selective reminding of PM is effective in naturalistic settings and for health-related behaviours in MS remains to be determined.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers

STUDY OBJECTIVES Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic. METHODS Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.37 years, 64.0% White, 36.0% Black; 59.2% male) presenting at a pediatric sleep clinic in an academic medical center. Neighborhood income data were based on ZIP codes entered into the United States Census Bureaus American Fact Finder. RESULTS Black patients (51.1%) were significantly more likely than White patients (20.0%) to bed-share with a caregiver (χ2 = 12.99, P ≤ .001). There were no other significant differences in presenting sleep patterns (bed/wake times, sleep onset latency, naps, night awakenings, or sleep opportunity). Logistic regressions showed that White patients were more likely to present with difficulty falling/staying asleep and receive an insomnia diagnosis, and Black patients were more likely to present with OSA-related concerns and receive a diagnosis of suspected OSA, even when controlling for relevant sociodemographic covariates. CONCLUSIONS In contrast to community-based research, Black and White children showed similar sleep patterns. However, there were differences by race in referral questions and diagnoses. Findings suggest the need to consider caregiver perceptions and other sociocultural factors that may contribute to differential rates of presentation for sleep services, as well as potential health disparities in this regard.