Marie Kanne Poulsen

Secondary analysis of primary and preventive services accessed and perceived service barriers by children with developmental disabilities and their families.

Children and youths with developmental disabilities (DD) have needs for more community-based services to address ongoing health, educational, employment, housing, transportation, and recreational concerns. Secondary data analysis was conducted to examine the array of services accessed and service obstacles to primary, preventive and special health care services of 102 children and youths with developmental disabilities. The two services most frequently reported as being used by families were SSI (29.4%) and MediCal (Californias Medicaid program) (27.8%). Speech therapy was the most frequently identified support service accessed by respondents (51%). Respondents identified a number of unaddressed concerns and perceived barriers to having these concerns addressed as it related to service referrals for speech therapy, nutrition services, dental services, and behavior management services.

Unique System of Care Issues and Challenges in Serving Children Under Age 3 and their Families

This article addresses the primary modifications necessary for system change to better meet the mental health needs of children under the age of three. The role of risk and resiliency factors in the young child, family and community and the necessity for a comprehensive community infant-family mental health system with a focus on the whole family are addressed. Barriers to care within early childhood systems of care are examined, including stigma, community referral and collaboration, diagnostic concerns during infancy, issues around family engagement, empowerment and partnership, funding of comprehensive and well coordinated infant-family services, workforce capacity and evaluation. Recommendations for implementation of system changes at the community and federal levels are proposed.

A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder.

The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger’s disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance.

Predictors of Memory Deficits in Adolescents and Young Adults with Congenital Heart Disease Compared to Healthy Controls

Introduction Adolescents and young adults with congenital heart disease (CHD) show a range of memory deficits, which can dramatically impact their clinical outcomes and quality of life. However, few studies have identified predictors of these memory changes. The purpose of this investigation was to identify predictors of memory deficits in adolescents and young adults with CHD after surgical palliation compared to healthy controls. Method One hundred fifty-six adolescents and young adults (80 CHD and 76 controls; age 14–21 years) were recruited and administered an instrument to assess memory [Wide Range Assessment of Memory and Learning Second Edition – general memory index (GMI) score] and completed questionnaires that measure anxiety, depression, sleepiness, health status, and self-efficacy. Descriptive and non-parametric statistics were used to assess group differences, and logistic regression to identify predictors of memory deficits. Results CHD subjects consisted of 58% males, median age 17 years, 43% Hispanic, and medians of 2 previous heart surgeries and 14 years since last surgery. Memory deficits (GMI ≤ 85) were identified in 50% CHD compared to 4% healthy controls (median GMI 85 vs. 104, p < 0.001). Of GMI subscale medians, CHD subjects had significantly worse memory performance vs. healthy controls (verbal 88 vs. 105, p < 0.001; attention 88 vs. 109, p < 0.001; working memory 86 vs. 108, p < 0.001). No significant differences appeared between groups for visual memory. Multiple clinical and psychosocial factors were identified which were statistically different on bivariate analyses between the subjects with and without memory deficits. By multivariate analysis, male gender, number of surgeries, anxiety, and self-efficacy emerged as independent predictors of memory deficits. Conclusion Adolescents and young adults with CHD, more than a decade since their last surgery, show significant verbal, attention, and working memory deficits over controls. To enhance patient memory/self-care, clinicians should explore ways to reduce anxiety, improve self-efficacy, and increase use of visual patient education material, especially in CHD males.

Validity of the Montreal Cognitive Assessment Screener in Adolescents and Young Adults With and Without Congenital Heart Disease

Background Cognitive deficits are common, long-term sequelae in children and adolescents with congenital heart disease (CHD) who have undergone surgical palliation. However, there is a lack of a validated brief cognitive screening tool appropriate for the outpatient setting for adolescents with CHD. One candidate instrument is the Montreal Cognitive Assessment (MoCA) questionnaire. Objective The purpose of the research was to validate scores from the MoCA against the General Memory Index (GMI) of the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML2), a widely accepted measure of cognition/memory, in adolescents and young adults with CHD. Methods We administered the MoCA and the WRAML2 to 156 adolescents and young adults ages 14–21 (80 youth with CHD and 76 healthy controls who were gender and age matched). Spearman’s rank order correlations were used to assess concurrent validity. To assess construct validity, the Mann–Whitney U test was used to compare differences in scores in youth with CHD and the healthy control group. Receiver operating characteristic curves were created and area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. Results The MoCA median scores in the CHD versus healthy controls were (23, range 15–29 vs. 28, range 22–30; p < .001), respectively. With the screening cutoff scores at <26 points for the MoCA and 85 for GMI (<1 SD, M = 100, SD = 15), the CHD versus healthy control groups showed sensitivity of .96 and specificity of .67 versus sensitivity of .75 and specificity of .90, respectively, in the detection of cognitive deficits. A cutoff score of 26 on the MoCA was optimal in the CHD group; a cutoff of 25 had similar properties except for a lower negative predictive value. The area under the receiver operating characteristic curve (95% CI) for the MoCA was 0.84 (95% CI [0.75, 0.93], p < .001) and 0.84 (95% CI [0.62, 1.00], p = .02) for the CHD and controls, respectively. Discussion Scores on the MoCA were valid for screening to detect cognitive deficits in adolescents and young adults aged 14–21 with CHD when a cutoff score of 26 is used to differentiate youth with and without significant cognitive impairment. Future studies are needed in other adolescent disease groups with known cognitive deficits and healthy populations to explore the generalizability of validity of MoCA scores in adolescents and young adults.

Use of a Noncycloplegic Autorefractor to Perform Vision Screening in Preschools

Early detection and treatment of vision disorders in children are important to avoid lifelong visual impairment; however, preschool vision-screening rates are low. Traditional methods of screening lack the precision of objective tests and are difficult to administer in preschoolers. This study adopted a method using school nurses to conduct vision screening in preschoolers with a portable autorefractor. In addition, the effectiveness of the school nurse in conducting follow-up was evaluated. In a sample of 600 children, more than 98% completed the screening, and 7% were referred for follow-up evaluation. Seventeen percent of parents had plans to follow-up after receiving a brochure indicating that their child would benefit from a comprehensive eye exam. However, after a conversation with the school nurse, 86% had plans to schedule an evaluation with an eye care professional. Of the 15 students with known follow-up, 10 received glasses. The described method is effective in identifying young children with potential vision problems and facilitating their correction after contact made by the school nurse.

Cardiovascular Risk in Preschool Children

The objective of this study is to determine the prevalence of cardiovascular risk in a primarily Latino/ Hispanic preschool population of low socioeconomic status. Preschool health screenings were conducted as part of a publicly funded demonstration project designed to provide consultation, education, services, and support to children living in underserved communities. Cross-sectional analysis was restricted to 2- to 5-year-olds with recorded values for age, gender, ethnicity, height, weight, triceps skinfold, resting heart rate, and blood pressure, resulting in 608 subjects. Most of the study population was of Latino/Hispanic descent. The prevalence of overweight and obesity rivaled adult data, with almost 50% of preschoolers aged 2 to 5 years being overweight or obese. Prevalence of overweight/obesity did not vary by age or gender. The Latino/Hispanic population had a significantly greater prevalence of overweight and obesity (P = .003, P = .02), but severe obesity (body mass index ≥99th percentile) did...

Broad Developmental Screening Misses Young Children With Social-Emotional Needs:

Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.

NEURODEVELOPMENTAL OUTCOME AT 3.5 YEARS OF AGE IN ECMO TREATED CHILDREN: RELATIONSHIP TO PRIMARY DIAGNOSIS † 1224

NEURODEVELOPMENTAL OUTCOME AT 3.5 YEARS OF AGE IN ECMO TREATED CHILDREN: RELATIONSHIP TO PRIMARY DIAGNOSIS † 1224

NEURODEVELOPMENTAL OUTCOME AND POTENTIAL FOR ACADEMIC DIFFICULTIES IN ECMO SURVIVORS AT FIVE YEARS OF AGE † 1192

Introduction. Neurodevelopmental outcome studies of school age children who required extracorporeal membrane oxygenation (ECMO) as a newborn due to severe cardiorespiratory failure suggest that these children are at greater risk for learning disabilities and mental retardation than in the general population. In an attempt to further clarify the nature of potential learning disabilities of children who received ECMO, we assessed the neurodevelopmental status of our ECMO survivors at five years of age.