Susan Brunssen

Pharmacologic Treatment for the Core Deficits and Associated Symptoms of Autism in Children

Autism is a neurodevelopmental condition affecting 1 out of 160 children in the United States today. Only risperidone has Food and Drug Administration approval for the pharmacologic management of autism in children. However, health care providers may prescribe other drugs used off-label to assist autistic children and their families with the core deficits and associated behaviors of this condition. Evidence for the use of these medications will be discussed in this continuing education offering. Meta analyses, randomized clinical trials, and other prospective experimental studies of pharmacotherapy conducted in the United States in the past 10 years in children between the ages of 5 and 15 years were reviewed. The results support moderate success in treating the associated behaviors of autism and minimal success in treating core deficits across all drug classes. Preliminary evidence demonstrates possible uses for atypical antipsychotic agents, selective-serotonin reuptake inhibitors, stimulants, and N-methyl-D-aspirate receptor antagonists in decreasing the core behaviors and associated symptoms of autism. More studies and longer periods of follow-up are needed before definitive guidelines can be suggested.

Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004.

Objectives: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0–19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. Methods: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. Results: 1,914 children ages 0–19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was

Review of the Evidence for Treatment of Children with Autism with Selective Serotonin Reuptake Inhibitors

133.8 million, or

Parents As Passengers During Pediatric Transport

69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was

Maternal role attainment with medically fragile infants: Part 1. measurement and correlates during the first year of life†

3,181 per child. The

Interleukin-6 (IL-6) receptor/IL-6 fusion protein (Hyper IL-6) effects on the neonatal mouse brain: possible role for IL-6 trans-signaling in brain development and functional neurobehavioral outcomes.

133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly

Perceptions of stress, worry, and support in Black and White mothers of hospitalized, medically fragile infants

2 billion spent by Medicaid in 2004 for all medical services for all children ages 0–19. Conclusions: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.

The nurse parent support tool.

PURPOSE To review the potential role of serotonin dysregulation in autism and the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating core deficits and associated symptoms of autism in children. The literature was searched for reports of SSRI use in children with autism. Data are presented from prospective clinical trials that evaluated treatment outcomes. CONCLUSIONS Some SSRIs show moderate success in managing specific behaviors. Only fluoxetine shows evidence of decreasing global autism severity. PRACTICE IMPLICATION Definitive conclusions concerning selection criteria, dosage, safety, and efficacy cannot be drawn given the current state of evidence.

Diffuse white matter injury and neurologic outcomes of infants born very preterm in the 1990s

INTRODUCTION The transport environment presents a unique setting in which the feasibility, advantages, and disadvantages of passengers accompanying a patient must be assessed carefully. The purpose of this study was to describe the current practice of including parents as passengers during pediatric interfacility transport. METHODS One-hundred-eighty-eight critical care transport programs in the United States responded to a voluntary mail survey, providing information about current policies, practices, and crew perceptions of the advantages and disadvantages of carrying parents as passengers. RESULTS Extra seating for passengers was available in 96% of ambulances, 86% of fixed-wing aircraft, and 54% of helicopters used for pediatric transport. Parents traveled as passengers in all types of vehicles; most frequently in ambulances and fixed-wing aircraft. Twenty percent of helicopter programs allowed parent passengers on more than half of their pediatric transports in this vehicle. Advantages of parent passengers included emotional benefit for the parent and child, availability of parents for history and consent, good public relations, and having the parent present if the child dies. Disadvantages included potential parent anxiety, crew distraction, and space limitations. DISCUSSION This study reflects the widely diverse policies, practices, and opinions relevant to this topic and confirms a need for further study.

Maternal infection and white matter toxicity

The purpose of this study was to extend scholarship on maternal role attainment (MRA). We used a triangulation of behavioral and self-report variables to measure MRA-identity, presence, and competence-with mothers of medically fragile infants (n = 81), and explored characteristics that influenced MRA longitudinally. Competence and presence were best measured using both self-report and observational methods, whereas identity was best measured with a questionnaire. Mothers with less worry reported higher levels of identity. Presence was higher with less alert infants, whereas competence was higher with more alert infants, lower parental role stress, higher education, and being married. Mothers with more illness-related distress and less alert infants, and unmarried and less educated mothers may need interventions to enhance MRA.