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Cheryl Dissanayake - One of the best experts on this subject based on the ideXlab platform.
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explaining culturally and linguistically diverse cald parents access of healthcare services for Developmental Surveillance and anticipatory guidance qualitative findings from the watch me grow study
BMC Health Services Research, 2017Co-Authors: Pankaj Garg, Cheryl Dissanayake, My Trinh Ha, John Eastwood, Susan R Harvey, Susan Woolfenden, Elisabeth Murphy, Bin Jalaludin, Katrina Williams, Anne MckenzieAbstract:Regular health visits for parents with young children provide an opportunity for Developmental Surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal Developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health Surveillance programs. This paper aims to describe and explain parental experiences for accessing Developmental Surveillance and anticipatory guidance for children. Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework. An overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service. CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.
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early markers of autism spectrum disorders in infants and toddlers prospectively identified in the social attention and communication study
Autism, 2013Co-Authors: Josephine Barbaro, Cheryl DissanayakeAbstract:The Social Attention and Communication Study involved the successful implementation of Developmental Surveillance of the early markers of autism spectrum disorders in a community-based setting. The objective in the current study was to determine the most discriminating and predictive markers of autism spectrum disorders used in the Social Attention and Communication Study at 12, 18 and 24 months of age, so that these could be used to identify children with autism spectrum disorders with greater accuracy. The percentage of 'yes/no' responses for each behavioural marker was compared between children with autistic disorder (n = 39), autism spectrum disorder (n = 50) and Developmental and/or language delay (n = 20) from 12 to 24 months, with a logistic regression also conducted at 24 months. Across all ages, the recurring key markers of both autistic disorder and autism spectrum disorder were deficits in eye contact and pointing, and from 18 months, deficits in showing became an important marker. In combination, these behaviours, along with pretend play, were found to be the best group of predictors for a best estimate diagnostic classification of autistic disorder/autism spectrum disorder at 24 months. It is argued that the identified markers should be monitored repeatedly during the second year of life by community health-care professionals.
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prospective identification of autism spectrum disorders in infancy and toddlerhood using Developmental Surveillance the social attention and communication study
Journal of Developmental and Behavioral Pediatrics, 2010Co-Authors: Josephine Barbaro, Cheryl DissanayakeAbstract:Objective: Despite behavioral markers of autism spectrum disorders (ASDs) being evident within the first year of life, there remains little research on the prospective identification of these children in a community-based setting before 18 months. The aim in the Social Attention and Communication Study was to identify infants and toddlers at risk of an ASD during their first 2 years. Methods: A total of 241 Maternal and Child Health nurses were trained on the early signs of ASDs at 8, 12, 18 and 24 months. Using a Developmental Surveillance approach with a community-based sample, a cohort of 20,770 children was monitored on early social attention and communication behaviors. Those infants/toddlers identified as "at risk" were referred to the Social Attention and Communication Study team from 12 months for Developmental and diagnostic assessments at 6 monthly intervals, until 24 months. Results: A total of 216 children were referred, with 110 being further assessed. Of these, 89 children were classified with an ASD at 24 months, and 20 children had Developmental and/or language delays, resulting in a Positive Predictive value of 81%. The estimated rate of ASDs in the Social Attention and Communication Study cohort ranged from 1:119 to 1:233 children. Estimated sensitivity ranged from 69% to 83.8%, and estimated specificity ranged from 99.8% to 99.9%. Conclusion: Developmental Surveillance of social and communication behaviors, which differ according to the age at which the child is monitored, enables the accurate identification of children at risk for ASDs between 12 and 24 months. Education on the early signs is recommended for all primary health care professionals to facilitate early identification of ASDs. (J Dev Behav Pediatr 31:376-385, 2010) Index terms: autism spectrum disorders, Developmental Surveillance, screening, infants, toddlers, prospective identification, community-based. Autism spectrum disorders (ASDs) are among the most severe and debilitating neuroDevelopmental dis- orders affecting children and include individuals who meet criteria for autistic disorder, Asperger's disorder, or Pervasive Developmental Disorder-Not Otherwise Specified. 1 Current prevalence rates of the combined ASDs are currently 1 in 160 in Australia, 2 1 in 100 in the United Kingdom, 3 and 1 in 91 in the United States. 4 Retrospective videotape analyses and parental report studies provide valuable evidence that symp- toms of ASDs are present during infancy. Indeed, 50% of parents of children with an ASD report hav- ing concerns before 12 months of age, with many more reporting recognition of abnormalities between
Paul H Lipkin - One of the best experts on this subject based on the ideXlab platform.
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promoting optimal development identifying infants and young children with Developmental disorders through Developmental Surveillance and screening
Pediatrics, 2020Co-Authors: Paul H Lipkin, Michelle M MaciasAbstract:Early identification and intervention for Developmental disorders are critical to the well-being of children and are the responsibility of pediatric professionals as an integral function of the medical home. This report models a universal system of Developmental Surveillance and screening for the early identification of conditions that affect children's early and long-term development and achievement, followed by ongoing care. These conditions include autism, deafness/hard-of-hearing, intellectual and motor disabilities, behavioral conditions, and those seen in other medical conditions. Developmental Surveillance is supported at every health supervision visit, as is as the administration of standardized screening tests at the 9-, 18-, and 30-month visits. Developmental concerns elicited on Surveillance at any visit should be followed by standardized Developmental screening testing or direct referral to intervention and specialty medical care. Special attention to Surveillance is recommended at the 4- to 5-year well-child visit, prior to entry into elementary education, with screening completed if there are any concerns. Developmental Surveillance includes bidirectional communication with early childhood professionals in child care, preschools, Head Start, and other programs, including home visitation and parenting, particularly around Developmental screening. The identification of problems should lead to Developmental and medical evaluations, diagnosis, counseling, and treatment, in addition to early Developmental intervention. Children with diagnosed Developmental disorders are identified as having special health care needs, with initiation of chronic condition management in the pediatric medical home.
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implementing Developmental screening and referrals lessons learned from a national project
Pediatrics, 2010Co-Authors: Tracy M King, Paul H Lipkin, Michelle M Macias, Darius S Tandon, Jill A Healy, Paula M Duncan, Nancy L Swigonski, Stephanie Mucha SkipperAbstract:OBJECTIVES: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for Developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts. BACKGROUND: In 2006, the AAP released a policy statement on Developmental Surveillance and screening that included an algorithm to aid practices in implementation. Simultaneously, the AAP launched a 9-month pilot project in which 17 diverse practices sought to implement the policy statement9s recommendations. METHODS: Quantitative data from chart reviews were used to calculate rates of screening and referral. Qualitative data on practices9 implementation efforts were collected through semistructured telephone interviews and inductively analyzed to generate key themes. RESULTS: Nearly all practices selected parent-completed screening instruments. Instrument selection was frequently driven by concerns regarding clinic flow. At the project9s conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after Surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals. CONCLUSIONS: A diverse sample of practices successfully implemented Developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.
Maja Steinlin - One of the best experts on this subject based on the ideXlab platform.
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pediatric aspects predicts outcomes following acute symptomatic neonatal arterial stroke
Neurology, 2020Co-Authors: Mark T Mackay, Nedelina Slavova, Manuela Pastorewapp, Sebastian Grunt, Belinda Stojanovski, Susan Donath, Maja SteinlinAbstract:Objective To test the hypothesis that the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is useful in determining outcomes after neonatal arterial ischemic stroke (NAIS), we assessed accuracy of the modified pediatric ASPECTS (pedASPECTS) to predict cerebral palsy (CP), neurologic impairment, and epilepsy. Methods Cross-sectional study included newborns with acute NAIS whose outcomes were assessed at ≥18 months after stroke. PedASPECTS accuracy to predict outcomes was determined by sensitivity, specificity, and receiver operator characteristic (ROC) curves, and correlation between pedASPECTS and infarct volume was determined by the Spearman correlation coefficient. Results Ninety-six children met the inclusion criteria. Median percentage infarct to supratentorial brain volume was 6.8% (interquartile range [IQR] 3.0%–14.3%). Median pedASPECTS was 7 (IQR 4–10). At a median age of 2.1 years, 35% developed CP, 43% had neurologic impairment, and 7% had epilepsy. Median pedASPECTS predicted outcomes of interest: CP (10, IQR 8–12) vs no CP (5, IQR 4–8) (p Conclusions This study provides Class II evidence that pedASPECTS has fair to good accuracy for predicting CP, neurologic impairment, and epilepsy after NAIS and correlates with infarct volume. PedASPECTS may assist with early identification of babies requiring close Developmental Surveillance.
Josephine Barbaro - One of the best experts on this subject based on the ideXlab platform.
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early markers of autism spectrum disorders in infants and toddlers prospectively identified in the social attention and communication study
Autism, 2013Co-Authors: Josephine Barbaro, Cheryl DissanayakeAbstract:The Social Attention and Communication Study involved the successful implementation of Developmental Surveillance of the early markers of autism spectrum disorders in a community-based setting. The objective in the current study was to determine the most discriminating and predictive markers of autism spectrum disorders used in the Social Attention and Communication Study at 12, 18 and 24 months of age, so that these could be used to identify children with autism spectrum disorders with greater accuracy. The percentage of 'yes/no' responses for each behavioural marker was compared between children with autistic disorder (n = 39), autism spectrum disorder (n = 50) and Developmental and/or language delay (n = 20) from 12 to 24 months, with a logistic regression also conducted at 24 months. Across all ages, the recurring key markers of both autistic disorder and autism spectrum disorder were deficits in eye contact and pointing, and from 18 months, deficits in showing became an important marker. In combination, these behaviours, along with pretend play, were found to be the best group of predictors for a best estimate diagnostic classification of autistic disorder/autism spectrum disorder at 24 months. It is argued that the identified markers should be monitored repeatedly during the second year of life by community health-care professionals.
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prospective identification of autism spectrum disorders in infancy and toddlerhood using Developmental Surveillance the social attention and communication study
Journal of Developmental and Behavioral Pediatrics, 2010Co-Authors: Josephine Barbaro, Cheryl DissanayakeAbstract:Objective: Despite behavioral markers of autism spectrum disorders (ASDs) being evident within the first year of life, there remains little research on the prospective identification of these children in a community-based setting before 18 months. The aim in the Social Attention and Communication Study was to identify infants and toddlers at risk of an ASD during their first 2 years. Methods: A total of 241 Maternal and Child Health nurses were trained on the early signs of ASDs at 8, 12, 18 and 24 months. Using a Developmental Surveillance approach with a community-based sample, a cohort of 20,770 children was monitored on early social attention and communication behaviors. Those infants/toddlers identified as "at risk" were referred to the Social Attention and Communication Study team from 12 months for Developmental and diagnostic assessments at 6 monthly intervals, until 24 months. Results: A total of 216 children were referred, with 110 being further assessed. Of these, 89 children were classified with an ASD at 24 months, and 20 children had Developmental and/or language delays, resulting in a Positive Predictive value of 81%. The estimated rate of ASDs in the Social Attention and Communication Study cohort ranged from 1:119 to 1:233 children. Estimated sensitivity ranged from 69% to 83.8%, and estimated specificity ranged from 99.8% to 99.9%. Conclusion: Developmental Surveillance of social and communication behaviors, which differ according to the age at which the child is monitored, enables the accurate identification of children at risk for ASDs between 12 and 24 months. Education on the early signs is recommended for all primary health care professionals to facilitate early identification of ASDs. (J Dev Behav Pediatr 31:376-385, 2010) Index terms: autism spectrum disorders, Developmental Surveillance, screening, infants, toddlers, prospective identification, community-based. Autism spectrum disorders (ASDs) are among the most severe and debilitating neuroDevelopmental dis- orders affecting children and include individuals who meet criteria for autistic disorder, Asperger's disorder, or Pervasive Developmental Disorder-Not Otherwise Specified. 1 Current prevalence rates of the combined ASDs are currently 1 in 160 in Australia, 2 1 in 100 in the United Kingdom, 3 and 1 in 91 in the United States. 4 Retrospective videotape analyses and parental report studies provide valuable evidence that symp- toms of ASDs are present during infancy. Indeed, 50% of parents of children with an ASD report hav- ing concerns before 12 months of age, with many more reporting recognition of abnormalities between
Mark T Mackay - One of the best experts on this subject based on the ideXlab platform.
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pediatric aspects predicts outcomes following acute symptomatic neonatal arterial stroke
Neurology, 2020Co-Authors: Mark T Mackay, Nedelina Slavova, Manuela Pastorewapp, Sebastian Grunt, Belinda Stojanovski, Susan Donath, Maja SteinlinAbstract:Objective To test the hypothesis that the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is useful in determining outcomes after neonatal arterial ischemic stroke (NAIS), we assessed accuracy of the modified pediatric ASPECTS (pedASPECTS) to predict cerebral palsy (CP), neurologic impairment, and epilepsy. Methods Cross-sectional study included newborns with acute NAIS whose outcomes were assessed at ≥18 months after stroke. PedASPECTS accuracy to predict outcomes was determined by sensitivity, specificity, and receiver operator characteristic (ROC) curves, and correlation between pedASPECTS and infarct volume was determined by the Spearman correlation coefficient. Results Ninety-six children met the inclusion criteria. Median percentage infarct to supratentorial brain volume was 6.8% (interquartile range [IQR] 3.0%–14.3%). Median pedASPECTS was 7 (IQR 4–10). At a median age of 2.1 years, 35% developed CP, 43% had neurologic impairment, and 7% had epilepsy. Median pedASPECTS predicted outcomes of interest: CP (10, IQR 8–12) vs no CP (5, IQR 4–8) (p Conclusions This study provides Class II evidence that pedASPECTS has fair to good accuracy for predicting CP, neurologic impairment, and epilepsy after NAIS and correlates with infarct volume. PedASPECTS may assist with early identification of babies requiring close Developmental Surveillance.