Case History for the Pediatric Eye Examination

The art of taking a patient's case history is essential for a solid understanding of pertinent details before proceeding with an examination. While establishing rapport with the patient, the clinician should ask questions about birth history, developmental history, educational and social history. Active listening skills and flexibility of the provider are useful tools for an effective start to the examination. This chapter reviews categories of questions needed for optimization of case history for the pediatric patient. This includes questions focused on specific age categories, including infants and toddlers, preschoolers, elementary-aged children, and adolescents. The chapter author provides clinical pearls for a more efficient and effective exam, including a section on assisting children with special needs.

Stakeholder informed development of the Emotion Awareness and Skills Enhancement team–based program (EASE-Teams)

Emotion dysregulation (ED) underlies psychiatric symptoms and impedes adaptive responses in autistic individuals. The Emotion Awareness and Skills Enhancement (EASE) program was the first mindfulness-based intervention designed to target emotion dysregulation in autistic adolescents (12–17 years old). This project partnered with stakeholders to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups who often benefit from caregiver support in treatment. Over three adaptation phases, we: (1) elicited stakeholder and expert feedback to adapt the original EASE program for autistic individuals with intellectual disability; (2) redesigned the adapted manual and expanded the target age range following a small “micro-trial” with a sample of autistic adolescents and adults with intellectual disability ( n = 6); and (3) demonstrated feasibility and acceptability of a caregiver-client team-based approach (EASE-Teams) in a sample of 10 autistic individuals with and without intellectual disability (ages 7–25) and their caregivers. EASE-Teams was both acceptable and helpful to families. Significant improvements were noted in participant emotion dysregulation, psychiatric symptoms, and caregiver stress from their child’s dysregulation. Findings suggest that EASE-Teams may be appropriate for heterogeneous developmental and cognitive needs. Future research to establish efficacy and refine EASE-Teams with community providers is warranted. Lay abstract Emotion dysregulation (ED) impacts mental health symptoms and well-being in autistic individuals. In prior work, we developed the Emotion Awareness and Skills Enhancement (EASE) to improve emotion dysregulation with autistic adolescents (aged 12–17). The study team partnered with autistic individuals, their caregivers, and expert clinicians to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups that often benefit from caregiver support in treatment. In three phases, we (1) gathered caregiver and expert feedback to adapt the original EASE program for autistic adults with intellectual disability, (2) revised the treatment after using it with six autistic adults with intellectual disability, and (3) tested the newly developed caregiver–client team-based treatment, called EASE-Teams, in a small group of 10 autistic individuals with and without intellectual disability (aged 7–25). Families found EASE-Teams to be acceptable and helpful. We found improvements in emotion dysregulation and mental health symptoms for autistic participants. Caregivers reported less stress from their child’s dysregulation after participating. These results show that EASE-Teams can be appropriate for different developmental and cognitive needs. Future studies will need to test the benefits of the treatment in community clinics.

Understanding Physical Activity Patterns Across the School Day in Urban Pre-Kindergarten and Elementary Schoolchildren

Purpose: Despite recommendations that children accrue ≥60 min/day of moderate-to-vigorous physical activity (MVPA), numerous barriers may exist. We examined school-day MVPA patterns in lower-income children (pre-K to 5th grade) to determine whether they were meeting the minimum school-day guidelines of at least 30-min/day of MVPA and to identify opportunities for intervention. Methods: Students (N = 629, pre-K-5th grade) from 4 urban schools wore Actigraph GT3X+ accelerometers over 2 school days. Mixed effects models evaluated sex- and grade-specific differences in MVPA and sedentary time. Results: Only 34.6% of elementary and 25.3% of pre-K students met the school-time MVPA recommendation. Among elementary-aged children, boys accrued more MVPA than girls (30.8 ± 13.3 vs. 23.5 ± 10.7 min/day; p < 0.0001) with similar sex differences observed among pre-K children (51.3 ± 17.1 vs 41.9 ± 17.5 min/day; p < 0.001). Sedentary time also increased significantly with grade among elementary-aged children (207.9 ± 34.7 vs. 252.0 ± 36.1 min/day for those in 1st and 5th grade, respectively; p < 0.001), with girls accruing more sedentary time than boys (242.5 ± 48.2 vs. 233.8 ± 46.8 min/day; p < 0.0001). Conclusion: MVPA declines across elementary school years, with sex disparities observed as early as pre-K. Extended sedentary bouts and clustering of activity highlight opportunities for more movement throughout the school day.

Impact of Congenital Heart Disease on School Adjustment in Elementary School Aged Children

Congenital heart disease or congenital heart defect (CHD) is an abnormality of the heart that develops before birth (American Heart Association, 2018). While much is known about how children are physically affected, less is known about the psychological impacts of CHD. In particular, little is known about school adjustment or the process of adapting to the role of a student and to various aspects of the school environment, while failure to adjust can cause academic and social-emotional problems (Lakhani, Jain, & Chandel, 2017). This review aims to investigate how and to what extent having CHD affects school adjustment in elementary school aged children (grades 1-5) (a group oftentimes overlooked as insignificant) and if the severity of CHD in elementary-aged children impacts their ability to adjust in schools. By reviewing literal and studies published in the past 50 years, the review reaches the conclusion that CHD does have negative effects on school adjustment and the severity of CHD positively correlates with difficulty to adjust. The purpose of this paper is to provide insight into the current studies regarding children with CHD and their relationship to different aspects of school and the school environment as well as propose a study that is multi-site, multi-informant, and multi-method. The result of this review has compelling clinical and theoretical significance, benefiting clinicians and practitioners, teachers and educators, and researchers by bridging the gap between existing and unknown knowledge of elementary-aged children with CHD and their school adjustment.

Effects of Parental Public Health Insurance Eligibility on Parent and Child Health Outcomes

Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010-2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents’ self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p &lt; 0.05), a 4.7% improvement. We found no significant changes in children’s utilization of routine doctor visits or parents’ assessment of their children’s health status. We observed modest decreases in children’s body mass index (BMI) of about 2% (p &lt; 0.05), especially for girls.

La competenza pragmatica come strumento inclusivo Uno studio di caso con bambini stranieri di prima e di seconda generazione

The aim of this research is to demonstrate the benefits of home language maintenance among first and second generation migrant children by investigating whether they would perform better than their monolingual peers in their ability to narrate stories. The study was conducted in four primary schools in the Veneto region engaging 49 early elementary aged children with different cultural, educational and migration backgrounds who were asked to perform story-telling and story-retelling tasks. After a brief introduction to the study, the second paragraph tackles the notion of pragmatic competence and its relevance for bilingual education. The third paragraph presents the method of the study as well as the survey procedures, followed by a discussion of the results. The conclusion contains limitations of the study and illustrates a number of pedagogical implications. Positive outcomes of this study should raise teachers’ awareness of the linguistic benefits of bilingualism and promote the concept of pragmatic competence.