Individuals with autism spectrum disorders have a higher comorbidity burden than the general pediatric population, including higher rates of seizures, psychiatric illness, and gastrointestinal disorders.

Comorbidities do not occur evenly. Our clustering analysis reveals subgroups characterized by seizure, psychiatric disorders, and complex multisystem disorders including auditory and gastrointestinal disorders. Correlations between seizure, psychiatric disorders, and gastrointestinal disorders are validated on a sample from a second hospital. (Read the full article)

Screening for autism spectrum disorders (ASDs) using the Modified Checklist for Autism in Toddlers (M-CHAT) improves early detection and long-term prognosis of ASD. Reducing the false-positive rate may increase implementation of screening for ASDs.

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), simplifies wording of the original M-CHAT. The current validation study indicates that the M-CHAT-R/F improves the ability to detect autism spectrum disorders in toddlers screened during well-child care visits. (Read the full article)

Previous analyses have documented increased health care costs for children with autism spectrum disorders but have not provided comprehensive estimates of the total economic burden.

There are substantial additional costs associated with caring for children with autism spectrum disorders, amounting to >$17 000 per child annually. Costs accrued outside of the health care system account for the majority of the financial burden. (Read the full article)

In children with congenital toxoplasmosis, ocular lesions can be detected and may relapse after birth despite pre- and postnatal treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.

Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment. (Read the full article)

Little is known about how thirdhand smoke beliefs are related to smoking and quitting behaviors, and how parental smokers’ thirdhand smoke beliefs influence behaviors to protect children. A previous study suggests thirdhand smoke beliefs are associated with home smoking bans.

This is the first study to show that parents’ beliefs about thirdhand smoke are associated with multiple smoking-related attitudes and behaviors that affect the health of children. (Read the full article)

Maternal prepregnancy obesity is associated with an increased risk of neurodevelopmental disorders in children, but previous studies have not taken paternal obesity into account. This has precluded differentiation between the effects of intrauterine exposures and potential genetic associations.

Robust associations were demonstrated between paternal obesity and the risk of autistic disorder and Asperger disorder in children. This study is the first to implicate paternal obesity as a risk factor for autism, and replication is warranted. (Read the full article)

Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like selective serotonin reuptake inhibitors (SSRIs). Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear.

This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays. However, underlying depression and its genetic underpinnings may be a confounder. (Read the full article)

It is well-established that parental smoking is associated with adolescent smoking initiation and regular tobacco use. However, we know less about how exposure to specific types of parental smoking affect adolescent smoking and progression to regular smoking in young adulthood.

Among adolescents with parents who are nicotine dependent, each previous year of parental smoking increases the likelihood they will be in a heavy smoking trajectory. Parental smoking cessation early in their children’s life is critical to prevent smoking in families. (Read the full article)

Animal studies document dose-dependent and duration-of-therapy-dependent fluoroquinolone cartilage toxicity in weight-bearing joints. Preliminary pediatric data collected after fluoroquinolone treatment and up to 1 year posttreatment in blinded and unblinded studies suggest the possibility of cartilage toxicity in children.

These are the first prospectively collected data on fluoroquinolone musculoskeletal safety collected posttherapy from randomized, comparative studies of respiratory tract infections and analyzed at 5 years. Long-term musculoskeletal adverse events occurred with equal frequency in both levofloxacin and comparator groups. (Read the full article)

Autism prevalence is reported to be highest among non-Hispanic white children, lower in Hispanic and African American/black children, and highly variable in Asian/Pacific Islanders. More comorbid intellectual disability and delays in expressive language have been observed among Hispanic and African American children.

Maternal nativity is a risk factor for childhood autism in US populations. We observed higher risk of severe autism phenotypes in children of foreign-born black, Central/South American, Filipino, and Vietnamese mothers and US-born African Americans and Hispanics compared with US-born whites. (Read the full article)

Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.

Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families. (Read the full article)

Prenatal maternal smoking has been associated with attention-deficit/hyperactivity disorder in children, but the causal nature of this association is unclear. Controlling for the association with paternal smoking has been inconsistent.

Women who used nicotine replacement also had children with a higher risk of attention-deficit/hyperactivity disorder. Mother's smoking behavior appears more important than father's, suggesting a possible causal effect of nicotine exposure or factors related to maternal nicotine dependence. (Read the full article)

Mothers of children with neurodevelopmental disabilities often experience poor health, high stress, anxiety, and depression. Highly stressed parents are less effective in their parenting roles, risking their children's developmental progress.

Evidence-based interventions in mindfulness and positive psychology significantly reduce distress in mothers of children with disabilities. Well-trained peer-mentors are effective interventionists. Adult-oriented services are needed for these mothers to improve their mental health and sustain their caregiving over the long-term. (Read the full article)

Preterm birth has been associated with increased risk of venous thromboembolism (VTE) in infancy, but the longer-term risk is unknown.

In a large national cohort, low gestational age at birth was associated with increased risk of VTE in infancy, early childhood, and young adulthood. These findings call for better awareness of the long-term risk of VTE among preterm birth survivors. (Read the full article)

Prescribing patterns in the US pediatric population are changing but not uniformly. A detailed examination of prescription variation is needed to better understand pharmacotherapy of children and to inform future exploration of the causes and consequences of diverse practices.

We examine pediatric pharmacotherapy and quantify payer type differences and small geographic area variation. Substantial payer-type differences and regional variations were found, likely reflecting local practice cultures. Variation was greatest for medications used in situations of diagnostic and therapeutic uncertainty. (Read the full article)

Exposure to second-hand tobacco smoke during pregnancy and infancy has been linked to development of asthma, rhinitis, and eczema in young children. It is unclear whether these risks persist into adolescence.

Exposure to second-hand smoke in utero or during infancy influences the development of allergic disease up to adolescence. Excess risks for asthma and rhinitis were seen primarily in early childhood, whereas those for eczema occurred at later ages. (Read the full article)

Adolescent males from low-income communities are a group at increased risk of obesity and related health concerns. Obesity prevention interventions targeting adolescents have so far had mixed success. Targeted interventions, tailored for specific groups, may be more appealing and efficacious.

A multicomponent school-based intervention using smartphone technology can improve muscular fitness, movement skills, and key weight-related behaviors among low-income adolescent boys. (Read the full article)

In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs). Since 2004, hyperglycemic and diabetes risk with SGAs has been stated in product labels, and published guidelines have recommended baseline metabolic screening.

Between 2006 and 2011, 11% of children 2 to 18 years starting an SGA had baseline glucose assessed. Youth at risk for diabetes may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia. (Read the full article)

Preterm birth and faster infant growth have been identified as independent risk factors for autism-spectrum disorders (ASD). However, associations between prematurity and ASD-related traits as a continuum and effects of infant growth among those born preterm are still little studied.

VLBW young adults reported higher levels of ASD-related traits, particularly traits related to poorer social skills. Within the VLBW group, faster growth in weight, height, and head circumference from birth to term was associated with lower levels of ASD-related traits. (Read the full article)

Randomized controlled trials (RCTs) of intensive clinician-implemented interventions have demonstrated significant improvements in outcomes of toddlers and preschool children with autism spectrum disorder. RCTs of parent-implemented interventions have demonstrated improvements in parent skills, but generally they have not demonstrated effects on children’s outcomes.

This RCT found significantly greater improvements with individual home coaching on child outcome measures of social communication, adaptive behavior, and developmental level. These findings support the efficacy of a parent-implemented intervention using little professional time, which increases potential community viability. (Read the full article)

Many population-based studies including pubertal children are based on self-assessment of pubertal maturation, the reliability of which is uncertain.

Self-assessment is not reliable for precise pubertal staging. Simple distinctions between prepuberty and puberty showed moderate agreement with clinical examinations. Parents and girls tended to underestimate and boys to overestimate pubertal development by up to 50% and 30%, respectively. (Read the full article)

Behavioral observations influence a clinician’s decision to diagnose or refer, and may even override formal screening results. In the case of autism spectrum disorder, an expected rate of atypical behavior during the span of a medical visit is unknown.

We are the first to quantify the high base rates of typical behavior in young children who have autism and language delay. When observation times are brief, the preponderance of typical behaviors may negatively impact referral decision accuracy. (Read the full article)

Light and intermittent smoking are harmful, but increasingly common, smoking patterns. It is unknown how adolescents perceive these smoking patterns, and whether these views differ by sociodemographic characteristics, and exposure to and use of tobacco.

US adolescents perceive light and intermittent smoking as significantly less dangerous than heavier smoking. One in 4 adolescents believes intermittent smoking causes little to no harm. Perceptions of relative safety were common among smokers. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Stevens-Johnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare.

We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non–Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate. (Read the full article)

Small-for-gestational-age neonates are at risk for thrombocytopenia during the first days and weeks after birth. However, the incidence, duration, severity, responsible mechanism, value of platelet transfusions, and risk of death from this variety of neonatal thrombocytopenia are unknown.

Ten percent of thrombocytopenic small-for-gestational-age neonates have a recognized cause for low platelets (aneuploidy, extracorporeal membrane oxygenation, disseminated intravascular coagulation); they have a high mortality rate (65%). Ninety percent have a moderate, transient (2 weeks), hyporegenerative thrombocytopenia with a low mortality rate (2%). (Read the full article)

The value of ultrasound imaging for the diagnosis, prognosis, and surgical planning of cryptorchidism is limited at best.

Ultrasound remains grossly overused by referring physicians throughout Ontario, Canada, which resulted in a 3-month delay to definitive surgery and unnecessary expenditures. (Read the full article)

In adults, there is significant increased length of stay, cost, and/or resource use associated with hospital-acquired conditions. Less is known about the epidemiology and impact of many hospital-acquired conditions in pediatric populations.

We find increased pediatric length of stay and costs due to venous thromboembolism and catheter-associated urinary tract infections. This is essential information for hospital administrators and safety departments who are planning interventions to reduce harm associated with these hospital-acquired conditions. (Read the full article)

Many studies have suggested that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly co-occuring neurodevelopmental conditions.

In children with co-occurring ASD and ADHD, an initial ADHD diagnosis may be associated with delayed ASD diagnosis and a higher likelihood of ASD diagnosis older than 6 years of age. Clinicians should consider ASD when evaluating young children presenting with ADHD symptoms. (Read the full article)

Both short and long interpregnancy intervals are associated with increased risk of autism in second-born children. However, it is not known if the association is explained by unfavorable birth outcomes of the previous siblings.

Both short and long interpregnancy intervals increase risk of autism in second-born children independently of previous siblings being born premature, having low birth weight, or being born by cesarean delivery and independently of maternal antidepressant use 3 months before pregnancy. (Read the full article)

Small for gestational age neonates (weight <10th percentile) are at risk for neutropenia during the first days after birth. However, the duration, responsible mechanism, and outcomes of this variety of neonatal neutropenia are not precisely known.

Six percent of small for gestational age neonates had neutrophils <1000/μL, with an average neutropenia duration of 7 days. Neutropenia was more closely linked with small for gestational age status than maternal hypertension. This neutropenia is associated with elevated nucleated red blood cell count and increased odds of necrotizing enterocolitis. (Read the full article)

The American Academy of Pediatrics discourages providers from dismissing families who refuse vaccines for their children, yet some providers continue to do so.

We show that ~1 in 5 pediatricians dismiss families who refuse vaccines, and there is significant regional variation in the practice. Dismissing families for refusing vaccines was also associated with stricter state nonmedical exemption policies. (Read the full article)

Children and adolescents with autism spectrum disorders (ASDs) may be at elevated risk for unhealthy weight. Samples of children with verified clinical diagnoses of ASD have been lacking, and associations with child behavior and functioning are not well understood.

Young children (2–5 years old) and adolescents (12–17 years old) with ASDs were at an elevated risk for unhealthy weight status compared with a general population sample. The presence of sleep or affective problems may confer increased risk among those with ASD. (Read the full article)

25 June 2007This briefing provides information on the legislative framework for promoting tourism in Scotland, describes the main organisations supporting tourism, provides statistical information and summarises Executive policies.

2 June 2011This briefing provides information on the legislative framework for promoting tourism in Scotland, describes the main organisations supporting tourism, provides key statistics, and summarises Scottish Government policies.

Groundbreaking, Grammy-winning quartet Béla Fleck & The Flecktones is celebrating its 30th anniversary with an extended tour that will stop by the Community Arts Center on Tuesday, March 24, at 7:30 p.m.

Students are learning how to research and write scripts, hone interviewing techniques, and edit video footage, and some teenagers are even earning certifications in media technology.

We visit Walderslade FC, where a Manchester United FC regular first made his mark.

We visit the grassroots club where it all began for the EURO '96 finalist and UEFA Champions League winner.

Read an extract from business author and coach Douglas Kruger's latest book, Virus-proof your small business.

Sensible, inclusive regulation of pastoralism that has mitigated tension in parts of the Sahel should be extended to the Democratic Republic of Congo (DRC) and the Central African Republic (CAR), where conflicts have worsened with the southward expansion of pastoralism.

​Religious intolerance is a growing but seriously underestimated risk in Cameroon, both between and inside the major faiths. To halt the spread of violent extremism in the country, Cameroon needs to bring all sects into a new social compact and within the bounds of a charter for religious tolerance.

L’image de havre de paix dans une région en proie aux conflits dont bénéficiait le Cameroun a volé en éclats depuis l’irruption de Boko Haram en 2013 au nord du pays. Ce mouvement, devenu l’Etat islamique en Afrique de l’Ouest en mars 2015, revendique son affiliation à Daech. Néanmoins, l’apparition brutale et sanglante de ce djihadisme africain est moins liée à l’essor de Daech en Irak et en Syrie qu’aux bouleversements du paysage religieux de l’Afrique en général et du Cameroun en particulier.

Texas has become the first state to have its "alternate assessment aligned to modified academic-achievement standards" pass the U.S. Department of Education's peer-review process.

The U.S. tests its students more than most nations, but is the deluge of data providing the information schools need?

Helen Janc Malone introduces this week's blog theme, "accountability and assessment systems." She writes that at the heart of the current accountability debate is a fundamental question, What is the purpose of all the collected assessment data? Are they an end game or a starting point to educational

If we continue to focus on student growth and improvement as learners, keep track of that progress, and watch its impact on standard test results, will we be able to know if what we are doing is helping students develop as learners and thinkers.