Moore, DR; Sieswerda, SL; Grainger, MM; Bowling, A; Smith, N; Perdew, A; Eichert, S; Alston, S; Hilbert, LW; Summers, L; Lin, L; Hunter, LL. Referral and Diagnosis of Developmental Auditory Processing Disorder in a Large, United States Hospital-Based Audiology Service. Journal of the American Academy of Audiology. 2018; 29(5):364-377.
Children with listening difficulties, but normal hearing as determined by an audiogram, often receive additional testing for ‘auditory processing disorder’ (APD). APD is a poorly defined diagnosis based on a series of tests that tap higher level language and cognitive factors as well as hearing. In this collaborative, retrospective study between the Division of Audiology and the Communication Sciences Research Center, we examined the records of over 1000 children who had received a ‘central auditory processing evaluation’. We found that APD test performance was generally higher than expected, and that cooccurrence of APD with other learning problems, especially language and attention, was near universal. We concluded that current guidelines for the diagnosis of APD are neither realistic nor appropriate. It is essential for progress in this field that clinicians and researchers work together.
Giambra, BK; Haas, SM; Britto, MT; Lipstein, EA. Exploration of Parent-Provider Communication During Clinic Visits for Children With Chronic Conditions. Journal of Pediatric Health Care. 2018; 32(1):21-28.
This secondary data analysis explored the communication behaviors used in the outpatient setting by provider team members and parents of children with chronic conditions when discussing the child’s plan of care. A novel method for coding the communication behaviors of providers and parents, based on the Theory of Shared Communication, created for this study and shown to have good inter-coder reliability. The results indicate that provider team members may have dominated most conversations. Parents’ use of asking, explaining, and advocating behaviors nearly as often as the provider team, however, suggests active parental engagement and co-creation of the child’s plan of care. The new communication coding scheme quantifies the behaviors used in the communication process and will be invaluable for identifying modifiable provider-parent behaviors leading to interventions designed to improve communication and child outcomes.
Quatman-Yates, C; Bailes, A; Constand, S; Sroka, MC; Nissen, K; Kurowski, B; Hugentobler, J. Exertional Tolerance Assessments After Mild Traumatic Brain Injury: A Systematic Review. Archives of Physical Medicine and Rehabilitation. 2018; 99(5):994-1010.
Mild traumatic brain injuries (mTBIs) affect up to 3.8 million individuals annually in the United States. Historically, management of this injury was rest from physical and cognitive activity. Recently the notion of rest until the individual is asymptomatic following their mTBI is being challenged as more studies emerge highlighting the benefits of exercise and potential prolonging of symptoms with rest. Therefore, the appropriate use and optimal timing of exertional tolerance testing to determine readiness to return to physical activity after suffering an mTBI is unknown. This systematic review succinctly summarized the best current evidence related to the use of exertional assessments after mTBI, acknowledged the need for standardized assessments that are both progressive in nature and clinically feasible across settings and highlights the growing body of literature that supports the use of exertional tolerance assessments in the rehabilitation process after injury and aiding the return to activity decision-making for healthcare providers.
Wehry, AM; Ramsey, L; Dulemba, SE; Mossman, SA; Strawn, JR. Pharmacogenomic Testing in Child and Adolescent Psychiatry: An Evidence-Based Review. Current Problems in Pediatric and Adolescent Health Care. 2018; 48(2):40-49.
Reviewed in this article is the evidence base for pharmacogenomic testing in youth with depressive and anxiety disorders as well as attention/deficit hyperactivity disorder (ADHD). The article summarizes and reviews general pharmacogenomic principles and functional variants in genes encoding metabolizing enzymes (including associated metabolizer phenotypes) and genes encoding the target of the medication. There is discussion of these commonly tested pharmacogenomic markers with regard to studies of drug levels, efficacy and side effects. The translation of pharmacogenomics to individualized/precision medicine in pediatric patients with ADHD, anxiety and depressive disorders has accelerated; however, its application remains challenging given that there are complex pathways relating medication/medication dose and clinical response and side effects. Nonetheless, by leveraging variations in individual genes that are relevant to medication metabolism or medication target engagement, pharmacogenomic testing can have a role in predicting treatment response, side effects and medication selection in youth with ADHD, depressive and anxiety disorders.