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This Month in Archives of Pediatrics and Adolescent Medicine
May 3, 2010

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(5):405. doi:10.1001/archpediatrics.2010.78
Stereotypies in Children With a History of Early Institutional Care

Stereotypies are repetitive, invariant movements with no obvious goal or function and are known to develop in association with especially restricted sensory environments or deprivation such as that of institutionalized settings. The Bucharest Early Intervention Project is the first randomized clinical trial to evaluate foster care as an alternative to institutional care for abandoned children and provided the opportunity to investigate the course of stereotypies in children exposed to extreme deprivation and the presence of sensitive periods for the development or remediation of stereotypies. At the baseline assessment prior to placement in foster care (mean age, 22 months), more than 60% of children in institutional care exhibited stereotypies. Follow-up assessments at 30, 42, and 54 months indicate that being placed in families significantly reduces stereotypies and that with earlier and longer placements, reductions become larger. These findings have implications beyond the unique population of children in orphanages, as the extreme example of institutional care can help us to better understand the impact of deprivation on children in many settings.

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Percentage of children exhibiting none, some, or many stereotypies in the care as usual group at baseline and at follow-up assessments at 30, 42, and 54 months.

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Association of Hospitalization for Infection With Diagnosis of Autism Spectrum Disorders

Prior studies have hypothesized that autism spectrum disorders (ASDs) may be caused by autoimmunity in the brain, possibly triggered by a viral infection. This population-based study from Denmark of 1.4 million children investigated the association between hospital admission due to perinatal/neonatal or childhood infection and the later diagnosis of ASDs or infantile autism. The findings revealed that, while being admitted to the hospital with an infection was associated with an increased risk of later diagnosis of an ASD, admission for a noninfectious disease was also associated with an increased rate of later ASD. Admission for infection thus does not appear to be causal for the development of an ASD, and the association is likely due to other factors.

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Prenatal Influences of Antidepressants, Serotonin Transporter Promoter Genotype, and Maternal Mood on Child Behavior

Antenatal maternal mood disturbances set up developmental trajectories that influence cognitive, behavioral, and emotional outcomes throughout childhood. While selective serotonin reuptake inhibitor (SSRI) antidepressants may treat maternal mood disorders, they may also contribute to developmental risk in the child by altering serotonergic activity during early brain growth. Oberlander and colleagues examined the effect of maternal mood disorders and exposure to SSRIs on children and how these exposures were modulated by polymorphisms in the serotonin transporter promoter gene. Both prenatal SSRI exposure and higher current maternal anxiety contributed to increased internalizing behaviors in 3-year-old children. Beyond the influences of prenatal exposure to SSRIs and maternal mood, child genotype moderated the impact of exposure to maternal mood in the third trimester.

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Enduring Effects of Prenatal and Infancy Home Visiting by Nurses in Children

Home visiting by nurses for low-income, at-risk families has been promoted as a means of preventing child abuse and neglect, children's mental health problems, and adolescent crime. In this randomized controlled trial of the Nurse-Family Partnership among low-income women in Memphis, Tennessee, the investigators studied the impact of the program on the children. By the time the first-born child was aged 12 years, those visited by nurses, compared with those in the control group, reported fewer days of having used tobacco, alcohol, and marijuana and were less likely to report having internalizing disorders that met the clinical/borderline threshold. Nurse-visited children born to mothers with low psychological resources scored higher on achievement tests in reading and math. There were no statistically significant program effects on children's externalizing or total behavioral problems. These results support the hypothesis that the program will continue to affect children's health and behavior, as found in an earlier trial.

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