The development of joint attention and vocalization in infants at heightened risk for autism spectrum disorder

This study was designed to evaluate joint attention (JA) and vocalizations and their co-occurrence in infants who are at heightened risk for autism spectrum disorder (HR). This prospective longitudinal study examined 50 HR infants, with 9 who received an ASD diagnosis, 15 who received a language delay (LD) and 26 who received no diagnosis (ND) at 14, 18 and 24 months. The Early Social Communication Scales, a structured toy play segment that assesses initiation and response to different types of JA, was administered to each infant at each age point in the home. JA behaviors, vocalizations, and instances where they overlapped were coded from videos. Findings indicated that infants in all three outcome groups produced similar rates of JA behaviors, with the exception of initiating JA. Rates of vocalizations and vocalization quality increased over time in all outcome groups. However, there were still significant differences between outcome groups at 24 months in the types of vocalizations that were most frequently produced. The ASD group consistently produced a higher proportion of lower quality vocalizations compared to its LD and ND peers. Lastly, compared to their LD and ND peers, the ASD group consistently paired fewer vocalizations with a JA behavior. These findings highlight a specific delay in coordinating behaviors in infants who later receive an ASD diagnosis and the importance of observing these behaviors to better understand how JA and vocalizations develop in a HR population

Parent-Child Interaction Therapy: Theory and Research to Practice

This chapter will focus on the theory behind and research on Parent-Child Interaction Therapy (PCIT), a treatment developed for young children with disruptive behavior problems. We will describe and provide details about PCIT, which is based on both attachment and social learning models, and incorporates an innovative approach to treatment in which therapists coach caregivers “live” via a wireless headset while each caregiver interacts with their child. In addition, we will review research that has examined PCIT with a variety of diverse populations (e.g., children with developmental delay, physical abuse histories, anxiety and depression, and children from underrepresented racial and ethnic minority families), settings (e.g., clinic, home, school) and formats (e.g., individual, group, intensive). Finally, we will present a case study of PCIT with a child younger than 2 years to demonstrate the effectiveness of PCIT and highlight some common challenges and pitfalls that clinicians may face in clinical practice

Effect of Therapist Coaching Statements on Parenting Skills in a Brief Parenting Intervention for Infants

Behavioral parenting interventions have been shown to decrease early childhood behavior problems by improving parenting skills. Few studies have examined the impact of therapist coaching statements on parenting skill acquisition, especially among ethnic minority families and non-English-speaking families. In this study, we examined therapists’ use of responsive and directive coaching statements during the first coaching session in a brief parenting intervention, the Infant Behavior Program (IBP), on changes in parenting skill acquisition. Participants were 24 mothers of 12- to 15-month-olds, with elevated levels of behavioral problems from primarily Latinx and low-income backgrounds. Mothers who heard more responsive coaching from their therapist showed greater increases in positive parenting skills. Spanish-speaking therapists used fewer responsive coaching statements and more commands, however, language spoken did not moderate the effect of these statements on changes in parenting skills. Responsive coaching statements in English and Spanish had a positive impact on parenting skill acquisition

Impact of Parenting Intervention on Observed Aggressive Behaviors in At-Risk Infants

Aggressive behaviors in early childhood persist through childhood and adolescence and result in negative outcomes. However, studies assessing aggressive behaviors in early childhood have focused primarily on parent report. Additionally, the effects of parenting interventions and associated parenting skills on early observed aggression have not been examined. In the present study, we examined the direct effect of a brief, in-home adaptation of Parent–Child Interaction Therapy, the Infant Behavior Program (IBP), on observed frequency of aggressive behaviors and global ratings of aggression in infants ages 12 to 15 months. Additionally, we examined behaviorally-based parenting skills as a mechanism by which the IBP impacted observed infant aggressive behaviors. Sixty infants with elevated levels of behavior problems were randomized to receive the IBP or standard pediatric primary care. Infants receiving the IBP demonstrated a significant decrease in the observed frequency of aggressive behaviors during infant-led play across a 3-month follow-up. Furthermore, the intervention led to decreases in parental use of don’t skills (i.e., directive and negative parent statements), which, in turn, led to decreases in the frequency of observed aggressive behaviors at a 3-month follow-up. However, effects were not maintained at a 6-month follow-up. Results provide preliminary evidence for the efficacy of a brief parenting intervention on reducing the frequency of infant aggressive behaviors, including the indirect effect of the IBP on the frequency of aggressive behaviors through reductions in parenting skills. The study highlights the importance of targeting negative parenting practices to decrease subsequent aggressive behaviors in early childhood

Infant-directed language following a brief behavioral parenting intervention: The importance of language quality

Behavioral parenting interventions decrease early childhood behavior problems and increase positive parenting skills. However, few studies have examined the impact of low intensity interventions for infants at risk for behavior problems on changes in parent language. This study examined the effect of a brief parenting intervention, the Infant Behavior Program, on changes in parent linguistic input and its influence on infant language. Participants were 58 mothers and their12- to 15-month-olds, with elevated levels of behavioral problems. Mothers and their infants were from primarily Hispanic and low-income backgrounds. Mother-infant dyads were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Mothers receiving the Infant Behavior Program provided more linguistic input, which indirectly influenced infant language, and suggest targeting infants at risk for behavior problems can have a broader impact on language development

Apps As Learning Tools: A Systematic Review

CONTEXT: Young children have increasing access to interactive applications (apps) at home and at school. Existing research is clear on the potential dangers of overuse of screens, but there is less clarity around the extent to which interactive apps may be helpful in supporting early learning. OBJECTIVE: In this systematic review, we present a narrative synthesis of studies examining whether children PsycInfo, PubMed, ACM Digital Library, and ERIC databases were searched. STUDY SELECTION: Studies were included if the study design was randomized or nonrandomized controlled (quasi-experimental), the sample mean age was \u3c6 \u3eyears, the intervention involved children playing with an interactive app, and academic, cognitive, or social-emotional skill outcomes were measured. DATA EXTRACTION: Of 1447 studies, 35 were included. RESULTS: Evidence of a learning benefit of interactive app use for early academic skills was found across multiple studies, particularly for early mathematics learning in typically developing children. Researchers did not find evidence of an intervention effect for apps aiming to improve social communication skills in children with autism spectrum disorder. LIMITATIONS: Risk of bias was unclear for many studies because of inadequate reporting. Studies were highly heterogenous in interventions, outcomes, and study design, making comparisons of results across studies difficult. CONCLUSIONS: There is emerging evidence to suggest that interactive apps may be useful and accessible tools for supporting early academic development. More research is needed to evaluate both the potential of educational apps to support early learning, and their limitations

Opposite Effects of Soluble Factors Secreted by Adipose Tissue on Proliferating and Quiescent Osteosarcoma Cells

Comment in Discussion: Opposite Effects of Soluble Factors Secreted by Adipose Tissue on Proliferating and Quiescent Osteosarcoma Cells. [Plast Reconstr Surg. 2016]International audienceBACKGROUND:Autologous adipose tissue transfer may be performed for aesthetic needs following resection of osteosarcoma, the most frequent primary malignant tumor of bone, excluding myeloma. The safety of autologous adipose tissue transfer regarding the potential risk of cancer recurrence must be addressed.METHODS:Adipose tissue injection was tested in a human osteosarcoma preclinical model induced by MNNG-HOS cells. Culture media without growth factors from fetal bovine serum were conditioned with adipose tissue samples and added to two osteosarcoma cell lines (MNNG-HOS and MG-63) that were cultured in monolayer or maintained in nonadherent spheres, favoring a proliferation or quiescent stage, respectively. Proliferation and cell cycle were analyzed.RESULTS:Adipose tissue injection increased local growth of osteosarcoma in mice but was not associated with aggravation of lung metastasis or osteolysis. Adipose tissue-derived soluble factors increased the in vitro proliferation of osteosarcoma cells up to 180 percent. Interleukin-6 and leptin were measured in higher concentrations in adipose tissue-conditioned medium than in osteosarcoma cell-conditioned medium, but the authors' results indicated that they were not implicated alone. Furthermore, adipose tissue-derived soluble factors did not favor a G0-to-G1 phase transition of MNNG-HOS cells in nonadherent oncospheres.CONCLUSIONS:This study indicates that adipose tissue-soluble factors activate osteosarcoma cell cycle from G1 to mitosis phases, but do not promote the transition from quiescent G0 to G1 phases. Autologous adipose tissue transfer may not be involved in the activation of dormant tumor cells or cancer stem cells

Engineering of a Bispecific Nanofitin with Immune Checkpoint Inhibitory Activity Conditioned by the Cross-Arm Binding to EGFR and PDL1

Re-education of the tumor microenvironment with immune checkpoint inhibitors (ICI) has provided the most significant advancement in cancer management, with impressive efficacy and durable response reported. However, low response rates and a high frequency of immune-related adverse events (irAEs) remain associated with ICI therapies. The latter can be linked to their high affinity and avidity for their target that fosters on-target/off-tumor binding and subsequent breaking of immune self-tolerance in normal tissues. Many multispecific protein formats have been proposed to increase the tumor cell’s selectivity of ICI therapies. In this study, we explored the engineering of a bispecific Nanofitin by the fusion of an anti-epidermal growth factor receptor (EGFR) and anti-programmed cell death ligand 1 (PDL1) Nanofitin modules. While lowering the affinity of the Nanofitin modules for their respective target, the fusion enables the simultaneous engagement of EGFR and PDL1, which translates into a selective binding to tumor cells co-expressing EGFR and PDL1 only. We demonstrated that affinity-attenuated bispecific Nanofitin could elicit PDL1 blockade exclusively in an EGFR-directed manner. Overall, the data collected highlight the potential of this approach to enhance the selectivity and safety of PDL1 checkpoint inhibition

Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay A Randomized Clinical Trial

Importance Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD.Objective To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD.Design, Setting, and Participants A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories.Interventions Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU).Main Outcomes and Measures Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups.Results The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] years; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).Conclusions and Relevance Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families