Publications

ABSTRACT:

OBJECTIVES: To determine impacts on social-emotional development at school entry of a
pediatric primary care intervention (Video Interaction Project [VIP]) promoting positive
parenting through reading aloud and play, delivered in 2 phases: infant through toddler
(VIP birth to 3 years [VIP 0–3]) and preschool-age (VIP 3 to 5 years [VIP 3–5]).
METHODS: Factorial randomized controlled trial with postpartum enrollment and random
assignment to VIP 0-3, control 0 to 3 years, and a third group without school entry
follow-up (Building Blocks) and 3-year second random assignment of VIP 0-3 and control
0 to 3 years to VIP 3-5 or control 3 to 5 years. In the VIP, a bilingual facilitator video
recorded the parent and child reading and/or playing using provided learning materials
and reviewed videos to reinforce positive interactions. Social-emotional development
at 4.5 years was assessed by parent-report Behavior Assessment System for Children,
Second Edition (Social Skills, Attention Problems, Hyperactivity, Aggression, Externalizing
Problems).
RESULTS: VIP 0-3 and VIP 3-5 were independently associated with improved 4.5-year
Behavior Assessment System for Children, Second Edition T-scores, with effect sizes
(Cohen’s d) ∼−0.25 to −0.30. Receipt of combined VIP 0-3 and VIP 3-5 was associated with
d = −0.63 reduction in Hyperactivity (P = .001). VIP 0-3 resulted in reduced “Clinically
Significant” Hyperactivity (relative risk reduction for overall sample: 69.2%; P = .03;
relative risk reduction for increased psychosocial risk: 100%; P = .006). Multilevel models
revealed significant VIP 0-3 linear effects and age × VIP 3-5 interactions.
CONCLUSIONS: Phase VIP 0-3 resulted in sustained impacts on behavior problems 1.5 years
after program completion. VIP 3-5 had additional, independent impacts. With our findings,
we support the use of pediatric primary care to promote reading aloud and play from birth
to 5 years, and the potential for such programs to enhance social-emotional development.

ABSTRACT:

Trauma exposure and posttraumatic stress disorder (PTSD), though prevalent among adolescent psychiatric inpatients, are underidentified in standard clinical practice. In a retrospective chart review of 140 adolescents admitted to a psychiatric inpatient unit, we examined associations between probable PTSD identified through the Child PTSD Symptom Scale and adolescents’ service use and clinical characteristics. Results suggest a large discrepancy between rates of probable PTSD identified through standardized assessment and during the emergency room psychiatric evaluation (28.6% vs. 2.2%). Adolescents with probable PTSD had greater clinical severity and service utilization, an increased likelihood of being diagnosed with bipolar disorder (27.5% vs. 9.2%) and being prescribed antipsychotic medications (47.5% vs. 27.6%), and were prescribed more psychotropic medications. Upon discharge, those with probable PTSD were more than those without to be assigned a diagnosis of PTSD (45% vs. 7.1%), a comorbid diagnosis of major depressive disorder (30% vs. 14.3%), to be prescribed an antidepressant medication (52.5% vs. 33.7%), and to be prescribed more medications. The underidentification of trauma exposure and PTSD has important implications for the care of adolescents given that accurate diagnosis is a prerequisite for providing effective care. Improved methods for identifying trauma-related problems in standard clinical practice are needed.

ABSTRACT:

OBJECTIVES:To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects.

DESIGN:Randomized controlled trial.

SETTING:Urban public hospital pediatric primary care clinic.

PARTICIPANTS: A total of 410 mother-newborn dyads enrolled after childbirth.

INTERVENTIONS: Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires).

OUTCOME MEASURES: Electronic media exposure in the home using a 24-hour recall diary.

RESULTS: The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01).

CONCLUSION: Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level.