Faculty Bibliography

IMPORTANCE:Recent studies have identified characteristic symptom patterns of long COVID (LC) in adults and children older than 5 years. However, LC remains poorly characterized in early childhood. This knowledge gap limits efforts to identify, care for, and prevent LC in this vulnerable population. OBJECTIVES:To identify symptoms that had the greatest difference in frequency comparing children with a history of SARS-CoV-2 infection to those without, to identify differences in the types of symptoms by age group (infants/toddlers [0-2 years] vs preschool-aged children [3-5 years]), and to derive an index that can be used in research studies to identify young children with LC. DESIGN, SETTING, AND PARTICIPANTS:This was a multisite longitudinal cohort study with enrollment from over 30 US health care and community settings, including infants, toddlers, and preschool-aged children with and without SARS-CoV-2 infection history. Study data were analyzed from May to December 2024. EXPOSURE:SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES:LC and 41 symptoms among infants/toddlers and 75 symptoms among preschool-aged children. RESULTS:The study included 472 infants/toddlers (mean [SD] age, 12 [9] months; 278 infected with SARS-CoV-2; 194 uninfected; 234 male [50%]; 73 Black or African American [16%]; 198 Hispanic, Latino, or Spanish [43%]; 242 White [52%]) and 539 preschool-aged children (mean [SD] age, 48 [10] months; 399 infected with SARS-CoV-2; 140 uninfected; 277 female [51%]; 70 Black or African American [13%]; 210 Hispanic, Latino, or Spanish [39%]; 287 White [54%]). The median (IQR) time between first infections and completion of symptom surveys was 318 (198-494) days for infants/toddlers and 520 (330-844) days for preschool-aged children. A research index was derived for each age group based on symptoms most associated with infection history. The index is calculated by summing scores assigned to each prolonged symptom that was present, where higher scores indicate greater magnitude of association with history of SARS-CoV-2 infection: poor appetite (5 points), trouble sleeping (3.5 points), wet cough (3.5 points), dry cough (3 points), and stuffy nose (0.5 points) for infants/toddlers, and daytime tiredness/sleepiness/low energy (6.5 points) and dry cough (3 points) for preschool-aged children. Among infants/toddlers with infection, 40 of 278 (14%) were classified as having probable LC by having an index of at least 4 points. Among preschool-aged children, 61 of 399 (15%) were classified as having probable LC by having an index of at least 3 points. Participants with higher indices often had poorer overall health, lower quality of life, and perceived delays in developmental milestones. CONCLUSIONS AND RELEVANCE:This cohort study identified symptom patterns and derived research indices that were distinct between the 2 age groups and differed from those previously identified in older ages, demonstrating the need to characterize LC separately across age ranges.

Lingering effects of the COVID-19 pandemic are still of grave concern to families within the U.S. Latine community, as pre-pandemic disparities in healthcare and economic stability were significantly exacerbated by the global crisis (Martínez et al., 2021). In this mixed-methods study, we interviewed 42 pregnant and postpartum Latine mothers from low-income households living in the New York Metropolitan area to better understand pandemic related challenges and potential sources of support unique to this group of women. First, we identified broad themes related to specific psychosocial stressors impacting Latine mothers and their families. Second, in an effort to investigate coping strategies that may buffer feelings of persistent stress, mothers were divided into sustained-stress and tapered-stress groups based on reported levels of perceived stress during the height of the pandemic (March-April 2020) compared to the time of interview (August-December 2020). These two groups of mothers were significantly different on levels of PTSD symptoms, social support, and perceived discrimination. Notably, mothers in the tapered-stress group who reported lower-levels of stress at the time of interview described experiences of being distracted by daily activities or by family members as a coping mechanism. Together, these findings highlight the need to address structural barriers and improve access to mental health support in order to mitigate continuing sources of pandemic related stressors for Latine families.

OBJECTIVE:To examine the effects of drug treatment for attention deficit/hyperactivity disorder (ADHD) on suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. DESIGN/METHODS:Emulation of target trials. SETTING/METHODS:Linkage of national registers in Sweden, 2007-20. PARTICIPANTS/METHODS:People aged 6-64 years with a new diagnosis of ADHD, who either started or did not start drug treatment for ADHD within three months of diagnosis. MAIN OUTCOME MEASURES/METHODS:First and recurrent events of five outcomes over two years after ADHD diagnosis: suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. RESULTS:90.1 per 1000 person years; incidence rate ratio 0.98, 0.96 to 1.01). The reduced rates were more pronounced among individuals with previous events, with incidence rate ratios ranging from 0.79 (0.72 to 0.86) for suicidal behaviours to 0.97 (0.93 to 1.00) for accidental injuries. For recurrent events, drug treatment for ADHD was significantly associated with reduced rates of all five outcomes, with incidence rate ratios of 0.85 (0.77 to 0.93) for suicidal behaviours, 0.75 (0.72 to 0.78) for substance misuse, 0.96 (0.92 to 0.99) for accidental injuries, 0.84 (0.76 to 0.91) for transport accidents, and 0.75 (0.71 to 0.79) for criminality. CONCLUSIONS:Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Unaccompanied migrant youths often confront traumatic experiences elevating their risk for mental health symptoms. However, United States-based research on mental health services for this population, particularly Indigenous youths, is limited. Objectives were to examine mental health screening and referral, characteristics associated with referrals, and clinical rationale for screening result/referral discordance. METHODS:All unaccompanied migrant youths with pediatric intake visits at a healthcare-legal clinic between 3/2020-2/2023 were included (N=100). Retrospective cohort data were extracted from medical chart and program registry, including pediatricians' rationale for referrals. Chi-square and t-tests were used to compare rates of screening, evaluation, and discordant referrals by sociodemographic characteristics. Logistic regression was used to identify associations with mental health referral. Exploratory analyses examined referrals by Indigenous group. RESULTS:Youths had a mean (SD) age of 17.5 (2.5) years, most were assigned male at birth (66 [66%]), from Central America (83 [83%]), and one-third were Indigenous. Odds of mental health referral were higher for youths who were assigned female at birth (adjusted OR, 3.00 [95% confidence interval, 1.13-7.87), non-Indigenous (adjusted OR, 2.73; 95% confidence interval, 1.01-7.40), and reported more trauma types (adjusted OR, 1.38; 95% confidence interval, 1.02-1.87). One-third of referrals were for trauma or mental health symptoms identified by pediatricians, but not screeners. CONCLUSION/CONCLUSIONS:Most unaccompanied migrant youths had mental health referrals, one-third of which were for mental health symptoms undetected by screeners at pediatric visit. Findings highlight sociodemographic differences in mental health referrals, with non-Indigenous and female youths having higher odds of referral.

While prior research has explored the neurobiological mechanisms underlying adolescent school performance, these mechanisms remain poorly understood in college students. Impulsivity has been highlighted as a key factor affecting academic success; however, its influence on the relationship between school performance and brain structure remains underexplored. In this study, we used a sample of college students to investigate which gray matter volume (GMV) in brain regions was associated with grade point average (GPA), and whether impulsivity mediates these relationships. Our findings revealed correlations between GMV in the caudate nucleus (CN) and cerebellum with GPA. Increased CN was correlated with poorer GPA through higher impulsivity, whereas higher cerebellum was associated with better GPA through lower impulsivity. These results indicate that CN and cerebellum play crucial roles in school performance and associated impulsivity. Various interventions targeting impulsivity, such as therapy, counseling, and medication, could improve educational outcomes by addressing the underlying neurobiological factors.

BACKGROUND:The maternal experience of intimate partner violence is associated with a range of emotional and behavioural problems in young children. OBJECTIVE:To prospectively examine the impact of maternal perinatal intimate partner violence experiences on children's risk trajectories of social-emotional development, including theoretically relevant social, economic, maternal mental health and trauma factors, as well as refugee status. PARTICIPANTS/METHODS:870 mother-child dyads in the WATCH mental health cohort study, half from refugee background. METHOD/METHODS:Multigroup trajectory modelling of annually collected longitudinal data at 5 timepoints, from when the children were 18-24 months to 60 months of age. RESULTS:The trajectory modelling revealed 4 distinct trajectories of child social-emotional development: (1) "none or low risk" trajectory (n = 710, 81.6 % of the sample); (2) "declining risk" trajectory (n = 66, 7.6 %); (3) "intermittent risk" trajectory (n = 64, 7.4 %); and (4) "high increasing risk" trajectory (n = 30; 3.4 %). Compared to the group 1 "none or low risk", maternal IPV exposure to physical abuse at baseline was associated with 2.45 times greater odds of children following the "intermittent risk" development trajectory, and 4.90 times greater odds of children following the "high increasing risk" trajectory. Children in trajectory 4 "high increasing risk" were more likely to be male, and mothers were more likely to be born in Australia, have no tertiary education, and experience social and economic difficulties. CONCLUSIONS:The study contributes significantly to understanding the deleterious impact of IPV on child development over time, including unique evidence that socially relevant and modifiable risk factors are more strongly associated with adverse child development than traditionally emphasised factors such as maternal mental health and child attachment factors.

BACKGROUND/UNASSIGNED:Magnetic resonance imaging (MRI) and electroencephalography (EEG) are valuable tools for studying neuroanatomical and electrophysiological features of early brain development. Studies implementing neuroimaging tools in low- and middle-income countries are still rare, and there is limited data on the acceptability of such tools among rural communities. The present study explores the perceptions, feasibility, and acceptability of introducing MRI and EEG for child development research in the rural Amhara region of Ethiopia. METHODS/UNASSIGNED:= 16). A semi-structured interview included four themes: (1) Baseline imaging knowledge, (2) Perceptions of MRI and EEG, (3) Facilitators and barriers to acceptability of MRI and EEG, and (4) Recommendations to improve MRI and EEG uptake. Interviews were conducted in Amharic, the local language. All interviews were transcribed verbatim to Amharic, translated into English, and double-coded. We used thematic analysis to organize data according to predefined and emerging themes. RESULTS/UNASSIGNED:Knowledge of MRI and EEG was limited, and none of the community members had previous experiences with either technology. Broadly, participants responded positively to our introductory videos showing MRI and EEG acquisition and expressed high levels of acceptability. However, participants reported concerns about possible harms related to radiation, electrical shock, and injury from MRI/EEG procedures. Those with lesser education were identified to be less accepting of MRI/EEG. In addition, several mothers expressed that consent from their husbands was necessary for their child's participation in neurodevelopmental research. Potential logistical barriers identified included transportation challenges to the neuroimaging study sites, especially for rural-dwelling families. Creating awareness, using explanatory videos, and engaging community members and clinicians were recommended to facilitate acceptance of EEG and MRI. CONCLUSION/UNASSIGNED:In this formative study, MRI and EEG were viewed as acceptable methods for assessing child neurodevelopment in rural areas of Ethiopia. Community members' and clinicians' views were impacted largely by social, religious, educational, and logistical aspects. Concerns related to MRI radiation, electrical shock, and injuries from EEG can be addressed through awareness creation and education. Engaging community leaders and healthcare providers is key to improving acceptability.