- United States
John Duby
Northeast Ohio Medical University, Pediatrics, Faculty Member
Research Interests:
Research Interests:
![Figure][1] Dr. Duby More than 90% of children with special health care needs survive into adulthood. Developing a seamless system for transition from child-centered to adult-centered services for these children was the goal of a... more
![Figure][1] Dr. Duby More than 90% of children with special health care needs survive into adulthood. Developing a seamless system for transition from child-centered to adult-centered services for these children was the goal of a conference co-hosted in 1984 by U.S. Surgeon General C.
Research Interests:
Pediatricians have been challenged to rethink the schedule, content, and structure of well-child care. There is growing recognition of the need to include a focus on promoting healthy social and emotional development in the context of the... more
Pediatricians have been challenged to rethink the schedule, content, and structure of well-child care. There is growing recognition of the need to include a focus on promoting healthy social and emotional development in the context of the parent-child relationship to minimize exposure to toxic stress and reduce the later burden of adult disease. Multiple opportunities exist for expanding the range of services delivered in the pediatric medical home and for strengthening community connections to advance the concept of teaching parents to teach their children. Public health approaches at the population level may hold the greatest promise
Research Interests:
Research Interests: Pediatrics, Child Development, Tobacco, Medicine, Pregnancy, and 13 moreHumans, Female, Male, Biological markers, Medicine and Health Sciences, Environmental Exposure, Cotinine, Motor Skills, Maternal Exposure, Medical specialties, tobacco smoke pollution, Rural Population, and Paediatrics and reproductive medicine
When children at risk for developmental variation are identified at a young age, their chances of success in school and in the future can be greatly enhanced through early intervention programs. Pediatric nurses in community and acute... more
When children at risk for developmental variation are identified at a young age, their chances of success in school and in the future can be greatly enhanced through early intervention programs. Pediatric nurses in community and acute care settings are in key positions to identify children "at risk" and to make appropriate referrals. Nurses are encouraged to engage in "developmental surveillance," that is, a continuous awareness of all activities relating to the detection of developmental problems and the promotion of development during primary child care. A parental interview of six questions can assist the nurse in developmental surveillance and the identification of developmental variations. Once a child is identified as "at risk" the nurse should initiate referrals for more thorough evaluation, diagnosis, and, if warranted, intervention.
Research Interests: Nursing, Pediatrics, Pediatric nursing, Medicine, Humans, and 13 morePubmed, Infant, Developmental disabilities, Risk factors, Newborn Infant, Risk Factors, Nursing Assessment, Guidance and Counseling Intervention Programs, Medicine and Health Sciences, Medical specialties, Child preschool, mass Screening, and Paediatrics and reproductive medicine
Approximately 20% of children in the United States meet the criteria for a psychosocial disorder; however, less than 25% of these children receive psychosocial services. A questionnaire assessed primary care... more
Approximately 20% of children in the United States meet the criteria for a psychosocial disorder; however, less than 25% of these children receive psychosocial services. A questionnaire assessed primary care pediatricians' (PCPs) perceptions of effectiveness, availability, and burden of treatment options for children's psychosocial difficulties and parents' acceptance and adherence with these treatments. Repeated measures analysis of variance found that PCPs are more likely to refer children with psychosocial problems to a mental health professional than to prescribe medication. PCPs prescribe medications more than counseling parents themselves or watchful waiting. PCPs reported children's behavior is more likely to improve with mental health services than with medication, though medication is the most available treatment. PCPs believe parent training programs are very effective for treating children's behavior problems, but believe parents are more accepting and compliant with other treatments. Findings indicate PCPs' perceptions of availability and acceptability of treatment options drive their treatment recommendations of psychosocial problems.
Research Interests: Nursing, Pediatrics, Primary Care, Mental Health, Primary Health Care, and 15 moreFamily Medicine, Adolescent, Medicine, Counseling, Child Behavior, Humans, Child, Female, Male, Psychosocial, Mental health services, Parents, Medicine and Health Sciences, Medical specialties, and Paediatrics and reproductive medicine
At the end of the session, participants will be able to: Consider the role that culture and language have on families’ perspectives of development. Identify culturally sensitive strategies to support families who do not seek treatment in... more
At the end of the session, participants will be able to: Consider the role that culture and language have on families’ perspectives of development. Identify culturally sensitive strategies to support families who do not seek treatment in a timely fashion. Devise solutions to help families navigate the process from the pediatrician’s office to community agencies
Research Interests:
At the end of the session, participants will be able to: Introduce mental health checkups to your office staff Identify strategies for engaging office staff in creating a supportive patient and family experience Address the logistics of... more
At the end of the session, participants will be able to: Introduce mental health checkups to your office staff Identify strategies for engaging office staff in creating a supportive patient and family experience Address the logistics of screening Determine staffing role
Research Interests:
At the end of the session, participants will be able to: Understand the ABC’s of behavior Obtain a behavior problem history in 2 minutes Utilize tools for tracking behavior problems Teach parents how to use specific praise Teach parents... more
At the end of the session, participants will be able to: Understand the ABC’s of behavior Obtain a behavior problem history in 2 minutes Utilize tools for tracking behavior problems Teach parents how to use specific praise Teach parents how to give clear, calm instructions Refer families to evidence-based behavioral family intervention service
Research Interests:
One of the primary areas of focus for the 2008-’09 AAP Agenda for Children is the future of the profession of pediatrics. ![Figure][1] Dr. Duby The Board of Directors has established the Vision of Pediatrics 2020 Task Force to think... more
One of the primary areas of focus for the 2008-’09 AAP Agenda for Children is the future of the profession of pediatrics. ![Figure][1] Dr. Duby The Board of Directors has established the Vision of Pediatrics 2020 Task Force to think broadly about the future of pediatrics, gather input
Research Interests: Medicine and Task Force
This study conducted in a pediatric hospital was initiated to determine whether an educational program focusing on the identification and referral of children at risk for developmental disturbances or variation would increase... more
This study conducted in a pediatric hospital was initiated to determine whether an educational program focusing on the identification and referral of children at risk for developmental disturbances or variation would increase nurses' ability to identify such children and increase the actual number of referrals. Data analysis comparing pre- and post-intervention referral rates revealed fewer children being referred than should have been. The number of referrals did not differ significantly between pre- and post-education groups. Implications for policy and practice are discussed.
Research Interests: Program Evaluation, Nursing, Pediatrics, Pediatric nursing, Medicine, and 15 moreHumans, Female, Male, Infant, Developmental disabilities, Risk factors, Newborn Infant, Adult, Risk Factors, Nursing Assessment, Medicine and Health Sciences, Medical specialties, Child preschool, Referral and consultation, and Referral
Research Interests: Leadership, Health Planning, Forecasting, Adolescent, Medicine, and 15 moreHumans, Child, Diffusion of Innovation, Infant, Patient Care Team, Interdisciplinary Communication, Medicine and Health Sciences, Futures Contract, Mandate, Health Priorities, Cooperative Behavior, Medical specialties, Child preschool, Delivery of Health Care, and Medical and Health Sciences
KBG syndrome (OMIM 148050) is a very rare genetic disorder characterized by macrodontia, distinctive craniofacial abnormalities, short stature, intellectual disability, skeletal, and neurologic involvement. Approximately 60 patients have... more
KBG syndrome (OMIM 148050) is a very rare genetic disorder characterized by macrodontia, distinctive craniofacial abnormalities, short stature, intellectual disability, skeletal, and neurologic involvement. Approximately 60 patients have been reported since it was first described in 1975. Recently mutations in ANKRD11 have been documented in patients with KBG syndrome, and it has been proposed that haploinsufficiency of ANKRD11 is the cause of this syndrome. In addition, copy number variation in the 16q24.3 region that includes ANKRD11 results in a variable phenotype that overlaps with KBG syndrome and also includes autism spectrum disorders and other dysmorphic facial features. In this report we present a 2½‐year‐old African American male with features highly suggestive of KBG syndrome. Genomic microarray identified an intragenic 154 kb deletion at 16q24.3 within ANKRD11. This child's mother was mosaic for the same deletion (present in approximately 38% of cells) and exhibited a milder phenotype including macrodontia, short stature and brachydactyly. This family provides additional evidence that ANKRD11 causes KBG syndrome, and the mild phenotype in the mosaic form suggests that KBG phenotypes might be dose dependent, differentiating it from the more variable 16q24.3 microdeletion syndrome. This family has additional features that might expand the phenotype of KBG syndrome. © 2013 Wiley Periodicals, Inc.
Research Interests: Genetics, Pediatrics, Biology, Intellectual Disability, Medicine, and 15 moreHumans, Female, Male, Infant, Haploinsufficiency, Phenotype, Clinical Sciences, Facies, Short stature, Mosaicism, Medicine and Health Sciences, Syndrome, Comparative Genomic Hybridization, Medical specialties, and Chromosome deletion
Research Interests: Health Planning, Forecasting, Electronic Health Records, Health Policy, Cultural Diversity, and 15 moreAdolescent, Medicine, Humans, Child, Female, Male, Infant, Newborn Infant, Morbidity, Medicine and Health Sciences, Futures Contract, Medical specialties, Child preschool, Delivery of Health Care, and Medical and Health Sciences
While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The... more
While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child's behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
BackgroundThe purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a... more
BackgroundThe purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a contributing factor. Children with ID may be masked in the health care system due to increased diagnosis and awareness of ASD. The needs, unmet needs and insurance coverage of children with ID alone, ASD alone, and co‐occurring ID and ASD were assessed in this study.MethodsThe 2016 to 2019 United States' Census Bureau National Survey of Children's Health was used to determine differences in unmet needs, care not received and health insurance coverage during the past year for children with ID and/or ASD. Adjusted odds ratios and 95% confidence intervals for care not received were determined controlling for sex, insurance, race, age and parents' highest education level.ResultsChildren with ID were nearly four times more likely not to receive needed medical care as children with ASD. Results were similar for unmet hearing and mental health care. Children with both ID and ASD were more likely to have unmet health care but less likely to have unmet medical care compared with children with ASD alone. There were no significant differences for unmet dental or vision care. Children with ID were 3.58 (95% confidence interval: 1.6–8.0) times more likely to have inconsistent health insurance compared with children with ASD.ConclusionsChildren with ID alone are more likely to have unmet medical, hearing and mental health care needs than children with ASD alone. Children with co‐occurring ID and ASD have a large amount of general unmet health care needs but less unmet medical needs. Children with ID are less likely to have consistent health insurance than children with ASD. This hinders the ability of children with ID to receive quality care. Further research is needed to determine if the diagnosis of ASD in children in the United States is negatively affecting children with ID alone.
Research Interests:
Two Screens by Two Years was the mantra initiated by the media on October 29, 2007, when the American Academy of Pediatrics (AAP) unveiled guidelines and an accompanying toolkit developed for the identification and management of children... more
Two Screens by Two Years was the mantra initiated by the media on October 29, 2007, when the American Academy of Pediatrics (AAP) unveiled guidelines and an accompanying toolkit developed for the identification and management of children with autism spectrum disorders (ASD). However, the mantra should have sounded: “Five Screens by Two and a Half Years” since screening for ASD is just one piece of the much bigger picture of developmental screening. Moreover, screening tests are simply instantaneous “snapshots” spliced into an ongoing “developmental surveillance video.” Periodic screening and continuous surveillance are important; all children should have both as part of a health maintenance protocol. Although primary care physicians long have been advised to monitor children’s growth, development, and behavior at health supervision visits, the recommendation to screen all children formally with standardized tools at specific ages is new. The recommendation for universal general developmental screening was launched by an AAP policy statement published in July 2006. Included in it was a recommendation to screen all children for ASD at the 18-month visit. The 2007 ASD guidelines reinforced the 2006 statement, expanded the process, and recommended an additional ASD-specific screen at the 24-month visit to detect the small subset of children with ASD who regress after 18 months of age. These recommendations were made in recognition of the mounting evidence that early diagnosis and intervention optimize outcomes in children with ASD and that ASD symptoms can be observed in very young children. ABOUT THE AUTHORS John C. Duby, MD, FAAP, is Co-director, The NeuroDevelopmental Center, Akron Children’s Hospital, Akron, Ohio; Professor of Pediatrics, Northeastern Ohio Universities College of Medicine, Rootstown; and is a member of the Executive Committee, American Academy of Pediatrics (AAP) Council on Children with Disabilities. Chris Plauché Johnson, MEd, MD, FAAP, is Clinical Professor of Pediatrics, University of Texas Health Science Center at San Antonio; Medical Director, Autism Diagnostic Team at the Village of Hope, San Antonio; and was Co-chair, Autism Expert Panel of the AAP Council on Children with Disabilities. Dr. Duby and Dr. Johnson have disclosed no relevant financial relationships. Address correspondence to: John C. Duby, MD, FAAP, via e-mail at jduby@chmca.org; or Chris Plauché Johnson, MEd, MD, FAAP, via e-mail at drchris@flash.net. EDUCATIONAL OBJECTIVES Objectively define developmental screening and developmental surveillance and how these are deployed in the office setting. Describe an inclusive strategy to monitor for signs of autism spectrum disorders (ASD) within the context of general developmental surveillance. Discuss the logistics of universal screening for ASD in the office setting with special attention to feasibility and benefits when balanced against other time/cost pressures in the office setting.
Research Interests:
The pediatric profession has been challenged to rethink the schedule, content, and structure of well-child care. There is a growing recognition of the need to include a focus on promoting healthy social and emotional development in the... more
The pediatric profession has been challenged to rethink the schedule, content, and structure of well-child care. There is a growing recognition of the need to include a focus on promoting healthy social and emotional development in the context of the parent–child relationship to minimize exposure to toxic stress and reduce the later burden of adult disease. Multiple opportunities exist for expanding the range of services delivered in the pediatric medical home and for strengthening community connections to advance the goal of supporting families to promote early childhood development. A range of opportunities for transforming the pediatric role in promoting early childhood development are discussed.
Research Interests:
Research Interests:
By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between... more
By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes...
Research Interests: Pediatrics, Health Promotion, Mental Health, Primary Health Care, Adolescent, and 15 moreMedicine, Humans, Child, Female, Male, Developmental disabilities, Mental Disorders, Emotional and Behavioral Disorders, Questionnaires, Cross Sectional Studies, Child behavior disorders, Affective symptoms, Psychology and Cognitive Sciences, mass Screening, and Medical and Health Sciences
Care coordination is a process that facilitates the linkage of children and their families with appropriate services and resources in a coordinated effort to achieve good health. Care coordination for children with special health care... more
Care coordination is a process that facilitates the linkage of children and their families with appropriate services and resources in a coordinated effort to achieve good health. Care coordination for children with special health care needs often is complicated because there is no single point of entry into the multiple systems of care, and complex criteria frequently determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. In their important role of providing a medical home for all children, primary care physicians have a vital role in the process of care coordination, in concert with the family.
Research Interests: Nursing, Pediatrics, Primary Health Care, Health Care, Medicine, and 15 moreHumans, Child, Point of Care, Case Management, Disabled children, Medical Home, Care Coordination, Medicine and Health Sciences, Continuity of Patient Care, Child Health Services, Medical specialties, Health Services Accessibility, Psychology and Cognitive Sciences, Comprehensive Health Care, and Medical and Health Sciences
Research Interests:
Research Interests:
At the end of the session, participants will be able to: Utilize validated tools for identifying substance use Identify initial steps in management and referral for substance us
Research Interests:
At the end of the session, participants will be able to: Consider the role that culture and language have on families’ perspectives of development. Identify culturally sensitive strategies to support families who do not seek treatment in... more
At the end of the session, participants will be able to: Consider the role that culture and language have on families’ perspectives of development. Identify culturally sensitive strategies to support families who do not seek treatment in a timely fashion. Devise solutions to help families navigate the process from the pediatrician’s office to community agencies
Research Interests:
At the end of the session, participants will be able to: Introduce mental health checkups to your office staff Identify strategies for engaging office staff in creating a supportive patient and family experience Address the logistics of... more
At the end of the session, participants will be able to: Introduce mental health checkups to your office staff Identify strategies for engaging office staff in creating a supportive patient and family experience Address the logistics of screening Determine staffing role
Research Interests:
At the end of the session, participants will be able to: Discuss the rationale for a system of continuous care that includes periodic use of surveillance and standardized screening tools to assess children’s development, behavior and... more
At the end of the session, participants will be able to: Discuss the rationale for a system of continuous care that includes periodic use of surveillance and standardized screening tools to assess children’s development, behavior and substance use Discuss the rationale for a system of continuous care that includes periodic use of surveillance and standardized screening tools to assess caregiver wellbeing and social support Discuss the rationale for a system of continuous care that includes periodic use of surveillance and standardized screening tools to assess environmental risk factors Utilize validated tools for screening from infancy through adolescence
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The pediatric profession has been challenged to rethink the schedule, content, and structure of well-child care. There is a growing recognition of the need to include a focus on promoting healthy social and emotional development in the... more
The pediatric profession has been challenged to rethink the schedule, content, and structure of well-child care. There is a growing recognition of the need to include a focus on promoting healthy social and emotional development in the context of the parent–child relationship to minimize exposure to toxic stress and reduce the later burden of adult disease. Multiple opportunities exist for expanding the range of services delivered in the pediatric medical home and for strengthening community connections to advance the goal of supporting families to promote early childhood development. A range of opportunities for transforming the pediatric role in promoting early childhood development are discussed.
Research Interests:
This cross-sectional study assessed associations between social-emotional development in young children and their number of daily routines involving an electronic screen. We hypothesized children with poor social-emotional development... more
This cross-sectional study assessed associations between social-emotional development in young children and their number of daily routines involving an electronic screen. We hypothesized children with poor social-emotional development have a significant portion of daily routines occurring with a screen. Two hundred and ten female caregivers of typically developing children 12 to 36 months old completed the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) and a media diary. Caregivers completed the diary for 1 day around 10 daily routines (Waking Up, Diapering/Toileting, Dressing, Breakfast, Lunch, Naptime, Playtime, Dinner, Bath, and Bedtime). Median number of daily routines occurring with a screen for children at risk and not at risk for social-emotional delay (as defined by the ASQ: SE) was 7 versus 5. Children at risk for social-emotional delay were 5.8 times more likely to have ≥5 routines occurring with a screen as compared to children not at risk for delay (χ12 = 9.28...
Research Interests: Developmental Psychology, Pediatrics, Child Development, Media, Medicine, and 15 moreEmotions, Computers, Humans, Female, Male, Infant, Caregivers, New York, Ohio, Medicine and Health Sciences, Cross Sectional Studies, Medical specialties, Child preschool, Clinical Pediatrics, and Paediatrics and reproductive medicine
Research Interests:
When children at risk for developmental variation are identified at a young age, their chances of success in school and in the future can be greatly enhanced through early intervention programs. Pediatric nurses in community and acute... more
When children at risk for developmental variation are identified at a young age, their chances of success in school and in the future can be greatly enhanced through early intervention programs. Pediatric nurses in community and acute care settings are in key positions to identify children "at risk" and to make appropriate referrals. Nurses are encouraged to engage in "developmental surveillance," that is, a continuous awareness of all activities relating to the detection of developmental problems and the promotion of development during primary child care. A parental interview of six questions can assist the nurse in developmental surveillance and the identification of developmental variations. Once a child is identified as "at risk" the nurse should initiate referrals for more thorough evaluation, diagnosis, and, if warranted, intervention.
Research Interests: Nursing, Pediatrics, Pediatric nursing, Medicine, Humans, and 12 moreInfant, Developmental disabilities, Risk factors, Newborn Infant, Risk Factors, Nursing Assessment, Guidance and Counseling Intervention Programs, Medicine and Health Sciences, Medical specialties, Child preschool, mass Screening, and Paediatrics and reproductive medicine
There is growing evidence that early intervention services have a positive influence on the developmental outcome of children with established disabilities as well as those who are considered to be “at risk” of disabilities. Various... more
There is growing evidence that early intervention services have a positive influence on the developmental outcome of children with established disabilities as well as those who are considered to be “at risk” of disabilities. Various federal and state laws now mandate the establishment of community-based, coordinated, multidisciplinary, family-centered programs that are accessible to children and families. The medical home, in close collaboration with the family and the early intervention team, can play a critical role in ensuring that at-risk children receive appropriate clinical and developmental early intervention services. The purpose of this statement is to assist the pediatric health care professional in assuming a proactive role with the interdisciplinary team that provides early intervention services.
Research Interests: Pediatrics, Early Intervention, Family, Medicine, Humans, and 12 moreChild, Nursing Home, Disabled children, Guidance and Counseling Intervention Programs, Multidisciplinary Approach, Medicine and Health Sciences, Mandate, Medical specialties, Child preschool, Delivery of Health Care, Psychology and Cognitive Sciences, and Medical and Health Sciences
Over the last decade, health care has experienced continuous, capricious, and ever-accelerating change. In response, the American Academy of Pediatrics convened the Vision of Pediatrics (VOP) 2020 Task Force in 2008. This task force was... more
Over the last decade, health care has experienced continuous, capricious, and ever-accelerating change. In response, the American Academy of Pediatrics convened the Vision of Pediatrics (VOP) 2020 Task Force in 2008. This task force was charged with identifying forces that affect child and adolescent health and the implications for the field of pediatrics. It determined that shifts in demographics, socioeconomics, health status, health care delivery, and scientific advances mandate creative responses to these current trends. Eight megatrends were identified as foci for the profession to address over the coming decade. Given the unpredictable speed and direction of change, the VOP 2020 Task Force concluded that our profession needs to adopt an ongoing process to prepare for and lead change. The task force proposed that pediatric clinicians, practices, organizations, and interest groups embark on a continual process of preparing, envisioning, engaging, and reshaping (PEER) change. Thi...
Research Interests: Leadership, Health Planning, Forecasting, Adolescent, Medicine, and 15 moreHumans, Child, Diffusion of Innovation, Infant, Patient Care Team, Interdisciplinary Communication, Medicine and Health Sciences, Futures Contract, Mandate, Health Priorities, Cooperative Behavior, Medical specialties, Child preschool, Delivery of Health Care, and Medical and Health Sciences
The benefits of physical activity are universal for all children, including those with disabilities. The participation of children with disabilities in sports and recreational activities promotes inclusion, minimizes deconditioning,... more
The benefits of physical activity are universal for all children, including those with disabilities. The participation of children with disabilities in sports and recreational activities promotes inclusion, minimizes deconditioning, optimizes physical functioning, and enhances overall well-being. Despite these benefits, children with disabilities are more restricted in their participation, have lower levels of fitness, and have higher levels of obesity than their peers without disabilities. Pediatricians and parents may overestimate the risks or overlook the benefits of physical activity in children with disabilities. Well-informed decisions regarding each child's participation must consider overall health status, individual activity preferences, safety precautions, and availability of appropriate programs and equipment. Health supervision visits afford pediatricians, children with disabilities, and parents opportunities to collaboratively generate goal-directed activity “prescr...
Research Interests:
One goal of Healthy People 2010 is to reduce the number of people with disabilities in congregate care facilities, consistent with permanency-planning principles, to 0 by 2010 for persons aged 21 years and under (objective 6–7).... more
One goal of Healthy People 2010 is to reduce the number of people with disabilities in congregate care facilities, consistent with permanency-planning principles, to 0 by 2010 for persons aged 21 years and under (objective 6–7). Congregate care, in this regard, is defined as any setting in which 4 or more persons with disabilities reside, regardless of whether the residence is located in the community, such as a school, group home, nursing facility, or institution. Although this particular public health objective may reflect an unfamiliar concept for some pediatricians, the American Academy of Pediatrics supports the goals and objectives of Healthy People 2010 as well as the medical home and the provision of community-based, culturally effective, coordinated, and comprehensive care for children with special health care needs and their families. To advise families caring for children with special health care needs effectively, the pediatrician should be familiar with the principles o...
Research Interests: Nursing, Pediatrics, Family, Foster Care, Adolescent, and 15 moreMedicine, Humans, Child, Infant, Children with Special Health Care Needs, Disabled children, Medical Home, Family Support, Healthy People Programs, Deinstitutionalization, Medicine and Health Sciences, Medical specialties, Healthy people, Community health services, and Medical and Health Sciences
Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the... more
Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.
Research Interests: Pediatrics, Adolescent, Medicine, Human Sexuality, Humans, and 15 moreChild, Child Sexual Abuse, Female, Male, Developmental disabilities, Interpersonal Relations, Caregivers, Children and Adolescents, Disabled children, Medicine and Health Sciences, Psychosexual Development, Precocious Puberty, Medical specialties, Psychology and Cognitive Sciences, and Medical and Health Sciences
Children and adolescents with chronic diseases and disabling conditions often need educationally related services. As medical home providers, physicians and other health care professionals can assist children, adolescents, and their... more
Children and adolescents with chronic diseases and disabling conditions often need educationally related services. As medical home providers, physicians and other health care professionals can assist children, adolescents, and their families with the complex federal, state, and local laws, regulations, and systems associated with these services. Expanded roles for physicians and other health care professionals in individualized family service plan, individualized education plan, and Section 504 plan development and implementation are recommended. Recent updates to the Individuals With Disabilities Education Act will also affect these services. Funding for these services by private and nonprivate sources also continue to affect the availability of these educationally related services. The complex range of federal, state, and local laws, regulations, and systems for special education and related services for children and adolescents in public schools is beyond the scope of this statem...
Research Interests:
Learning disabilities, including reading disabilities, are commonly diagnosed in children. Their etiologies are multifactorial, reflecting genetic influences and dysfunction of brain systems. Learning disabilities are complex problems... more
Learning disabilities, including reading disabilities, are commonly diagnosed in children. Their etiologies are multifactorial, reflecting genetic influences and dysfunction of brain systems. Learning disabilities are complex problems that require complex solutions. Early recognition and referral to qualified educational professionals for evidence-based evaluations and treatments seem necessary to achieve the best possible outcome. Most experts believe that dyslexia is a language-based disorder. Vision problems can interfere with the process of learning; however, vision problems are not the cause of primary dyslexia or learning disabilities. Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavi...
Research Interests: Pediatrics, Evidence Based Medicine, Treatment Outcome, Dyslexia, Medicine, and 13 moreNeurocognitive, Humans, Child, Learning Disability, Vision screening, Patient Care Team, Learning Disorders, Vision Disorders, Cooperative Behavior, Psychology and Cognitive Sciences, Medical and Health Sciences, Referral and consultation, and Referral
The pediatric primary care provider in the medical home has a central and unique role in the care of children with spina bifida. The primary care provider addresses not only the typical issues of preventive and acute health care but also... more
The pediatric primary care provider in the medical home has a central and unique role in the care of children with spina bifida. The primary care provider addresses not only the typical issues of preventive and acute health care but also the needs specific to these children. Optimal care requires communication and comanagement with pediatric medical and developmental subspecialists, surgical specialists, therapists, and community providers. The medical home provider is essential in supporting the family and advocating for the child from the time of entry into the practice through adolescence, which includes transition and transfer to adult health care. This report reviews aspects of care specific to the infant with spina bifida (particularly myelomeningocele) that will facilitate optimal medical, functional, and developmental outcomes.
Research Interests:
Research Interests:
Research Interests:
This study conducted in a pediatric hospital was initiated to determine whether an educational program focusing on the identification and referral of children at risk for developmental disturbances or variation would increase... more
This study conducted in a pediatric hospital was initiated to determine whether an educational program focusing on the identification and referral of children at risk for developmental disturbances or variation would increase nurses' ability to identify such children and increase the actual number of referrals. Data analysis comparing pre- and post-intervention referral rates revealed fewer children being referred than should have been. The number of referrals did not differ significantly between pre- and post-education groups. Implications for policy and practice are discussed.