Long‐term use of methylphenidate continues to confer benefits

Patients continue to receive benefits from treatment for attention‐deficit/hyperactivity disorder (ADHD) with methylphenidate after long‐term use, researchers have found. Some patients may be withdrawn from the medication, however. Therefore, all patients should be assessed periodically to determine whether they continue to need the medication. The study, published in the American Journal of Psychiatry, was conducted because, while long‐term use of methylphenidate for children with ADHD is frequent clinical practice, its benefits are unclear. They looked at whether the medication remains beneficial after 2 years. Methylphenidate, a stimulant, has been controversial in some quarters because it is a controlled substance, However, the first‐line treatment for ADHD is psychostimulant medication, such as methylphenidate. How long children should take is is a question, but 60% of children receive stimulant treatment for ADHD for more than 2 years, and this is increasingly common, extending even into adolescence and adulthood. This is partly due to the awareness that ADHD is not a pediatric‐only condition. The study, “Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo‐controlled discontinuation study,” was published online May 21 by the American Journal of Psychiatry.     

Associations Between Toddlers' Naturalistic Media Experience and Observed Learning from Screens

Using secondary analysis, researchers examined associations between two‐year‐olds' (N = 135) naturalistic use of interactive and noninteractive media with performance on a screen‐based learning task. Parents reported the number of minutes that children spent the previous day doing nine media‐related activities (e.g., watching television, playing handheld videogames). The object‐retrieval task required children to watch a hiding event on video and then search for the object on another screen or a real felt board. Results indicated that toddlers' naturalistic experience with interactive (but not noninteractive) media predicted their screen‐based learning in the laboratory. This was true regardless of whether children were tested using interactive or noninteractive video, suggesting that using interactive media (but not watching noninteractive video) is associated with children's learning from screen media generally.     

Briefly Noted

Most children whose mothers have alcohol use disorder (AUD) experience adverse effects — not just a vulnerable subgroup — according to new research published in Pediatrics last month. The study looked at multiple outcomes, including birth, child protection, justice contact and academic outcomes for indigenous and nonindigenous children (the study was conducted in Australia). The adverse effects were higher in the indigenous children. For the study, all women with a birth recorded from 1983 to 2007 and their offspring were included. Fifty‐five percent of the exposed nonindigenous children and 84% of the indigenous children whose mothers had AUD experienced a negative outcome. The odds of experiencing a negative outcome were highest for those children whose mothers were diagnosed while pregnant; however, this was a small number overall. The researchers concluded that universal prevention strategies are needed to reduce harmful alcohol use and to support at‐risk women and children. For the study, go to https://pediatrics.aappublications.org/content/early/2020/02/20/peds.2019‐1574 .     

Engaging with children as co-researchers: challenges,counter-challenges and solutions

Participatory approaches have become de rigueur in social research involving children. A growing trend is research by children where researchers engage (or employ) children as co-researchers or primary researchers. In this paper, we critique the ethical, methodological and practical issues associated with this participatory approach. The discussion is framed around six challenges: (1) Children lack research competence; (2) A comprehensive training programme is required; (3) Insider/outsider perspectives are difficult to balance; (4) Remuneration is complex; (5) Power differentials need to be overcome; and (6) Children need to be protected. For each challenge we propose a counter-challenge. Additionally, we offer pragmatic solutions to the issues raised, so that the paper holds practical utility to social researchers who utilise this type of participatory approach. Overall we argue that despite the approach’s inherent challenges, children as researchers are a powerful conduit for other children’s voices.     

Longitudinal Dyad Models in Family Research

Multilevel modeling allows for the simultaneous analysis of data gathered at more than 1 unit of analysis (e.g., children nested in schools). It is often used to examine the effects of various contexts on individual differences in change. This paper promotes the application of multilevel models to longitudinal dyadic data in family research. By focusing on the dyad as context, researchers can examine within‐dyad change and begin to understand the interactive processes that constitute the relationship between partners. They can then frame questions about interdyad differences in within‐dyad change. We present several longitudinal models that researchers can use to examine the pattern of change within dyads, assess heterogeneity in change across dyads, and investigate cross‐partner effects on change. We comment on the implications of these models for family research.     

Divorced Parents’ Qualitative and Quantitative Reports of Children's Living Arrangements

We use data from a sample of divorced parents in Wisconsin (N = 1,392) to examine how parents describe their children's living arrangements. When the children spend substantial time in both parents’ homes, both parents are less likely to use the phrase live with to describe living arrangements. When children spend most nights with their mother, mothers are more likely than fathers to state that the children live with their mother. Together, these findings suggest that family researchers no longer can rely on simple questions to capture complex living arrangements. We need clearer and more careful question wording and, in some instances, follow‐up questions to accurately describe where children live.     

The Family Unpredictability Scale: Reliability and Validity

We developed the Family Unpredictability Scale (FUS) to better understand the factors that underlie the presence and consequences of family dysfunction. Familial unpredictability is defined as a lack of consistency in family behaviors and regulatory systems. Family researchers and therapists generated and evaluated items, which were self‐administered by married parents who had children aged 2 to 18 (N= 314 ). Principal‐components analysis yielded four subscales (discipline, nurturance, meals, and money; 22 items total) that were internally consistent; confirmatory factor analysis based on a separate subsample yielded an adequate preliminary representation of this factor structure. The FUS related significantly to known measures of family and individual functioning but not to social desirability. The present study provides preliminary reliability, construct validity, and concurrent validity for this new multidimensional, self‐report assessment of family unpredictability. Research and clinical implications are discussed.     

Children as Peer Researchers: Reflections on a Journey of Mutual Discovery

This article is based on a small‐scale study evaluating the work of an emotional literacy project in the North West of England. It focuses on the research process and the challenging experience of involving children as peer researchers. The author draws on theoretical and epistemological insights from feminism and the sociology of childhood to explore some of the enduring tensions and contradictions facing adults involved in children’s research. The primary intention is to use post‐research reflections to raise questions and stimulate debate amongst children’s researchers rather than offer solutions. © 2010 The Author(s). Children & Society © 2010 National Children’s Bureau and Blackwell Publishing Limited.     

Briefly Noted

Internalizing and externalizing problems predicted onset of any tobacco use in youth; however, findings differed for internalizing and externalizing problems across tobacco products, researchers found in analyzing the Population Assessment of Tobacco and Health Study of 12‐ to 24‐year‐old never‐users. Self‐reported internalizing and externalizing symptoms were assessed at wave 1 (45,971 subjects), and past‐12‐month use of tobacco products was assessed at wave 2 (38,443 subjects). The researchers found that high‐severity internalizing symptoms at wave 1 increased the risk by 1.5 times of using tobacco by wave 2, and that high‐severity externalizing problems increased the risk of tobacco use by 1.3 times at wave 2. Low‐ and moderate‐severity problems did not predict tobacco onset. The study was funded by the National Institute on Drug Abuse and the Food and Drug Administration. Several authors declared conflicts of interest — one as an expert witness in a lawsuit against the tobacco industry. The article, “Mental Health Problems and Onset of Tobacco Use Among 12‐ to 24‐Year‐Olds in the PATH Study,” was published in the December 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.     

Exploring Parents' Experiences and Reactions to Adolescents' Hyperactivity,Impulsivity, and Attention Problems

Adolescents' hyperactivity, impulsivity, and attention problems (HIA) have been shown to make parents feel powerless. In this study, the authors examined whether these feelings were dependent on parents' experiences with their older children. Two models that offer different predictions of how parents make use of their earlier experiences when raising their later‐born children were explored: the learning‐from‐experience model and the spillover model. The authors used reports from 372 parents with 1 child (M_age = 11.92) and 198 parents with 2 children (M_age = 11.89 and 14.35) from a small town in a European country. The results did not support a learning‐from‐experience process. Instead, consistent with a spillover process, parents felt particularly powerless about their younger children with HIA if they also felt powerless about their older children. This study suggests that parents' experiences of raising their older children are important for their reactions to HIA in their younger children     

Psychosocial Well‐Being and the Relationship Between Divorce and Children's Academic Achievement

As an unprecedented number of children live in families experiencing divorce, researchers have developed increasingly complex explanations for the consequences associated with marital dissolution. Current accounts focus on changes to family finances, destabilized parenting practices, elevated parental conflict, and deterioration of the parent–child relationship, to explain the impact of divorce. A less studied explanation draws attention to children's diminished psychosocial well‐being following divorce. Using data from the Early Childhood Longitudinal Study—Kindergarten cohort (ECLS‐K) (N = 10,061), I examined the role of psychosocial well‐being in the relationship between divorce and children's outcomes. The results suggest that divorce is associated with diminished psychosocial well‐being in children, and that this decrease helps explain the connection between divorce and lower academic achievement.     

EVALUATING THE EFFECTIVENESS OF CHILD SAFETY SEATS AND SEAT BELTS IN PROTECTING CHILDREN FROM INJURY

Young children are required to use child safety seats, and the age threshold at which children can legally graduate to seat belts has steadily increased. This article tests the relative effectiveness of child safety seats, lap‐and‐shoulder seat belts, and lap belts in preventing injuries among motor vehicle passengers aged 2–6 yr. We analyze three large, representative samples of crashes reported to police, as well as linked hospital data. We find no apparent difference in the two most serious injury categories for children in child safety seats versus lap‐and‐shoulder belts. Child safety seats provide a statistically significant 25% reduction in the least serious injury category. Lap belts are somewhat less effective than the two other types of restraints but far superior to riding unrestrained. (JEL I18)     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.     

Parental Influence on Friendships Between Native and Immigrant Adolescents

Parental influence on friendships between native (N = 5,683) and immigrant (N = 3,371) adolescents (aged ± 15) was investigated with the CILS4EU data of pupils in German and Dutch school classes (N = 446) and parents. The researchers examined whether parents affect friendships across group boundaries by shaping the structural opportunities to establish out‐group friends and their children's out‐group attitudes. The results show that if parents have more out‐group friends and if they consider it less important to maintain in‐group traditions, their children have more out‐group friends. Part of this relationship is mediated by children's out‐group attitudes. Some evidence is found that the opportunity structure mediates the relationship between parental characteristics and adolescent out‐group friendship.     

The Development of Referential Communication and Autism Symptomatology in High‐Risk Infants

Non‐verbal referential communication is impaired in children with autism spectrum disorders (ASD). However, the development of difficulties with referential communication in the younger siblings of children with ASD (High‐Risk Siblings)—and the degree to which early referential communication predicts later autism symptomatology—is not clear. We modeled the early developmental trajectories of three types of referential communication: responding to joint attention (RJA), initiating joint attention (IJA), and initiating behavioral requests (IBR) across 8, 10, 12, 15, and 18 months of age in High‐Risk Siblings (n = 40) and the infant siblings of children without ASD (Low‐Risk Siblings; n = 21). Hierarchical linear modeling indicated that High‐Risk Siblings exhibited lower levels of baseline RJA and IJA and a lower rate of linear change in IBR than Low‐Risk Siblings. When the 10 High‐Risk Siblings who received an ASD diagnosis were excluded from analyses, group differences in the development of referential communication remained significant only for RJA. Baseline levels of IJA were associated with later ASD symptomatology among High‐Risk Siblings, suggesting that individual differences in referential communication development at 8 months may index early manifestations of ASD.     

Poverty and Material Hardship in Grandparent‐Headed Households

Using the 2001 Survey of Income and Program Participation, the current study examines poverty and material hardship among children living in 3‐generation (n = 486), skipped‐generation (n = 238), single‐parent (n = 2,076), and 2‐parent (n = 6,061) households. Multinomial and logistic regression models indicated that children living in grandparent‐headed households experience elevated risk of health insecurity (as measured by receipt of public insurance and uninsurance)—a disproportionate risk given rates of poverty within those households. Children living with single parents did not share this substantial risk. Risk of food and housing insecurity did not differ significantly from 2‐parent households once characteristics of the household and caregivers were taken into account.     

Marital Conflict Trajectories and Associations With Children's Disruptive Behavior

We seek to identify heterogeneous trajectories of marital conflict during the early childhood period, identify predictors associated with these trajectories, and examine associations between trajectory group membership and children's disruptive behavior. Participants were 469 families examined 4 times when the children were 2 to 54 months of age. Maternal reports of marital conflict, adverse childhood experiences, depressive symptoms, and sociodemographic characteristics were collected, and averaged maternal and paternal reports of child disruptive problems were used. Using growth mixture modeling, 3 trajectories of marital conflict were identified: high increasing (21.8%), high decreasing (7%), and low stable (71.2%). Maternal adverse childhood experiences predicted increased risk of belonging in the high‐increasing group, whereas depressive symptoms predicted increased risk of belonging in the high‐decreasing group. Importantly, children of mothers in the high‐increasing group exhibited higher levels of disruptive behavior at 54 months when compared with children of mothers in the high‐decreasing and low‐stable groups.     

Briefly Noted

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school‐aged children and adolescents. However, there is not enough evidence to recommend tobacco‐cessation interventions in this population, according to the draft recommendation, released in June. The USPSTF is not part of the U.S. government, but its recommendations are taken into consideration by clinical and payer organizations. It only makes recommendations for interventions when it has found adequate evidence that the interventions do more good than harm. In the case of tobacco interventions, the task force found no evidence at all of harms of providing behavioral prevention interventions. However, once kids are already using nicotine, there is not enough evidence to recommend for or against cessation options. The recommendations were first published in the Annals of Internal Medicine and in Pediatrics in 2013; the final draft recommendations were issued in June, for public comment by July 22. For a link, go to https://www.uspreventiveservicestaskforce.org/Page/Document/draft‐recommendation‐statement/tobacco‐and‐nicotine‐use‐prevention‐in‐children‐and‐adolescents‐primary‐care‐interventions .     

Toddlers Involve Their Caregiver to Help Another Person in Need

Three experiments with 18‐ to 35‐month‐old children (n = 169) studied toddler–caregiver interactions when being confronted with another person in need. In particular, we explored whether toddlers would request their caregiver to help a needy other when they are not able to help themselves. Children observed another person who needed help to accomplish a task, but were either not able to provide help as the object was out of reach (Experiment 1) or because an obstacle prevented children from interacting with the other person (Experiments 2, 2b). The experiments revealed the same developmental trend with 2.5‐year‐olds selectively involving their caregiver to help the needy other. The results are interpreted in terms of toddlers’ motivation to see others helped and with respect to their developing ability to actively involve others to regulate their emotions.     

Briefly Noted

Vaping and nicotine replacement therapy (NRT) were equally effective at decreasing craving and withdrawal symptoms for smokers discharged from smoke‐free residential treatment for substance use disorder, a pilot study has found. The study, a randomized controlled trial to be published in Nicotine & Tobacco Research on behalf of the Society for Research on Nicotine and Tobacco in Australia, also found that retention was greater for the vaping group (96% at 12 weeks) than the NRT group (68%). For the study, 100 patients received telephone Quitline support and a 12‐week supply of either NRT or a vaping device. At 12 weeks, 14% of the vaping group and 18% of the NRT group report not smoking at all in the last seven days. The researchers concluded that their criteria for retention might have been too strict, and that “some leeway and looking at eventual success over the period people continue to engage with the aids would give a better picture of their long‐term potential.” There is a big movement to legalize vaping in Australia. A key point, however, is that patients readily engaged with smoking cessation after treatment when given the chance. “QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification” by Billie Bonevski and colleagues is available open access, go to https://academic.oup.com/ntr/advance‐article/doi/10.1093/ntr/ntaa143/5889985 .