Abstracts of Plenary Sessions and Posters Accepted for Presentation at the 2011 Annual Meeting of the Society for Developmental and

s of Plenary Sessions and Posters Accepted for Presentation at the 2011 Annual Meeting of the Society for Developmental and Behavioral Pediatrics Plenary Session Abstracts Abstract 1A Developmental Outcome of Children Whose Mothers Reported Loss of Fetal Activity During Pregnancy Andrew Adesman, MD, Pediatrics, Cohen Children's Medical Center of NY, Lake Success, NY, Sarah A. Keim, PhD, Pediatrics, The Research Institute at Nationwide Children's Hosp, Columbus, OH1A Developmental Outcome of Children Whose Mothers Reported Loss of Fetal Activity During Pregnancy Andrew Adesman, MD, Pediatrics, Cohen Children's Medical Center of NY, Lake Success, NY, Sarah A. Keim, PhD, Pediatrics, The Research Institute at Nationwide Children's Hosp, Columbus, OH Purpose: Loss of fetal activity during pregnancy is a potential red flag of obstetric complications and/or fetal compromise. Few analyses have examined the developmental consequences associated with this concern. Using data from the U.S. Collaborative Perinatal Project (CPP), a large, prospective cohort study of pregnancy and child health, our objective was to examine the long-term developmental outcome of children whose mothers reported loss of fetal activity. Methods: A multivariate statistical analysis was performed on 59,407 pregnancies from the CPP; we limited analyses to 29,979 pregnancies. Exclusions included: implausible gestational age estimate (>44 wks), multiple gestations, and women for whom fetal activity data was not collected or missing. Separate analyses were done for mothers who reported loss of fetal activity >1 time in the 2nd trimester (T2; N=432) and >1 time in the 3rd trimester (T3; N=1074) when queried at each prenatal visit. The primary outcome variables were APGAR scores, IQ scores at ages 4 (Stanford-Binet) and 7 (WISC), and psychologist ratings of inattention (IA), impulsivity (IMP) and hyperactivity (HA) during testing. Multivariate linear and logistic regression was performed; models were adjusted for gestational age, smoking, sex, SES, race, parity, and maternal age. Results: For each additional instance of loss of fetal activity in T2, APGAR scores decreased by 0.12 points (beta= -.12; p=.03), but there was no difference in IQ or ADHD symptoms at age 4 or 7. For reported loss of fetal activity in T3, there was no difference in APGAR. IQ score at age 4 was lower (Beta = -1.0; p<.05) but no IQ difference was noted at age 7. No difference in ADHD symptoms during testing were noted at age 4 or 7 years in relation to fetal activity in T3. Conclusion: Loss of fetal activity is frequently of concern to pregnant women and their physicians. Although a modestly lower APGAR score at birth and lower IQ at age 4 was associated with 2nd trimester loss of fetal activity by maternal report, no differences were noted at age 7. Likewise, there was no difference in psychologist ratings of IMP, HA, or IA at ages 4 or 7 years. Abstract 1B Neuromotor Outcome of Young Children Whose Mothers Reported Loss of Fetal Activity Andrew Adesman, MD, Pediatrics, Cohen Children's Medical Center of NY, Lake Success, NY, Sarah A. Keim, PhD, Pediatrics, The Research Institute at Nationwide Children's Hosp, Columbus, OH1B Neuromotor Outcome of Young Children Whose Mothers Reported Loss of Fetal Activity Andrew Adesman, MD, Pediatrics, Cohen Children's Medical Center of NY, Lake Success, NY, Sarah A. Keim, PhD, Pediatrics, The Research Institute at Nationwide Children's Hosp, Columbus, OH Purpose: Loss of fetal activity (LFA) during pregnancy is a potential red flag of obstetric complications and/or fetal compromise. Few analyses have examined the neuromotor consequences of maternal reports of LFA during pregnancy. Using data from the U.S. Collaborative Perinatal Project (CPP), a large, prospective cohort study of pregnancy and child health, our objective was to examine the early neuromotor outcome of children whose mothers reported LFA. Methods: A multivariate statistical analysis was performed on 59,407 pregnancies from the CPP; we limited analyses to 29,979 pregnancies. Exclusions included: implausible gestational age estimate (>44 wks), multiple gestations, and women for whom fetal activity data was not collected or missing. Separate analyses were done for mothers who reported LFA >1 time in the 2nd trimester (MRLFA2, N=432) and >1 time in the 3rd trimester (MRLFA3, N=1074) when queried at each prenatal visit. The primary outcome variables were motor milestones at 4 months and 1 year, hypotonia at age 1 year and 4 years, and fine motor (FM) or gross motor (GM) delay at age 4 years. Multivariate linear and logistic regression was performed; models were adjusted for gestational age, smoking, sex, SES, race, parity, and maternal age. Results: At 4 months, infants with MRLFA2 were more likely to be unable to sit with support at 4 months with head erect and steady (adjusted Odds Ratio (aOR) 2.0, 95% CI [1.4, 2.8]. At 1 year, infants were more likely to be unable to walk, stand, pull-up, and creep if MRLFA2 (aOR 2.4, [1.1, 5.1] or if MRLFA 3 (aOR 1.8, [1.0, 3.3]. There was no increase in hypotonia at 1 or 4 years among children whose mothers reported loss of fetal activity, and results were imprecise (e.g., any hypotonia at age 1: aOR 2.0, [0.7, 5.6]. FM delay was more common in MRLFA3 (aOR 1.8, [1.0, 3.1] but not MRLFA2 (aOR 0.8, [0.3, 2.6]); GM delay was not associated with FLA in the 2nd or 3rd trimester. Conclusion: Maternal report of loss of fetal activity in the 2nd trimester is associated with motor milestone delay at 4 and 12 months. LFA in the 3rd trimester was not associated with early delays, but mild FM delays at age 4 years. Abstract 2 Association between Screen Time Use and Developmental Outcomes in Hispanic Children under age 3 years Helena Duch, PsyD, Marta Font, MS, Mailman School of Public Health, Caroline Taromino, BA, Ipek Ensari, BS, Teacher's College, Alison Harrington, BFA, Mailman School of Public Health, Columbia University, New York, NY, John Shuler, Psychology, Georgetown University, Washington, DC2 Association between Screen Time Use and Developmental Outcomes in Hispanic Children under age 3 years Helena Duch, PsyD, Marta Font, MS, Mailman School of Public Health, Caroline Taromino, BA, Ipek Ensari, BS, Teacher's College, Alison Harrington, BFA, Mailman School of Public Health, Columbia University, New York, NY, John Shuler, Psychology, Georgetown University, Washington, DC Purpose: 1) To test the feasibility of measuring screen time use in Hispanic young children and explore its association with children's developmental outcomes and; 2) To identify factors that contribute to screen time use and physical activity in this population. Methods: We conducted a mixed-methods, cross-sectional study by collecting data on the screen use of 155 Hispanic infants and toddlers attending an urban Early Head Start (EHS) program. We administered a detailed questionnaire on screen time use and daily activities to EHS parents, including a 24 hour recall of television use. We obtained results from developmental screenings (Ages and Stages Questionnaire III) administered by EHS personnel. A subgroup of children (n=60) whose parents reported high and low screen time use received a more in depth developmental assessment using the Bayley Scales of Infant and Toddler Development III. Bivariate analyses were used to identify associations between screen time use and developmental outcomes. Analysis of variance tests were used to assess differences in screen time use by categorical variables. Multivariable linear regressions were conducted to explore the relationship between screen time use and developmental outcomes. To address the second aim, we conducted 3 focus groups (n=30 families). Focus groups explored families' use of media in the home, opportunities for physical activity, sedentary habits and the role of cultural factors in decision making around these issues. Focus group data was transcribed and analyzed using open and selective coding. Results: Results indicate that toddlers in the high screen time use group were reported to have lower scores in the language domain as measured by the ASQ III when compared to toddlers in the low screen time use group. No significant differences were observed in other developmental domains. Results from the Bayley III are being analyzed at this time. Focus groups identified important contributors to screen time use and physical activity in children such as seasonality, access to playgrounds, social isolation and cultural factors. Conclusion: Screen time use is associated with negative developmental outcomes at a very early age. Pediatricians need to provide guidance to specific groups about how to promote physical activity and reduce screen time in very young children. Recommendations will be provided as well as further areas for research. Abstract 3 Grade at Entry to Special Education and Academic Achievement in Children with Reading Disorders Jennifer Ehrhardt, MD, Noelle Huntington, PhD, Janine Molino, MS, William Barbaresi, MD, Division of Developmental Medicine, Children's Hospital Boston, Boston, MA3 Grade at Entry to Special Education and Academic Achievement in Children with Reading Disorders Jennifer Ehrhardt, MD, Noelle Huntington, PhD, Janine Molino, MS, William Barbaresi, MD, Division of Developmental Medicine, Children's Hospital Boston, Boston, MA Purpose: Additional research is needed to understand how the timing of educational interventions for children with Reading Disorders (RD) impacts their academic achievement. The objectives of our study were to determine if grade at entry to special education influences academic achievement in children with RD and if the effect of grade at entry to special education differs by socioeconomic status (SES). Methods: We conducted a secondary data analysis using data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative cohort of children identified in kindergarten and followed longitudinally through 8th grade (1998-2007). Using data from the 5th grade wave of the study, we identified children with RD (n=260). Our outcome was a child's change in score between 1st and 5th grade on the reading achievement test, which was developed by ECLS-K staff. Using multiple linear regression, we modeled our outcome as a function of a child's grade at entry to special education. We controlled for several covariates, including score on the reading achievement test in 1st grade, average hours/week of special education services, gender, maternal education, household income, and co-morbid mental health disorder. Results: We found that early entry to special education (1st grade or earlier v. 2nd grade or later) is associated with larger gains in reading achievement scores between 1st and 5th grade. Children who enter special education during or before 1st grade gain 3.8 more points on the reading achievement test than those who enter during or after 2nd grade (p<0.0001). We also found that the magnitude of gains is greater for children of low SES, where early entry to special education is associated with a gain of 4.8 points on the reading achievement test (p<0.0001). In contrast, in children of high SES, early entry to special education is associated with a gain of 3 points (p=0.005). Conclusion: For children with RD, the provision of needed educational interventions early in elementary school can have long-term benefits, especially for those children from more vulnerable populations. Abstract 4 Getting Ready for School: A Preliminary Evaluation of a Parent-focused School Readiness Program Helena Duch, PsyD, Mailman School of Public Health, Kimberly G. Noble, MD/PhD, GH Sergievsky Center and Dept of Pediatrics, Columbia University, New York, NY4 Getting Ready for School: A Preliminary Evaluation of a Parent-focused School Readiness Program Helena Duch, PsyD, Mailman School of Public Health, Kimberly G. Noble, MD/PhD, GH Sergievsky Center and Dept of Pediatrics, Columbia University, New York, NY Purpose: The primary objective of this study was to assess the promise of the Getting Ready for School (GRS) program, a parent-focused intervention that was administered to Latino families participating in an urban Head Start program. A secondary objective was to collect qualitative data from parents participating in the intervention to assess their response to the materials and their perceived impact of the intervention. Methods: A small, experimental pilot study was conducted with a group of Latino children participating in Head Start. We hypothesized that parent participation in the GRS curriculum would improve children's literacy and math skills, relative to participation in Head Start-as-usual. Randomization occurred at the classroom level. Data were available on 39 children (20 intervention & 19 control children). Participants predominantly identified as Hispanic, spoke Spanish at home, and had a high school education or less. Families in the GRS intervention group participated in a weekly 2-hour workshop for 15 weeks focusing on promoting children's school readiness skills in reading and math. Children in both groups participated in a brief prepost-intervention assessment of their early literacy and math skills using the Woodcock-Johnson Test of Academic Achievement (WJIII) / Batería WoodcockMunoz. A multivariate repeated measures MANOVA was performed, with time as the within-group variable (2 levels: pre and post), and intervention as the between-group variable (2 levels: intervention and control). A focus group was conducted post-intervention with participating families. Focus group data were transcribed and later analyzed using open and selective coding. Results: Overall children's performance improved from pre-test to post-test. As predicted, a significant time x GRS interaction was found (F (6, 32) = 2.492; p<0.05), confirming that Head Start children whose parents received GRS showed more growth in skills relative to children enrolled in Head Start-as-usual. Six main themes emerged from focus groups. Conclusion: This study demonstrates that a targeted parent-focused program may be effective in supporting the development of school readiness skills of disadvantaged preschool children. The pediatric practice plays an important role in disseminating school readiness messages to parents. We discuss how a curriculum like GRS may be adapted for use in the primary care setting. Abstract 5 Symptoms of Attention Deficit/ Hyperactivity Disorder (ADHD) Differentially Predict Social Functioning in High School Students Julia S. Anixt, MD, Richard Gilman, PhD, Developmental & Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH5 Symptoms of Attention Deficit/ Hyperactivity Disorder (ADHD) Differentially Predict Social Functioning in High School Students Julia S. Anixt, MD, Richard Gilman, PhD, Developmental & Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Purpose: To describe patterns of social acceptance and ostracism associated with the core ADHD symptom domains of attention problems and hyperactivity. Methods: Peerand self-reported behavioral and social functioning variables were obtained through a 2011 computer-administered survey of 546 students in one public high school. Self-reported attention problems and hyperactivity were measured using the Behavior Assessment System for Children (BASC). Two forms of ostracism (active social exclusion and passive ignored) were measured using the Ostracism Experiences Scale (OES). Peer-reported social networks and perceived acceptance/ exclusion of their classmates were also obtained. The consent rate was 96%. Results: Separate hierarchical regressions revealed that hyperactivity and attention problems differentially predicted each ostracism dimension, after controlling for gender as a potential confounder. Hyperactivity was a significant and positive predictor of passive ignoring (β = 0.21) and a negative predictor of active exclusion (β = -0.28). Attention problems were a significant predictor only of passive ignoring (β = 0.18). All p-values were < 0.001. Paralleling self-reported social outcomes, each core ADHD symptom domain differentially predicted an adolescent's location in the social network, as well as peer-perceived acceptance/ exclusion. Conclusion: This study examined the patterns of social difficulties experienced by adolescents with ADHD symptoms. Increasing levels of both hyperactive and inattentive symptoms predicted passive ignoring by peers. However, increasing levels of hyperactivity were associated with decreased risk of active social exclusion. These findings were consistent with respect to selfand peer-ratings, indicating strong method convergence. These findings, interpreted from a social network perspective, underscore the importance of developing targeted interventions to improve the social experiences of youth with varying ADHD symptom profiles. Abstract 6 Gender Differences in Clinical Presentation of Autism Spectrum Disorders Yamini J. Howe, MD, Developmental Behavioral Pediatrics, Hasbro Children's Hospital, Brown Medical School, Providence, RI, Yvette E. Yatchmink, MD, PhD, Developmental Behavioral Pediatrics, Hasbro Childrens Hospital, Brown Medical School, Providence, RI, Eric M. Morrow, MD, PhD, Dept of Molecular Biology, Cell Biology and Biochem, Brown University, Providence, RI6 Gender Differences in Clinical Presentation of Autism Spectrum Disorders Yamini J. Howe, MD, Developmental Behavioral Pediatrics, Hasbro Children's Hospital, Brown Medical School, Providence, RI, Yvette E. Yatchmink, MD, PhD, Developmental Behavioral Pediatrics, Hasbro Childrens Hospital, Brown Medical School, Providence, RI, Eric M. Morrow, MD, PhD, Dept of Molecular Biology, Cell Biology and Biochem, Brown University, Providence, RI Purpose: The aim of this study was to examine differences in clinical presentation of Autism Spectrum Disorders (ASDs) between males and females across a range of developmental functioning using standardized measures of symptom severity. Methods: Data were obtained from the Autism Genetics Resource Exchange, a national dataset of primarily multiplex families with children with ASDs. There were 1702 subjects (1379 males and 323 females) over the age of 5 that met Autism Diagnostic Interview criteria for Autism and Autism Diagnostic Observation Schedule (ADOS) criteria for Autism or Spectrum. Subjects were separated into 4 groups based on developmental ability, similar to the methods proposed by Gotham et al in their 2007 revised ADOS algorithm, based on verbal ability and age: 1) those administered ADOS Module 1 who were nonverbal, 2) those administered ADOS Module 1 who had some words, 3) those administered Module 2 (for those with phrase speech), and 4) those administered Modules 3 or 4 (for those who are fluent). Within each group, scores on the StanfordBinet Intelligence Scales, Vineland Adaptive Behavioral Scales (VABS), and parent-rated Social Responsiveness Scales (SRS), were compared between the genders. Results: There were no significant age or IQ differences between genders, within each group. Parent-rated SRS scores were higher (more severe symptoms) for females versus males in all groups. Among those administered Modules 3 or 4, differences in SRS "Autistic Mannerisms" scores achieved the highest level of significance (p<0.0001) with females being rated as having more "Autistic Mannerisms" than males. VABS scores were similar between males and females who had been administered ADOS 1 or 2, but were higher (better adaptive functioning) for females who had been administered ADOS Modules 3 or 4 than males (p<0.01). Conclusion: Across levels of functioning, autistic females were perceived as having more social impairments than autistic males. However, lower functioning autistic females have equally impaired adaptive abilities as boys. Higher functioning autistic females have in particular more autistic mannerisms, but better adaptive functioning overall than males. These results suggest that an autism diagnosis may be missed in higher functioning girls, unless autistic mannerisms are prominent. Abstract 7 Birds of a Feather do not Flock Together: Subtypes of Intellectual Functioning in Children with Mild Intellectual Disabilities Nikhil S. Koushik, PhD, Pediatric Psychology, MetroHealth Medical Center, Cleveland, OH, Andrew Taylor, PhD, Psychology, Windsor Essex Community Health Centre, Windsor, ON, Canada, Cory Saunders, PhD, John Strang, PhD, Joseph Casey, PhD, Psychology, Ozad Institute, Windsor, ON, Canada7 Birds of a Feather do not Flock Together: Subtypes of Intellectual Functioning in Children with Mild Intellectual Disabilities Nikhil S. Koushik, PhD, Pediatric Psychology, MetroHealth Medical Center, Cleveland, OH, Andrew Taylor, PhD, Psychology, Windsor Essex Community Health Centre, Windsor, ON, Canada, Cory Saunders, PhD, John Strang, PhD, Joseph Casey, PhD, Psychology, Ozad Institute, Windsor, ON, Canada Purpose: Subtypes of intellectual functioning have been established in children with learning disabilities (Saunders et al., 2006) but little research has examined subtypes of functioning in children with intellectual disabilities (ID). We explored the presence of cognitive subtypes in children with mild IDs and externally validated the subtypes on measures of academic achievement and adaptive functioning. Methods: 167 patients with mild IDs (102 boys, 65 girls), ages 6-16 years (M= 10.6 years, SD= 2.2 years) were assessed at a developmental centre in Southwestern Ontario. Participants reflected the diverse ethnic composition of the area and completed standardized tests of intellectual functioning (Wechsler Intelligence Scale for Children, 3rd Edition [WISC-III]), academic achievement (Wechsler Individual Achievement Test), and adaptive functioning (Vineland Adaptive Behavior Scales). Mean full-scale intelligence (FSIQ) on the WISC-III was 63.32 (SD= 9.0; range= 60.5-73.4). Most children had non-specific etiologies of IDs but 27% had identifiable conditions (e.g. neurological or genetic conditions) Results: Two-stage cluster analysis using the four WISC-III index scores generated four strength-based subtypes: language-strength (highest score on the verbal comprehension index); nonverbal strength (highest score on the perceptual-organization index); symbol-processing strength (highest scores on processing speed and freedom from distractibility indices); and global deficits (relatively low scores across all indices). After controlling for FSIQ, significant differences were found on tests of academic achievement (F= 2.5, p<.01) and adaptive functioning (F= 2.9, p<.05). Conclusion: Pediatricians involved in the care of children with mild IDs need to advocate for appropriately modified interventions that target the unique patterns of cognitive, academic, and adaptive functioning found in this population. Abstract 8 Ostracism Predicts Increased Risk of Internalizing Conditions in Youth with Special Health Care Needs Margaret McKenna, MD, Pediatrics, Medical University of South Carolina, Charleston, SC, Conway Saylor, PhD, Kaitlin Twomey, BS, Kristina Kenny, BA, Psychology, The Citadel, Charleston, SC, Eve Spratt, MD, Psychiatry, Michelle Macias, MD, Pediatrics, Medical University of South Carolina, Charleston, SC8 Ostracism Predicts Increased Risk of Internalizing Conditions in Youth with Special Health Care Needs Margaret McKenna, MD, Pediatrics, Medical University of South Carolina, Charleston, SC, Conway Saylor, PhD, Kaitlin Twomey, BS, Kristina Kenny, BA, Psychology, The Citadel, Charleston, SC, Eve Spratt, MD, Psychiatry, Michelle Macias, MD, Pediatrics, Medical University of South Carolina, Charleston, SC Purpose: This study investigated bullying, ostracism, and illness status as predictors of depression and other internalizing problems in children and youth with special health care needs (CYSHCN). Methods: Participants aged 8-17 (33 males, 31 females) were recruited from developmental pediatrics, pulmonary, hematology, cardiology, and endocrinology subspecialty clinics. IQ >70 was required for participation. Children with diagnosed developmental disabilities and/or chronic medical conditions were assessed for the occurrence of bullying and/or ostracism using Saylor's Bullying and Ostracism Screening Scale (BOSS). The BOSS quantifies bullying by asking about physical, verbal-social, and cyberbullying experiences. A separate BOSS section asks about and quantifies ostracism experiences. Hierarchical multiple regression analyses examined the relative weight of ostracism experiences, bullying experiences, presence/absence of chronic health conditions, presence/absence of ADHD, gender, and age on child reported depression (Kovac's Child Depression Inventory Short Form, CDI-SF) and parent reported internalizing problems (Achenbach's Child Behavior Checklist, CBCL). Results: Ostracism experience was the sole significant predictor of CDI-SF T-score, accounting for 37% of the variance (F=37.12, B=36.31, SE=2.2, P<.001). Ostracism and chronic illness status combined in the most robust predictive model for CBCL Internalizing score, accounting for 28% of the variance (F=11.85, B=49.63, SE=4.35, P<.001). Conclusion: CYSHCN who report experiencing ostracism by their peers may be at elevated risk of depression and other internalizing emotional-behavioral problems. Impact of ostracism appears to be greater that of bullying or chronic health condition alone. Screening for ostracism and bullying is recommended in the ongoing care of CYSHCN. Abstract 9 Developmental-Behavioral Pediatric Teaching of Medical Students: A National Survey of Clerkship Directors Neelkamal S. Soares, MD, Shibani Kanungo, MD, MPH, Pediatrics, University of Kentucky, Lexington, KY, Daisha Seyfer, MD, Pediatrics, Nationwide Children's Hospital, Columbus, OH9 Developmental-Behavioral Pediatric Teaching of Medical Students: A National Survey of Clerkship Directors Neelkamal S. Soares, MD, Shibani Kanungo, MD, MPH, Pediatrics, University of Kentucky, Lexington, KY, Daisha Seyfer, MD, Pediatrics, Nationwide Children's Hospital, Columbus, OH Purpose: The Council on Medical Student Education in Pediatrics (COMSEP) developed a national curriculum for medical student education in the Pediatrics clerkship and entire medical school experience. While there is no mandatory component of developmental-behavioral pediatric (DBP) teaching in the clerkship, many programs provide opportunities for students to participate in clinicbased and sometimes community-based activities. COMSEP curriculum has outlined knowledge based competencies for DBP, and suggested processes to accomplish these goals. To our knowledge, there has been no study of the extent of, or the nature of these activities, nor how clerkship directors are implementing the suggested curriculum. Methods: With IRB approval from University of Kentucky Office of Research Integrity, a survey was administered to the membership of COMSEP. The survey was embedded into a larger annual survey that COMSEP sends to its membership listserv, with additional IRB approval from University of Washington. Statistical analysis was done with SPSS-19. Results: Of the 147 medical schools, survey completion rate was 71% with respondents 58% female, 97% Board-certified in Pediatrics, and 92% follow the national COMSEP curriculum. Only 9% also direct the DBP rotation for Pediatric residents, and 47% have a sub-intern elective in DBP. 59% have some form of preclinical student teaching in DBP, mostly didactic lectures (89%). Exposure to DBP in the clerkship is in clinical settings (91%) and didactics (74%). Most teaching is done by General Pediatricians (87%), with 50% by DBP/Neurodevelopmental physicians. DBP competencies are mostly assessed by case logs and faculty feedback (45% each). Barriers towards implementing the curriculum were time constraints, lack of DBP faculty, and training in DBP topics. Electronic learning tools, increasing DBP training of General Pediatricians and increasing clerkship length were suggested as ways to overcome barriers. Conclusion: While most Pediatric clerkships follow the national COMSEP curriculum, directors report barriers to implementation, mostly related to personnel and content limitations for DBP competencies. DBP physicians should take a greater role in undergraduate medical education (UME) by developing electronic resources and providing community opportunities for students. Information in this study will be used to design DBP curricular elements for UME. Abstract 10 Dysphagia in Young Infants with Down Syndrome Maria A. Stanley, MD, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, Randall J. Roper, PhD, Department of Biology, Nicole E. Shepherd, Undergraduate Student, Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, Charlene M. Davis, MSN, Pediatrics, Riley Hospital for Children, Indianapolis, IN, Marilyn J. Bull, MD, Pediatrics, Indiana University School of Medicine, Indianapolis, IN10 Dysphagia in Young Infants with Down Syndrome Maria A. Stanley, MD, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, Randall J. Roper, PhD, Department of Biology, Nicole E. Shepherd, Undergraduate Student, Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, Charlene M. Davis, MSN, Pediatrics, Riley Hospital for Children, Indianapolis, IN, Marilyn J. Bull, MD, Pediatrics, Indiana University School of Medicine, Indianapolis, IN Purpose: Dysphagia has been described in children with a variety of neurodevelopmental disabilities, including Down syndrome (DS). Dysphagia can be associated with serious sequellae such as failure to thrive and respiratory complications, including aspiration pneumonia. Incidence of dysphagia in young infants with DS has not previously been reported. Methods: To assess incidence of dysphagia in young infants with DS, we conducted a retrospective chart review of 174 infants, ages 0 to 6 months (corrected for prematurity, if indicated), referred to the Down Syndrome Program at a large academicaffiliated children's hospital from August 2005 to June 2010. Results: 100/174 (57%) of these infants had clinical concerns that warranted referral for Videofluroscopic Swallow Study (VFSS). 96/174 (55%) had some degree of oropharyngeal dysfunction. 69/174 (39%) had dysphagia severe enough to warrant recommendation for alteration of breast milk/formula consistency or for non-oral feeds. Infants with certain comorbidities were at increased risk for significant dysphagia, including those with prematurity (OR=1.7) and functional airway/respiratory abnormalities (OR=7.2). Infants with desaturation with feeds were at dramatically increased risk (OR=15.8). Conclusion: Infants with DS are at high risk for dysphagia. All young infants with DS should be screened clinically for swallowing concerns. If concerns are identified, consideration should be given to further evaluation with VFSS. Poster Symposia Abstracts Abstract 11 Pediatricians' Views of Mental Health Screening and Intervention Brandi S. Henson, PsyD, Emily N. Neger, BA, R. Christopher Sheldrick, PhD, Ellen C. Perrin, MD, Pediatrics, Tufts Medical Center, Floating Hospital, Boston, MA11 Pediatricians' Views of Mental Health Screening and Intervention Brandi S. Henson, PsyD, Emily N. Neger, BA, R. Christopher Sheldrick, PhD, Ellen C. Perrin, MD, Pediatrics, Tufts Medical Center, Floating Hospital, Boston, MA Purpose: There is growing consensus that the pediatric practice is a viable and efficient context for the identification of and early intervention for children s mental health problems. We worked with 10 pediatric practices to administer a brief behavioral screening tool to parents at 2and 3year well child visits. Parents whose children scored high were invited to participate in a parenting class (The Incredible Years). At the completion of the project, pediatric staff were asked to complete a survey regarding the implementation of the screening tool and parenting classes. Methods: Two electronic surveys were distributed in each of the 10 participating practices: one to pediatric leaders and administrators; one to providers. Results: 60% (75) of providers and 86% (19) of pediatric leaders and administrators completed the survey. Providers were generally satisfied with the feasibility of the screening protocol and found it clinically useful, particularly to initiate discussion of behavioral concerns with parents. 19% of providers reported improved attitudes about screening in general. The biggest concern was the potential increase in visit times. All but 1 provider wanted parenting groups to continue in their practice (61% definitely, 38% maybe). 57% of providers had received feedback from patients about the groups, and this feedback was primarily positive (45% Very Satisfied, 30% Satisfied). Most providers thought parenting groups should be available to any interested parent (82%), but only 37% of leaders and administrators indicated that they were very likely to run groups after the research. Potential barriers included finding enough parents, finding staff to organize and run groups, and managing costs. Conclusion: Routine screening can be implemented in pediatric practices and provides information to enhance clinical impressions. Parenting groups are a mental health intervention that can be offered in response to screening results. Both screening and parenting groups are of considerable interest to pediatric providers and administrators, particularly when they see direct benefits and receive feedback from parents, but concerns about feasibility may limit widespread implementation. Abstract 12 Co-located Developmental and Mental Health Care within Pediatric Primary Care Practice Kathryn Mattern, BA, R. Christopher Sheldrick, PhD, Ellen C. Perrin, MD, Pediatrics, Floating Hospital, Tufts Medical Center, Boston, MA12 Co-located Developmental and Mental Health Care within Pediatric Primary Care Practice Kathryn Mattern, BA, R. Christopher Sheldrick, PhD, Ellen C. Perrin, MD, Pediatrics, Floating Hospital, Tufts Medical Center, Boston, MA Purpose: Previous studies have suggested that there are benefits to providing developmental/mental health care in the same setting as primary pediatric care. How frequently pediatricians have established such arrangements, the level of integration and collaboration between medical and developmental/mental health clinicians, and their experience with these arrangements, is unknown. Methods: We surveyed members of the MA Chapter of the American Academy of Pediatrics who provide primary care (n=752) via a web survey. Results: Of the 305 physicians (40%) who completed the survey, 33% reported that they had one or more mental health/developmental (MH/D) specialist(s) located within their practice setting. Of these, 39% identified a psychologist or social worker (MH), 15% identified a physician, nurse, or nurse practitioner (MED), and 42% identified both a mental health and a medical clinician (MH&MED) as the co-located MH/D specialist. The majority of these clinicians are on the practice payroll, but their revenues generally do not cover their costs (see Figure). More than half of the co-located MH/D clinicians are reported to receive support staff assistance, attend staff meetings, and share charts with primary care physicians. Responsibilities vary considerably across the three categories (see Figure). Using a 4-point scale (from 1 'never' to 4 'usually'), respondents whose practices include physicians or nurses/nurse practitioners rated consistency of feedback, timeliness of access, and overall satisfaction higher than those with MH clinicians (see Figure). Conclusion: Pediatricians have developed many unique arrangements to facilitate developmental and mental health care in their practices. One third of respondents have developed various systems of co-located care. Abstract 13 Child Behavioral Severity and Parents' Perceptions of the Effectiveness and Likelihood of Seeking Behavioral Health Treatment Aimee M. West, BA, Robert Dempster, MA, Beth Wildman, PhD, Psychology, Kent State University, Kent, OH, Diane Langkamp, MD, NeuroDevelopmental Center, Akron Children's Hospital, Akron, OH13 Child Behavioral Severity and Parents' Perceptions of the Effectiveness and Likelihood of Seeking Behavioral Health Treatment Aimee M. West, BA, Robert Dempster, MA, Beth Wildman, PhD, Psychology, Kent State University, Kent, OH, Diane Langkamp, MD, NeuroDevelopmental Center, Akron Children's Hospital, Akron, OH Purpose: Although externalizing behavior problems are the most common problems in childhood, most remain untreated. Identifying barriers to treatment-seeking can help close the gap between need and use. This study examined how child behavior severity moderates the relationship between parents' perceptions of treatment effectiveness and the likelihood of using 4 interventions. Severity was measured with the Pediatric Symptom Checklist (PSC), and the interventions included hospital-based mental health professional, community-based mental health professional, research-based parent training program, and prescription medication. Methods: Participants were 69 parents of 2 to 8 yearold children at primary care pediatric visits in 5 Midwestern community-based practices. Parents completed questionnaires rating the perceived effectiveness of the treatment, likelihood of attending, and PSC. Results: Separate linear regressions were conducted for each treatment type, with perceived likelihood of using the treatment as the dependent variable, perceived effectiveness and severity entered in the first step, and the interaction of the two entered in the second step. Results for the hospital-based intervention only were significant. Child behavior moderated the relationship between parental perceived effectiveness and likelihood to use hospital-based intervention, p < .05. Parents of children with high behavioral severity were likely to use the intervention, regardless of believing if it will work. For parents of children with low behavioral severity, belief in a hospital-based intervention's effectiveness was positively associated with likelihood of use, R2 = .58, p < .001. All other regressions were not significant. Conclusion: The impact of perceived effectiveness on help-seeking for hospitalbased out-patient services varies depending on child's symptom severity. Parents may believe that a Figure. Comparing co-located MH/D providers 0% 25% 50% 75% 100% On payroll Cover costs Often give feedback Often see patients in a timely fashion Parents & pediatricans often satisf ied w ith services developmental assessments MH assessments counseling or therapy prescribe medication monitor tx response facilitate referrals manage screening access social services