Lynne Huffman, MD

  • Lynne Coe Huffman

Trabajo y educación


George Washington University, Washington, DC, 05/29/1981

Primeros años de residencia

Children's National Medical Center Pediatric Infectious Diseases Fellowship, Washington, DC, 06/30/1982

Últimos años de residencia

Children's National Medical Center Pediatric Infectious Diseases Fellowship, Washington, DC, 06/30/1984


UCSF Pediatric Residency, San Francisco, CA, 06/30/1986

Certificado(s) de especialidad

Developmental Behavioral Pediatrics, American Board of Pediatrics

Pediatrics, American Board of Pediatrics



Development Delays and Disorders

Todo Publicaciones

Sleep Problem Detection and Documentation in Children With ASD and ADHD by Developmental-Behavioral Pediatricians: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Won, D. C., Feldman, H. M., Huffman, L. C. 2018


OBJECTIVE: To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.METHODS: Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).RESULTS: Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.CONCLUSION: Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.

View details for PubMedID 30339559

Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach FRONTIERS IN PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2018; 6: 60


Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician.Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work excuse note if needed. After the visit, SDM was assessed by both parents and DBP clinicians. SDM was scored as present if the respondent answered "strongly agree" to all SDM-related items. Logistic regression tested effects of visit, child, parent, clinician characteristics, and intervention group status on parent-reported SDM. Cohen's kappa assessed alignment between parent and clinician perceptions of SDM.Of 88 parents screened, 50 (61%) met eligibility criteria and agreed to participate (intervention n=26; comparison n=24). Eligible participants (parents and clinicians) for analysis completed the surveys with no missing data. Overall, SDM was present in 76% of parents and 34% of clinicians. With high rates of parent-reported SDM in both intervention and comparison groups, no main intervention effect was detected. Compared to the comparison group, there was greater alignment between parent and clinician perception of SDM in the intervention group.Parent and clinician enrollment and data collection with minimal loss suggest that this novel approach is easy to use and could be employed in future outpatient studies exploring SDM. In this clinical setting, both intervention and comparison group parents reported high levels of SDM participation and no main group effect was detected. Further study of this novel parent-directed SDM intervention approach is needed in a larger sample with greater variability in parent-reported SDM to determine its efficacy.

View details for PubMedID 29616204

Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2016; 37 (1): 20-32


Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment.Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group.SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group.A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.

View details for DOI 10.1097/DBP.0000000000000242

View details for Web of Science ID 000367826900004

Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., Loe, I. M. 2015; 36 (3): 207-217


The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

View details for PubMedID 25793891

Hospitalizations of Children with Autism Increased from 1999 to 2009 JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2014; 44 (5): 1087-1094


We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

View details for DOI 10.1007/s10803-013-1965-x

View details for Web of Science ID 000336330200009

View details for PubMedID 24122446

Research Training of Developmental-Behavioral Pediatrics Fellows: A Survey of Fellowship Directors by Developmental-Behavioral Pediatrics Research Network JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wiley, S., Schonfeld, D. J., Fredstrom, B., Huffman, L. 2013; 34 (6): 406-413


To describe research training in Developmental-Behavioral Pediatrics (DBP) Fellowship Programs.Thirty-five US-accredited DBP fellowships were contacted through the Developmental-Behavioral Pediatrics Research Network to complete an online survey on scholarly work and research training.With an 83% response rate, responding programs represented 110 (87 filled) fellowship positions. External funding for fellowship positions was minimal (11 positions fully funded, 13 funded above 50% of cost). Structured research training included didactic lectures, web-based training, university courses, direct mentoring, journal clubs, and required reading. Of the 159 fellows described, spanning a 5-year training period, the majority chose projects relying on their own data collection (57%) rather than joining an existing research study and focused on clinical research (86%). Among 96 fellows with completed scholarly work, 29% were observational/epidemiological studies, 22% secondary analyses of large data sets, 16% community-based research, and 15% survey design. A limited number of fellows pursued basic science, meta-analysis/critical appraisal of the literature, or analysis of public policy. Barriers to successful fellow research are as follows: lack of time and money, challenges in balancing clinical demands and protected faculty research time, limited faculty research opportunities, time or expertise, and a lack of infrastructure for fellow research mentoring.The scholarly work of fellows in DBP fellowship programs has primarily focused on clinical research using observational/epidemiological research and secondary analysis of large data set. Barriers largely in faculty time and expertise for research mentoring and inadequate funding in programs that have high clinical demands and little resources for research efforts were noted.

View details for DOI 10.1097/DBP.0b013e31829a7bfe

View details for Web of Science ID 000330358800054

View details for PubMedID 23838586

Predictors of Hospitalization After an Emergency Department Visit for California Youths With Psychiatric Disorders PSYCHIATRIC SERVICES Huffman, L. C., Wang, N. E., Saynina, O., Wren, F. J., Wise, P. H., Horwitz, S. M. 2012; 63 (9): 896-905


This study examined patient, hospital, and county characteristics associated with hospitalization after emergency department visits for pediatric mental health problems.Retrospective analysis of emergency department encounters (N=324,997) of youths age five years to 17 years with psychiatric diagnoses was conducted with 2005-2009 California Office of Statewide Health Planning and Development emergency department statewide data.For youths with any psychiatric diagnosis, 23.4% of emergency department encounters resulted in hospitalization. In these cases, hospitalization largely was predicted by clinical need. Nonclinical factors that decreased the likelihood of hospitalization included demographic characteristics (such as younger age, lack of insurance, and rural residence) and resource characteristics (private hospital ownership, lack of psychiatric consultation in the emergency department, and lack of pediatric psychiatric beds). For youths with a significant psychiatric diagnosis plus a suicide attempt, 53.8% of emergency department encounters resulted in hospitalization. In these presumably more life-threatening cases, nonclinical factors that decreased the likelihood of hospitalization persisted: demographic characteristics (lack of insurance and rural residence) and resource characteristics (public hospital ownership, lack of psychiatric consultation, and lack of pediatric psychiatric beds).Mental health service delivery can improve only by addressing nonclinical demographic and resource obstacles that independently decrease the likelihood of hospitalization after an emergency department visit for a mental health issue; this is true even for the most severely ill youths-those with a suicide attempt as well as a serious psychiatric diagnosis.

View details for DOI 10.1176/

View details for PubMedID 22710574

Neurodevelopmental outcomes among extremely premature infants with linear growth restriction JOURNAL OF PERINATOLOGY Meyers, J. M., Tan, S., Bell, E. F., Duncan, A. F., Guillet, R., Stoll, B. J., D'Angio, C. T., Caplan, M. S., Laptook, A. R., Keszler, M., Vohr, B. R., Hensman, A. M., Vieira, E., Little, E., Alksninis, B., Keszler, M., Knoll, A. M., Leach, T. M., McGowan, E. C., Watson, V. E., Walsh, M. C., Fanaroff, A. A., Hibbs, A., Newman, N. S., Payne, A. H., Wilson-Costello, D. E., Siner, B. S., Bhola, M., Yalcinkaya, G., Friedman, H. G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Poindexter, B. B., Schibler, K., Alexander, B., Grisby, C., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Fisher, K. A., Finkle, J., Gustafson, K. E., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Wereszczak, J., Carlton, D. P., Hale, E. C., Adams-Chapman, H., Loggins, Y., Carter, S. L., LaRossa, M., Wineski, L. C., Bottcher, D., Mackie, C., Higgins, R. D., Archer, S., Sokol, G. M., Papile, L., Harmon, H. M., Hines, A. C., Wilson, L., Herron, D. E., Gunn, S., Smiley, L., Kennedy, K. A., Tyson, J. E., Allain, E., Arldt-McAlister, J., Dempsey, A. G., Garcia, C., John, J., Jones, P. M., Lillie, L. M., Martin, K., Martin, S. C., McDavid, G. E., Rodgers, S., Siddiki, S., Sperry, D., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Fortney, C. A., Luzader, P., Besner, G. E., Parikh, N. A., Das, A., Wallace, D., Newman, J. E., Auman, J., Crawford, M., Gabrio, J., Gantz, M. G., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Hintz, S. R., Ball, M., Proud, M. S., Bentley, B., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R., Weiss, H. E., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Colaizy, T. T., Brumbaugh, J. E., Ellsbury, D. L., Johnson, K. J., Walker, J. R., Campbell, D. B., Eastman, D. L., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C., Duncan, A. F., Dupont, T., Kuan, E., Beauman, S., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Bernbaum, J. C., Gerdes, M., Hurt, H., Cook, N., Cucinotta, D. M., Lakshminrusimha, S., Reynolds, A., Jensen, R. L., Merzbach, J., Myers, G. J., Williams, A., Yost, K., Zorn, W., Wynn, K., Maffett, D., Prinzing, D., Hunn, J., Guilford, S., Osman, F., Rowan, M., Sacilowski, M. G., Wadkins, H. M., Bowman, M., Fallone, C., Binion, K., Orme, C., Scorsone, A., Andrews-Hartley, M., Wyckoff, M. H., Brion, L. P., Vasil, D. M., Chen, L., Heyne, R. J., Adams, S. S., Heyne, E., Guzman, A., Lee, L. E., Boatman, C., Shankaran, S., Pappas, A., Natarajan, G., Chawla, S., Bajaj, M., February, M., Agarwal, P., Childs, K., Woldt, E., Bara, R., Goldston, L. A., Barks, J., Christensen, M., Wiggins, S., White, D., Eunice Kennedy Shriver Natl Inst 2019; 39 (2): 193202


To compare neurodevelopmental outcomes in linear growth-restricted (LGR) infants born <29 weeks with and without weight gain out of proportion to linear growth.We compared 2-year neurodevelopmental outcomes between infants with and without LGR and between LGR infants with and without weight gain out of proportion to linear growth. The outcomes were Bayley-III cognitive, motor, and language scores, cerebral palsy, Gross Motor Function Classification System (GMFCS) level2, and neurodevelopmental impairment.In total, 1227 infants were analyzed. LGR infants were smaller and less mature at birth, had higher BMI, and had lower Bayley-III language scores (82.3 vs. 85.0, p<0.05). Among infants with LGR, infants with high BMI had lower language scores compared with those with low-to-normal BMI (80.8 vs. 83.3, p<0.05), and were more likely to have GMFCS level 2 and neurodevelopmental impairment.Among infants with LGR, weight gain out of proportion to linear growth was associated with poorer neurodevelopmental outcomes.

View details for PubMedID 30353080

Behavioral problems are associated with cognitive and language scores in toddlers born extremely preterm. Early human development Lowe, J. R., Fuller, J. F., Do, B. T., Vohr, B. R., Das, A., Hintz, S. R., Watterberg, K. L., Higgins, R. D., Eunice Kennedy Shriver National Institute of Child Health, Human Development Neonatal Research Network 2018; 128: 4854


OBJECTIVE: To evaluate the relationship of parent-reported child behaviors on the Child Behavior Checklist (CBCL) to cognition, language, and motor skills on the Bayley Scales of Infant and Toddler Development - III (Bayley-III) in toddlers born extremely preterm.STUDY DESIGN: Toddlers born extremely preterm (gestational ages 22 0/7 to 26 6/7weeks) were tested at 22-26months corrected age with Bayley-III while parents completed the CBCL. Socio-demographic variables and medical history were recorded. Linear regression models were used to assess the relationship of Bayley-III cognitive, motor, and language scores with CBCL scores, adjusting for medical and socio-demographic factors.RESULTS: Internalizing, affective, and pervasive development problem behavior scores on the CBCL correlated significantly with lower Bayley-III cognitive, language, and motor scores on unadjusted and adjusted analyses. Although externalizing and anxiety problems were significantly associated with cognitive and language scores on unadjusted analysis, the relationships were not significant after adjusting for socio-economic factors. CBCL scores were similar for boys and girls, with the exception of the pervasive developmental problem scale; boys had significantly more problems than girls (p=0.02).CONCLUSIONS: This study showed that parent reported behavior problems were related to lower cognitive, language, and motor development in toddlers born extremely preterm. Early findings of behavioral problems in toddlers born extremely premature may help identify children at greater risk for later learning difficulties. Adding a measure of behavior to the evaluation of these children may help better understand factors that can contribute to delays, especially in cognition and language.

View details for PubMedID 30522091

Shared Decision Making in the Care of Children with Autism Spectrum Disorder. Journal of developmental and behavioral pediatrics : JDBP Huffman, L. C. 2018; 39 (4): 34344

View details for PubMedID 29708909

Outcome of Preterm Infants with Transient Cystic Periventricular Leukomalacia on Serial Cranial Imaging Up to Term Equivalent Age JOURNAL OF PEDIATRICS Sarkar, S., Shankaran, S., Barks, J., Do, B. T., Laptook, A. R., Das, A., Ambalavanan, N., Van Meurs, K. P., Bell, E. F., Sanchez, P. J., Hintz, S. R., Wyckoff, M. H., Stoll, B. J., Carlo, W. A., Eunice Kennedy Shriver Natl Inst C 2018; 195: 59-+


To determine the outcome of preterm infants whose cystic periventricular leukomalacia "disappeared" on serial screening cranial imaging studies.Infants 26 weeks of gestation born between 2002 and 2012 who had cranial imaging studies at least twice, the most abnormal study at <28 days of age and another closest to 36 weeks, were reviewed. The outcome of late death (after 36 weeks postmenstrual age) or neurodevelopmental impairment (NDI) in surviving infants at 18-26 months corrected age was compared between the infants with no cystic periventricular leukomalacia on both studies and cystic periventricular leukomalacia that disappeared (cystic periventricular leukomalacia at <28 days but not at 36 weeks), persisted (cystic periventricular leukomalacia on both studies), or appeared late (cystic periventricular leukomalacia only at 36 weeks). Predictors of NDI were evaluated by logistic regression.Of 7063 eligible infants, 433 (6.1%) had cystic periventricular leukomalacia. Among the 433 infants with cystic periventricular leukomalacia, cystic periventricular leukomalacia disappeared in 76 (18%), persisted in 87 (20%), and 270 (62%) had late cystic periventricular leukomalacia. Loss to follow-up ranged between 3% and 13%. Death or NDI was more common in infants with disappeared cystic periventricular leukomalacia compared with those with no cystic periventricular leukomalacia (38 of 72 [53%] vs 1776 of 6376 [28%]; OR [95% CI] 2.8 [1.8-4.6]). Disappeared, persistent, and late cystic periventricular leukomalacia were all also independently associated with NDI (OR 1.17, 1.21, and 1.16, respectively).Infants with "disappeared" cystic periventricular leukomalacia are at increased risk of adverse outcome similar to infants with persistent or late cystic periventricular leukomalacia.

View details for PubMedID 29398046

Effects of a Disability Education Module During Pediatrics Clerkship: A Randomized Controlled Trial Whitgob, E., Santoro, J., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2018: S6
Online Training in Shared Decision-Making: A DBPNet Medical Education RCT Huffman, L., Hubner, L., Hansen, R. LIPPINCOTT WILLIAMS & WILKINS. 2018: S2
A Novel Approach to Increasing Access to Developmental-Behavioral Pediatrics Subspecialty Care JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C. 2017; 38 (6): 42930

View details for PubMedID 28661953

Beyond immigrant status: Book-sharing in low-income Mexican-American families JOURNAL OF EARLY CHILDHOOD RESEARCH Salinas, M., Perez-Granados, D. R., Feldman, H. M., Huffman, L. C. 2017; 15 (1): 1733
Documentation of Sleep Problems in Children with ASD and ADHD by Developmental-Behavioral Pediatricians in DBPNet Won, D. C., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2017: S20S21
Multi-Table Differential Correlation Analysis of Neuroanatomical and Cognitive Interactions in Turner Syndrome. Neuroinformatics Seiler, C., Green, T., Hong, D., Chromik, L., Huffman, L., Holmes, S., Reiss, A. L. 2017


Girls and women with Turner syndrome (TS) have a completely or partially missing X chromosome. Extensive studies on the impact of TS on neuroanatomy and cognition have been conducted. The integration of neuroanatomical and cognitive information into one consistent analysis through multi-table methods is difficult and most standard tests are underpowered. We propose a new two-sample testing procedure that compares associations between two tables in two groups. The procedure combines multi-table methods with permutation tests. In particular, we construct cluster size test statistics that incorporate spatial dependencies. We apply our new procedure to a newly collected dataset comprising of structural brain scans and cognitive test scores from girls with TS and healthy control participants (age and sex matched). We measure neuroanatomy with Tensor-Based Morphometry (TBM) and cognitive function with Wechsler IQ and NEuroPSYchological tests (NEPSY-II). We compare our multi-table testing procedure to a single-table analysis. Our new procedure reports differential correlations between two voxel clusters and a wide range of cognitive tests whereas the single-table analysis reports no differences. Our findings are consistent with the hypothesis that girls with TS have a different brain-cognition association structure than healthy controls.

View details for PubMedID 29270892

Survival and Neurodevelopmental Outcomes among Periviable Infants. New England journal of medicine Younge, N., Goldstein, R. F., Bann, C. M., Hintz, S. R., Patel, R. M., Smith, P. B., Bell, E. F., Rysavy, M. A., Duncan, A. F., Vohr, B. R., Das, A., Goldberg, R. N., Higgins, R. D., Cotten, C. M. 2017; 376 (7): 617-628


Data reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes.We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008-2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death.Data on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P<0.001). The percentage of infants who survived without neurodevelopmental impairment increased from 16% (217 of 1391) in epoch 1 to 20% (276 of 1348) in epoch 3 (P=0.001), whereas the percentage of infants who survived with neurodevelopmental impairment did not change significantly (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P=0.29). After adjustment for changes in the baseline characteristics of the infants over time, both the rate of survival with neurodevelopmental impairment (as compared with death) and the rate of survival without neurodevelopmental impairment (as compared with death) increased over time (adjusted relative risks, 1.27 [95% confidence interval {CI}, 1.01 to 1.59] and 1.59 [95% CI, 1.28 to 1.99], respectively).The rate of survival without neurodevelopmental impairment increased between 2000 and 2011 in this large cohort of periviable infants. (Funded by the National Institutes of Health and others; numbers, NCT00063063 and NCT00009633 .).

View details for DOI 10.1056/NEJMoa1605566

View details for PubMedID 28199816

Growth Outcomes of Preterm Infants Exposed to Different Oxygen Saturation Target Ranges from Birth. journal of pediatrics Navarrete, C. T., Wrage, L. A., Carlo, W. A., Walsh, M. C., Rich, W., Gantz, M. G., Das, A., Schibler, K., Newman, N. S., Piazza, A. J., Poindexter, B. B., Shankaran, S., Snchez, P. J., Morris, B. H., Frantz, I. D., Van Meurs, K. P., Cotten, C. M., Ehrenkranz, R. A., Bell, E. F., Watterberg, K. L., Higgins, R. D., Duara, S. 2016; 176: 62-68 e4


To test whether infants randomized to a lower oxygen saturation (peripheral capillary oxygen saturation [SpO2]) target range while on supplemental oxygen from birth will have better growth velocity from birth to 36weeks postmenstrual age (PMA) and less growth failure at 36weeks PMA and 18-22months corrected age.We evaluated a subgroup of 810 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial, randomized at birth to lower (85%-89%, n=402, PMA 261weeks, birth weight 839186g) or higher (91%-95%, n=408, PMA 261weeks, birth weight 840191g) SpO2 target ranges. Anthropometric measures were obtained at birth, postnatal days 7, 14, 21, and 28; then at 32 and 36weeks PMA; and 18-22months corrected age. Growth velocities were estimated with the exponential method and analyzed with linear mixed models. Poor growth outcome, defined as weight <10th percentile at 36weeks PMA and 18-22months corrected age, was compared across the 2 treatment groups by the use of robust Poisson regression.Growth outcomes including growth at 36weeks PMA and 18-22months corrected age, as well as growth velocity were similar in the lower and higher SpO2 target groups.Targeting different oxygen saturation ranges between 85% and 95% from birth did not impact growth velocity or reduce growth failure in preterm infants.

View details for DOI 10.1016/j.jpeds.2016.05.070

View details for PubMedID 27344218

Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. Journal of perinatology Wallenstein, M. B., Birnie, K. L., Arain, Y. H., Yang, W., Yamada, N. K., Huffman, L. C., Palma, J. P., Chock, V. Y., Shaw, G. M., Stevenson, D. K. 2016; 36 (2): 112-115


To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.A retrospective chart review was conducted for all ELBW infants 1000g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5min of life or if intubation was attempted during the first 10min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.Journal of Perinatology advance online publication, 5 November 2015; doi:10.1038/jp.2015.158.

View details for DOI 10.1038/jp.2015.158

View details for PubMedID 26540244

Mental Illness Drives Hospitalizations for Detained California Youth. journal of adolescent health Anoshiravani, A., Saynina, O., Chamberlain, L., Goldstein, B. A., Huffman, L. C., Wang, N. E., Wise, P. H. 2015; 57 (5): 455-461


The purpose of the study was to describe inpatient hospitalization patterns among detained and nondetained youth in a large, total population of hospitalized adolescents in California.We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997 to 2011. We considered hospitalized youth aged 11-18 years "detained" if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay between detained youth and their nondetained counterparts in the general population.There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus nondetained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared with 19.8% of nondetained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median length of stay compared with nondetained inpatient youth with mental illness ( 6 days vs. 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays ( 43 days).Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention.

View details for DOI 10.1016/j.jadohealth.2015.05.006

View details for PubMedID 26208862

Sensory processing in preterm preschoolers and its association with executive function EARLY HUMAN DEVELOPMENT Adams, J. N., Feldman, H. M., Huffman, L. C., Loe, I. M. 2015; 91 (3): 227-233


Symptoms of abnormal sensory processing have been related to preterm birth, but have not yet been studied specifically in preterm preschoolers. The degree of association between sensory processing and other domains is important for understanding the role of sensory processing symptoms in the development of preterm children.To test two related hypotheses: (1) preterm preschoolers have more sensory processing symptoms than full term preschoolers and (2) sensory processing is associated with both executive function and adaptive function in preterm preschoolers.Cross-sectional study.Preterm children (34weeks of gestation; n=54) and full term controls (37weeks of gestation; n=73) ages 3-5years.Sensory processing was assessed with the Short Sensory Profile. Executive function was assessed with (1) parent ratings on the Behavior Rating Inventory of Executive Function - Preschool version and (2) a performance-based battery of tasks. Adaptive function was assessed with the Vineland Adaptive Behavior Scales-II.Preterm preschoolers showed significantly more sensory symptoms than full term controls. A higher percentage of preterm than full term preschoolers had elevated numbers of sensory symptoms (37% vs. 12%). Sensory symptoms in preterm preschoolers were associated with scores on executive function measures, but were not significantly associated with adaptive function.Preterm preschoolers exhibited more sensory symptoms than full term controls. Preterm preschoolers with elevated numbers of sensory symptoms also showed executive function impairment. Future research should further examine whether sensory processing and executive function should be considered independent or overlapping constructs.

View details for DOI 10.1016/j.earlhumdev.2015.01.013

View details for Web of Science ID 000352042600011

View details for PubMedID 25706317

INTERACTIVE AND TRADITIONAL BOOKS Literacy Beliefs and Practices in Latino Families RESEARCH ON TECHNOLOGY USE IN MULTICULTURAL SETTINGS Perez-Granados, D. R., Huffman, L. C., Ganesh, T. G., Boriack, A. W., Stillisano, Davis, T. J., Waxman, H. C. 2015: 1144
Respiratory Outcomes of the Surfactant Positive Pressure and Oximetry Randomized Trial (SUPPORT). journal of pediatrics Stevens, T. P., Finer, N. N., Carlo, W. A., Szilagyi, P. G., Phelps, D. L., Walsh, M. C., Gantz, M. G., Laptook, A. R., Yoder, B. A., Faix, R. G., Newman, J. E., Das, A., Do, B. T., Schibler, K., Rich, W., Newman, N. S., Ehrenkranz, R. A., Peralta-Carcelen, M., Vohr, B. R., Wilson-Costello, D. E., Yolton, K., Heyne, R. J., Evans, P. W., Vaucher, Y. E., Adams-Chapman, I., McGowan, E. C., Bodnar, A., Pappas, A., Hintz, S. R., Acarregui, M. J., Fuller, J., Goldstein, R. F., Bauer, C. R., O'Shea, T. M., Myers, G. J., Higgins, R. D. 2014; 165 (2): 240-249 e4


To explore the early childhood pulmonary outcomes of infants who participated in the National Institute of Child Health and Human Development's Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial (SUPPORT), using a factorial design that randomized extremely preterm infants to lower vs higher oxygen saturation targets and delivery room continuous positive airway pressure (CPAP) vs intubation/surfactant.The Breathing Outcomes Study, a prospective secondary study to the Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial, assessed respiratory morbidity at 6-month intervals from hospital discharge to 18-22months corrected age (CA). Two prespecified primary outcomes-wheezing more than twice per week during the worst 2-week period and cough longer than 3days without a cold-were compared for each randomized intervention.One or more interviews were completed for 918 of the 922 eligibleinfants. The incidences of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between the study arms of either randomized intervention. Infants randomized to lower vs higher oxygen saturation targets had a similar risk of death or respiratory morbidity (except for croup and treatment with oxygen or diuretics at home). Infants randomized to CPAP vs intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs 36.5%; P<.05), respiratory illnesses diagnosed by a doctor (47.7% vs 55.2%; P<.05), and physician or emergency room visits for breathing problems (68.0% vs 72.9%; P<.05) by 18-22months CA.Treatment with early CPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18-22months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates.

View details for DOI 10.1016/j.jpeds.2014.02.054

View details for PubMedID 24725582

Executive function is associated with social competence in preschool-aged children born preterm or full term. Early human development Alduncin, N., Huffman, L. C., Feldman, H. M., Loe, I. M. 2014; 90 (6): 299-306


Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.Cross-sectional study.Study subjects had a history of preterm birth (34weeks of gestation) and birth weight <2500g (n=70). Controls were born full term (37weeks) (n=79).Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.

View details for DOI 10.1016/j.earlhumdev.2014.02.011

View details for PubMedID 24661446

Executive function mediates effects of gestational age on functional outcomes and behavior in preschoolers. Journal of developmental and behavioral pediatrics Loe, I. M., Feldman, H. M., Huffman, L. C. 2014; 35 (5): 323-333


To investigate the role of executive function (EF) skills, measured by parent-rating and performance-based instruments, as mediators of the effects of gestational age (GA) on functional outcomes and behavior symptoms in preterm (PT) and full-term (FT) preschoolers.Children born PT (n = 70; mean GA, 29.6 weeks; mean birth weight, 1365 g) were compared to children born FT (n = 79) on composite measures of EF (using the Behavior Rating Inventory of Executive Function and a performance-based EF battery), adaptive function, prereading skills, and behavior symptoms. For the entire sample, mediation analyses examined the effect of GA on the outcomes with EF as mediator.Compared to children born FT, children born PT had significantly higher parent-rated EF scores and lower performance-based EF scores, both indicating more problems; furthermore, children born PT had lower adaptive function and prereading scores and more problematic behavior. GA contributed to adaptive function, prereading skills, and behavior symptoms for all children. EF acted as a mediator of GA for all 3 outcomes; different patterns emerged for parent-rated and performance-based EF evaluations. For adaptive function, both EF measures significantly mediated the effects of GA; for prereading skills, only performance-based EF was significant; for behavior symptoms, only parent-rated EF was significant.We propose standard assessment of EF, using both parent-rating and performance-based EF measures, in young PT children and other children at the risk of EF impairments. EF skills are measurable, mediate important functional outcomes, and may serve as intervention targets.

View details for DOI 10.1097/DBP.0000000000000063

View details for PubMedID 24906034

Psychosocial Changes Associated With Participation in Art Therapy Interventions for Siblings of Pediatric Hematopoietic Stem Cell Transplant Patients ART THERAPY Wallace, J., Packman, W., Huffman, L., Horn, B., Cowan, M., Amylon, M., Kahn, C., Cordova, M., Moses, J. 2014; 31 (1): 411
Does Multiple Language Exposure Influence Executive Function Skills in Preschool Children? Loe, I. M., Alduncin, N., Chatav, M., Chang, W. S., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S4
Research Experience and Efforts by Developmental-Behavioral Pediatrics Fellows: A Survey of Fellowship Directors by DBPNet Schonfeld, D. J., Wiley, S., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2013: S4
Executive Function Skills in Preterm Preschool Children Loe, I. M., Chatav, M., Alduncin, N., Chang, W. S., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2013: S7
A Systematic Review of Interventions for Adults with ASD Huffman, L. C., Slay, J. A., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S10
Tetrahydrobiopterin as a treatment for autism spectrum disorders: a double-blind, placebo-controlled trial. Journal of child and adolescent psychopharmacology Klaiman, C., Huffman, L., Masaki, L., Elliott, G. R. 2013; 23 (5): 320-328


Abstract Objective: The purpose of this study was to determine if tetrahydrobiopterin (BH4) reduced core symptoms of autism spectrum disorder (ASD). Method: In this study, 46 children, 3-7 years of age diagnosed with an ASD were randomly assigned to double-blind treatment with 20mg/kg/day BH4 or placebo for 16 weeks. The primary outcome measure was the Clinical Global Impressions Improvement and Severity Scales (CGI-I and CGI-S); secondary outcomes were the Preschool Language Scale-4 (PLS-4), Social Responsiveness Scale (SRS), Aberrant Behavior Checklist (ABC), and Vineland Adaptive Behavior Scales (Vineland). Results: Overall, no differences were found on global improvement as measured with the CGI-I or CGI-S. Secondary measures indicated significant improvements for BH4 relative to placebo with regard to social awareness, autism mannerisms, hyperactivity, and inappropriate speech. Side effects were minimal and similar between both active medication and placebo. Conclusions: These results indicate that BH4 offers promise in reducing symptoms of ASD. Clinical Identifier: NCT00850070.

View details for DOI 10.1089/cap.2012.0127

View details for PubMedID 23782126

Associations Between First-Time Expectant Women's Representations of Attachment and Their Physiological Reactivity to Infant Cry. Child development Ablow, J. C., Marks, A. K., Shirley Feldman, S., Huffman, L. C. 2013; 84 (4): 137391


Associations among 53 primiparous women's Adult Attachment Interview classifications (secure-autonomous vs. insecure-dismissing) and physiological and self-reported responses to infant crying were explored. Heart rate, skin conductance levels, and respiratory sinus arrhythmia (RSA) were recorded continuously. In response to the cry, secure-autonomous women demonstrated RSA declines, consistent with approach-oriented responses. Insecure-dismissing women displayed RSA and electrodermal increases, consistent with behavioral inhibition. Furthermore, insecure-dismissing women rated the cries as more aversive than secure-autonomous women. Nine months postpartum, secure-autonomous women, who prenatally manifested an approach-oriented response to the unfamiliar cry stimulus, were observed as more sensitive when responding to their own distressed infant, whereas women classified prenatally as insecure-dismissing were observed as less sensitive with their own infants.

View details for DOI 10.1111/cdev.12135

View details for PubMedID 23786152

Improving Healthy Eating in Families With a Toddler at Risk for Overweight: A Cluster Randomized Controlled Trial JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Agras, W. S., Hammer, L. D., Huffman, L. C., Mascola, A., Bryson, S. W., Danaher, C. 2012; 33 (7): 529-534


To ascertain whether a parent education program based on Satter's division of responsibility in feeding children (DOR) is effective in enhancing parent/child feeding interactions for children with an overweight/obese parent. The primary hypothesis was that the intervention would decrease parental pressure to eat.Sixty-two families with a child between 2 and 4 years with at least 1 overweight/obese parent were randomly allocated using a cluster design to either the DOR intervention or a control group. The control group focused on increasing family consumption of healthy foods and activity levels and enhancing child sleep duration. The primary outcome was parent pressure on their child to eat.The DOR intervention was superior to the control group in reducing the pressure to eat. Two moderators of pressure to eat were found: disinhibition of eating and hunger. The parents in the DOR group, irrespective of disinhibition levels, lowered the pressure to eat, whereas those in the control group with low disinhibition increased the pressure to eat. There were similar findings for hunger. Gender moderated restrictive feeding with DOR parents lowering restriction more than parents of the control group in girls only.The DOR intervention was more effective in reducing the parent pressure to eat and food restriction (in girls only) than the control group.

View details for DOI 10.1097/DBP.0b013e3182618e1f

View details for PubMedID 22947882

Missed Opportunities in the Referral of High-Risk Infants to Early Intervention PEDIATRICS Tang, B. G., Feldman, H. M., Huffman, L. C., Kagawa, K. J., Gould, J. B. 2012; 129 (6): 1027-1034


Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California.From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening.Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit.In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.

View details for DOI 10.1542/peds.2011-2720

View details for PubMedID 22614772

REASONS FOR HOSPITALIZATION IN CHILDREN WITH CEREBRAL PALSY AND DOWN SYNDROME ACROSS CHILDHOOD Western Regional Meeting of the American-Federation-for-Medical-Research Nayfack, A., Chan, J., Huffman, L., Feldman, H., Wise, P. LIPPINCOTT WILLIAMS & WILKINS. 2012: 13132
Activation During Observed Parent-Child Interactions with Anxious Youths: A Pilot Study JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT Gonzalez, A., Moore, P. S., Garcia, A. M., Thienemann, M., Huffman, L. 2011; 33 (2): 159-170


Parent-child interaction paradigms are often used to observe dysfunctional family processes; however, the influence of such tasks on a participant's level of activation remain unclear. The aim of this pilot project is to explore the stimulus value of interaction paradigms that have been commonly used in child anxiety research. Twenty-nine parent-child dyads with clinically anxious (n=16) and non-anxious (n=13) youths engaged in a series of tasks (threat and non-threat) used in previous studies of parenting and youth anxiety. Heart rate (HR) data, as an indicator of physiological activation, were collected across tasks, and participants rated the perceived representativeness of their interactions in the laboratory to their usual behavior at home. Significant HR changes were observed for both parent and child. Change in child HR from baseline to non-threat task was smaller than change in HR from baseline to threat tasks. Change in parent HR from baseline to ambiguous situations tasks was smaller than changes from baseline to other threat tasks. Differences in HR change between anxious and non-anxious children were explored. Participants rated laboratory interactions as similar to those experienced in the home. Results suggest that presumably emotionally-charged discussion tasks may produce increased activation compared to tasks that were designed to be more neutral. Implications for future research and limitations are discussed.

View details for DOI 10.1007/s10862-011-9216-y

View details for Web of Science ID 000291169600002

View details for PubMedCentralID PMC3105235

Management of Symptoms in Children With Autism Spectrum Disorders: A Comprehensive Review of Pharmacologic and Complementary-Alternative Medicine Treatments JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C., Sutcliffe, T. L., Tanner, I. S., Feldman, H. M. 2011; 32 (1): 56-68


In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms.

View details for DOI 10.1097/DBP.0b013e3182040acf

View details for PubMedID 21160435

MISSED OPPORTUNITIES IN HIGH RISK INFANT FOLLOW-UP? Tang, B., Huffman, L., Feldman, H., Gray, E., Kagawa, K., Gould, J. B. LIPPINCOTT WILLIAMS & WILKINS. 2011: 95
Tetrahydrobiopterin as a Novel Therapeutic Intervention for Autism NEUROTHERAPEUTICS Frye, R. E., Huffman, L. C., Elliott, G. R. 2010; 7 (3): 241-249


Tetrahydrobiopterin (BH(4)) is an essential cofactor for several critical metabolic pathways that have been reported to be abnormal in autism spectrum disorder (ASD). In addition, the cerebrospinal fluid concentration of BH(4) is reported to be depressed in children with ASD. Over the past 25 years, several clinical trials have suggested that treatment with BH(4) improves ASD symptomatology in some individuals. Two ongoing clinical protocols may help further define the efficacy of BH(4) treatment in children with ASD. First, children with ASD who had low concentrations of cerebrospinal fluid or urine pterins were treated in an open-label manner with 20 mg/kg per day of BH(4). The majority of children (63%) responded positively to treatment, with minimal adverse events (AEs). Second, a double-blind placebo-controlled study examining the efficacy of 20 mg/kg per day of BH(4) treatment in children with ASD is currently underway. Safety studies from the commercially available forms of BH(4) document the low incidence of AEs, particularly serious AEs. Studies have also documented the ability of BH(4) to cross the blood-brain barrier. Based on the importance of BH(4) in neurodevelopmental metabolic pathways, the safety of BH(4) treatment, and the evidence for a therapeutic benefit of BH(4) treatment in children with ASD, we conclude that BH(4) represents a novel therapy for ASD, one that may gain wider use after further clinical studies have established efficacy and treatment guidelines.

View details for Web of Science ID 000280063300004

View details for PubMedID 20643376

View details for PubMedCentralID PMC2908599

Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access, Health Care Utilization, and Health Status MATERNAL AND CHILD HEALTH JOURNAL Javier, J. R., Huffman, L. C., Mendoza, F. S., Wise, P. H. 2010; 14 (4): 567-579


To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0-11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent's language, parental education, ethnicity, and children's insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.

View details for DOI 10.1007/s10995-009-0487-9

View details for Web of Science ID 000279477400010

View details for PubMedID 19554437

Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California PEDIATRICS Chamberlain, L. J., Chan, J., Mahlow, P., Huffman, L. C., Chan, K., Wise, P. H. 2010; 125 (6): 1190-1199


Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

View details for DOI 10.1542/peds.2009-1109

View details for PubMedID 20439593

Examining Depressive Symptoms and Use of Counseling in the Past Year Among Filipino and Non-Hispanic White Adolescents in California JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Javier, J. R., Lahiff, M., Ferrer, R. R., Huffman, L. C. 2010; 31 (4): 295-303


We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California.This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed.Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score > or = 7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes > or = 300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004-0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00-15.89).Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

View details for DOI 10.1097/DBP.0b013e3181dbadc7

View details for Web of Science ID 000277769600005

View details for PubMedID 20431400

Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of health care for the poor and underserved Weintraub, D., Rodgers, M. A., Botcheva, L., Loeb, A., Knight, R., Ortega, K., Heymach, B., Sandel, M., Huffman, L. 2010; 21 (2): 157-168


As a preliminary investigation of the effectiveness of medical-legal partnership in pediatrics, we conducted a 36-month prospective cohort study of the impact of clinic- and hospital-based legal services. We hypothesized that integration of legal services into pediatric settings would increase families' awareness of and access to legal and social services, decrease barriers to health care for children, and improve child health.Health care providers referred families with legal or social needs to the Peninsula Family Advocacy Program (FAP).Fifty four families completed both baseline and six-month follow-up assessments. Comparison of follow-up with baseline demonstrated significantly increased proportions of families who utilized food and income supports and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost. Two-thirds of respondents reported improved child health and well-being.This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services.

View details for DOI 10.1353/hpu.0.0311

View details for PubMedID 20453383

Impact of Managed Care on Publicly Insured Children with Special Health Care Needs ACADEMIC PEDIATRICS Huffman, L. C., Brat, G. A., Chamberlain, L. J., Wise, P. H. 2010; 10 (1): 48-55


The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

View details for PubMedID 20129481

Lessons learned from a community-academic partnership addressing adolescent pregnancy prevention in Filipino American families. Progress in community health partnerships : research, education, and action Javier, J. R., Chamberlain, L. J., Rivera, K. K., Gonzalez, S. E., Mendoza, F. S., Huffman, L. C. 2010; 4 (4): 305-313


Filipino Americans have more adolescent pregnancies than other Asian-Pacific Islanders (APIs). Few community-academic collaborations have addressed adolescent pregnancy prevention in this community.We sought to describe the lessons learned from and impact of a community-based teen pregnancy prevention program for Filipino Americans implemented by a Filipina pediatrics resident.We formed a community-academic partnership between the Filipino Youth Coalition, a community-based organization (CBO) in San Jose, California, and the Stanford School of Medicine's Pediatric Advocacy Program. We developed a culturally tailored parent-teen conference addressing adolescent pregnancy prevention in Filipino Americans. We qualitatively and quantitatively evaluated this intervention by collecting both pre- and post-conference data using a convenience sample design.Engaging particular aspects of Filipino culture (i.e., religion and intergenerational differences) helped to make this community-academic partnership successful. For physicians-in-training who are conducting community-based participatory research (CBPR), project challenges may include difficulties in building and maintaining academic- community relationships, struggles to promote sustainability, and conflicting goals of "community insiders" and "academic outsiders." Authors offer insights and implications for residents interested in practicing CBPR.CBPR is a key tool for exploring health issues in understudied populations. CBPR experiences can provide meaningful educational opportunities for physicians-in-training and can build sustained capacity in CBOs. They can also help residents to develop analytic skills, directly affect the health of the communities they serve, and, for minority physicians, give back to the communities they call home.

View details for DOI 10.1353/cpr.2010.0023

View details for PubMedID 21169708

Emphasizing Cultural Competence in Evaluation A Process-Oriented Approach AMERICAN JOURNAL OF EVALUATION Botcheva, L., Shih, J., Huffman, L. C. 2009; 30 (2): 176-188
Physiological Correlates of Social Avoidance Behavior in Children and Adolescents With Fragile X Syndrome JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Hall, S. S., Lightbody, A. A., Huffman, L. C., Lazzeroni, L. C., Reiss, A. L. 2009; 48 (3): 320-329


To investigate whether eye-gaze avoidance, a striking phenotypic feature in fragile X syndrome (FXS), is associated with high levels of "hyperarousal" during social interactions with others. To date, almost all studies in this area have been confounded by inclusion of task demands in addition to social demands.We monitored the cardiovascular activity and eye-gaze avoidance of 50 boys and girls with FXS aged 5 to 20 years during a 25-minute intensive social interaction session with an unfamiliar experimenter. To control for possible family and genetic factors in cardiovascular activity, we compared each child with FXS with their same-sex typically developing biological sibling.Participants with FXS obtained significantly higher heart rates, lower vagal tone, and lower heart rate variability estimates both at baseline and during the social interaction session compared with their typically developing siblings. Although eye-gaze avoidance occurred at significantly higher levels in the children with FXS, this behavior decreased slightly over the course of the session (a "warm-up" effect) and did not seem to be associated with cardiovascular activity. In the girls with FXS, higher levels of the fragile X mental retardation protein were associated with higher (and more typical) heart rate variability.These data suggest that both sympathetic and parasympathetic nervous systems are dysregulated in FXS. However, given that prolonged exposure to social demands does not inevitably lead to increased anxiety or "hyperarousal," professionals should not be deterred from providing much needed social skills interventions for individuals with FXS.

View details for DOI 10.1097/CHI.0b013e318195bd15

View details for PubMedID 19182690

Is Child Psychiatric Service Different When Provided by Attendings Versus Clinicians-in-Training? ACADEMIC PSYCHIATRY Williams, S. E., Martin, J. L., Dyer-Friedman, J., Huffman, L. C. 2008; 32 (5): 400-404


This study examines the clinical management characteristics of outpatient child and adolescent psychiatric care provided by attendings and clinicians-in-training in an academic institution. The authors hypothesized that no significant differences would exist between initial evaluations conducted by attendings and those conducted by clinicians-in-training.The amount of information obtained during an initial evaluation and the number and type of services recommended postevaluation were assessed for 429 patients treated in the child and adolescent psychiatry clinics at Stanford University by attending psychiatrists and clinicians-in-training.No significant differences were found for the evaluations conducted by attendings and clinicians-in-training for the amount of data collected during an evaluation of the number or type of recommendations made postevaluation.These findings lend themselves to the conclusion that attendings and clinicians-in-training offer comparable services in the assessment of new patients. Study limitations and future areas of study are discussed.

View details for PubMedID 18945979

Filipino child health in the United States: do health and health care disparities exist? Preventing chronic disease Javier, J. R., Huffman, L. C., Mendoza, F. S. 2007; 4 (2): A36-?


Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy.We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United States crossed with specific topics in child and adolescent health that fall under one of Healthy People 2010's 28 focus areas.Filipino children are underrepresented in medical research. Studies that compare Filipino children and adolescents with white children or children of other Asian Pacific Islander subgroups suggest disparities with regard to gestational diabetes, rates of neonatal mortality and low birth weight, malnutrition in young children, overweight, physical inactivity and fitness, tuberculosis, dental caries, and substance abuse. Studies that compare Filipino adults with white adults describe adult Filipino health problems similar to those of Filipino children, including higher rates of diabetes, hypertension, and metabolic syndrome. Health care disparities remain to be determined.Health and health care disparities appear to exist for Filipino children, but more research is needed to confirm these findings. Practitioners serving this population need to consider social and cultural factors that can increase or diminish risk for health problems. There are priorities in research and policy that, if pursued, may improve the health care and health outcomes of Filipino children.

View details for PubMedID 17362627

Psychometric properties of the Peer Interactions in Primary School (PIPS) Questionnaire JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tarshis, T. P., Huffman, L. C. 2007; 28 (2): 125-132


Recently, national and international scientific and popular press has focused on bullying and victimization. Unfortunately, many interventions that address bullying and victimization are yet to be empirically validated. One problem is the lack of a psychometrically sound instrument for the measurement of bullying and victimization.To alleviate this shortcoming, the Peer Interactions in Primary School Questionnaire (PIPS) was developed and tested. Twenty-two questions designed to capture direct and indirect forms of bullying and victimization were created at a third-grade reading level. Psychometric data were collected from administration of the questionnaire to 270 students in third through sixth grades at three different elementary schools. An exploratory factor analysis yielded two factors (bullying and victimization).Internal consistency for the questionnaire was high (Cronbach's alpha = .90). Intraclass correlation coefficients (ICCs) and Spearman's rho established that test-retest reliability was high for both scales: bullying (ICC = .84; rho = .76) and victimization (ICC = .88; rho = .87). Significant Kruskal-Wallis tests of relationships between PIPS scales and items on the Olweus Bullying/Victimization Questionnaire and the Strengths and Difficulties Questionnaire supported concurrent validity. Bullying and victimization were widespread, as 89.5% of children experienced some form of victimization and 59.0% of students participated in some form of bullying.With these data, the PIPS is the first self-report bullying and victimization measure designed for elementary school use determined reliable (internally consistent and reproducible) and valid. The PIPS is a tool that could be used in the design and evaluation of school-based bullying/victimization interventions.

View details for PubMedID 17435463

A Critical Analysis of Care Coordination Strategies for Children AHRQ Technical Reviews Wise, P. H., Huffman, L. C., Brat, G. 2007; 07-0054 (14)
Provider recognition of psychosocial problems in low-income Latino children JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Tarshis, T. P., Jutte, D. P., Huffman, L. C. 2006; 17 (2): 342-357


The purpose of this study was to determine the frequency of identification of psychosocial problems in Latino children by primary care providers (PCPs). This was a cross-sectional study of 269 low-socioeconomic status (SES), Latino children, ages 2-16 years, seen at a community clinic for well-child care. Primary care providers completed a World Health Organization checklist, which organized provider assessment of child psychosocial problems. Clinicians identified one or more psychosocial problems in 39.8% of children. Clinicians recognized only 20% of children with clinically significant aggression symptoms, 18% of children with clinically significant attention/hyperactivity symptoms, and none (0%) of the children with clinically significant anxiety/depression symptoms with clinical data from parent-completed child-behavior checklists used as the benchmark. Despite high rates of identification of psychosocial problems in a low-SES, Latino population, PCPs still miss symptoms of mental health difficulties, especially anxiety and depression. Since symptoms of anxiety and depression are likely to be more pronounced in Latino populations, there is a continued need for improvement in detection of mental health concerns among these children.

View details for PubMedID 16702719

Filipino American families and intergenerational communication about sex. Ambulatory pediatrics Javier, J. R., Chamberlain, L., Huffman, L., Mendoza, F. 2006; 6 (2): 120-?

View details for PubMedID 16530151

Are residents ready for self-directed learning? A pilot program of individualized learning plans in continuity clinic AMBULATORY PEDIATRICS Stuart, E., Sectish, T. C., Huffman, L. C. 2005; 5 (5): 298-301


Changes in training and certification requirements demand that trainees and practitioners take charge of planning and documenting their ongoing learning. Individualized learning plans (ILPs) have been proposed as a tool to guide this process. We report on a pilot program using ILPs as part of the pediatric continuity clinic experience.The goal of the project was to explore residents' and faculty members' reactions to using ILPs when ILPs were offered as an optional tool.A group of 42 residents and 13 faculty members volunteered to use ILPs in continuity clinic. Nine months into the intervention, residents and faculty completed questionnaires about their experiences using ILPs. We performed a content analysis of questionnaire responses to identify perceived benefits and barriers to using ILPs.ILP users reported that the program was helpful in providing a framework and focus for learning and in amplifying their awareness of the learning process. Barriers to using ILPs included lack of time and difficulty establishing and working with learning goals.Our results suggest that residents are unaccustomed to taking active roles in planning their own learning. To prepare trainees for lifelong learning and continuous professional development, residency programs need to provide explicit education in the process of self-directed learning.

View details for PubMedID 16167854

Impact of child advocacy training on pediatric residents Chamberlain, L. J., Huffman, L. C., Shocket, S., Sanders, L. M., Sectish, T. C., Mendoza, F. S., Takayama, J. I. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2002: 77A
Child behavior symptoms and parental stress: Findings from a community behavioral healthcare agency out-patient population Huffman, L. C., Blasey, C., Nichols, M. J., McNee INT PEDIATRIC RESEARCH FOUNDATION, INC. 2000: 27A