2022 Associates Meeting - Posters

Hyperactivity and restricted and repetitive behaviors (RRBs) are associated in children with and without ASD, however their associations over time remain unstudied. We found stability of these symptoms between 3 and 5 years, and strong associations with each other at each timepoint. Further, elevated hyperactivity at 3 years was predictive of RRBs at 5 years and vice-versa, supporting the idea of similar alterations in brain connectivity contributing to both symptoms, and underscoring the importance of early assessment.

Alexandra Boxberger <alexandra.boxberger@yale.edu>

Reward Value Learning (RVL) is the ability to assign value to stimuli based on experiences (rewards). Infants demonstrate this skill when non-social stimuli are paired with non-social or social rewards. However, it remains unknown whether infants demonstrate RVL when pairing social stimuli with social rewards and when in infancy RVL arises. We found that RVL in the social domain emerges at 6 months of age. RVL may be a prerequisite for the development of social attention skills that emerge at 9-12-months and are impaired in autistic individuals.

Veda Donthireddy <veda.donthireddy@yale.edu>

Reeda Iqbal <reeda.iqbal@yale.edu>

Clinicians rated autism features higher than caregivers for boys and rated autism features lower than caregivers for girls. Additionally, children who received lower ratings from clinicians than they did from caregivers tended to be diagnosed at an older age and to receive less intervention. These findings suggest that when caregiver and clinician ratings of autism features do not align, it may be important to make extra space for caregivers’ ratings to obtain a full picture of the child’s autism features and the support they may need.

Margaret Azu <margaret.azu@yale.edu>

Externalizing problems such as aggression, defiance, and inattention are elevated in children with developmental disorders and are associated with increased anxiety and depression, peer rejection, and parental stress. Understanding early predictors of externalizing problems is imperative to identifying vulnerable children and implementing preventative interventions. We found that executive functioning impairment and social adaptive functioning at age 3 predict externalizing problems at age 5, particularly in children with lower levels of autism symptoms.

Katherine All <katherine.all@yale.edu>

This study evaluated the effectiveness of a 10-week support group for siblings of children on the autism spectrum. Results demonstrated that, following the support group, siblings showed increased knowledge about autism and increased satisfaction in their relationship with their sibling. Additionally, parents reported a reduction in negative behaviors within the sibling relationship both by the child who participated in the group and by their autistic sibling.

Julie Wolf <julie.wolf@yale.edu>

Julia Zhong <julia.zhong@yale.edu>

As many as 34% of autistic adolescents also have social anxiety disorder (Kreiser & White, 2014). Because social anxiety can strongly impact the quality of people's lives, it is important to improve our understanding of the relationship between these two conditions (Spain et al., 2018). Eye-tracking allows scientists to see where a participant is looking on the screen, which makes it a useful way to look at social attention in people with and without autism and social anxiety. The current study showed pictures of fearful and happy faces to autistic and non-autistic children with various levels of social anxiety symptoms and measured the average percentage of time that participants looked at the face, as well as specifically at the eyes. The results showed that autistic children looked less at faces than non-autistic children, while children with higher social anxiety looked less at eyes than those with lower social anxiety. Additionally, autistic participants with higher social anxiety looked more at faces than autistic participants with lower social anxiety.

Cassandra Franke <cassandra.franke@yale.edu>

The use of games for measuring cognitive function offers an alternative engaging method to traditional forms of cognitive assessments. However, it is unclear how well game-based assessments of cognitive function compare to current traditional cognitive tests among children and adolescents. We conducted a systematic review to examine the validity of game-based assessments of cognitive function. Game-based assessments of cognitive function may be valid alternatives to traditional assessments although factors such as age, sex and prior exposure to games may affect the validity of these assessments.

Isabella Gomati <isabella.gomati@yale.edu>

Amanda Dettmer <amanda.dettmer@yale.edu>

Wan-Ling Tseng <wan-ling.tseng@yale.edu>

The Adverse Childhood Experiences (ACEs) questionnaire is a widely used screener for pediatric trauma exposure and general household dysfunction. On a population level, ACEs are cumulative risk factors for a range of mental health and physical conditions. ACEs research has been largely based on self-reported ACEs exposures and health conditions. In contrast, data mined directly from the electronic health record (EHR) allows for more objective analysis and reduces potential harms and limitations of self-report. The objectives of this pilot were to generate and test an algorithm for deriving proxy ACEs values from existing EHR data, and to study the population-level association between derived proxy ACEs, medical morbidity, and healthcare utilization. We generated a dataset of 142,719 patients aged <18 years old who received care at Yale, spot-checked the derivation algorithm, and iterated modifications to obtain their final proxy ACEs scores. Proxy ACEs scores were positively correlated with all medical morbidity and healthcare utilization outcome variables, with the strongest associations for number of medical diagnoses, number of prescribed medications, and number of emergency room visits. Our findings are proof of concept that proxy ACEs scores can be meaningfully derived from the EHR. Future directions include incorporating natural language processing methodology to account for unstructured data stored in the EHR and creating an individual-level risk stratification model using our proxy ACEs dataset.

Jelena MacLeod, MD, MHS <jelena.macleod@yale.edu>

Background: Our prior study showed that a large proportion of ECE professionals struggled with clinically relevant depressive symptoms within the first couple of months of the COVID-19 pandemic(Elharake, 2022). In this paper, we aimed to further investigate the current stage of the workforce with the most recent, nationwide survey data. This paper examines two cohorts of ECE professionals working in the USA to estimate nationally representative, weighted proportions of depression.

Method: Data. The data used in this study came from Yale-CARES Surveys, a nationwide survey for early care and education professionals that collects information on the mental, physical and financial well-being of the workforce as well as a wide range of background and program-level characteristics. Survey sent through the contact lists of the National Workforce Registry Alliance and its member state child care registries, the National Association for the Education of Young Children, and Child Care Aware of America, as described in other studies (Gilliam et al., 2021; Murray et al., 2022; Patel et al., 2021; Patel et al., 2021). Cohort 1: Baseline and Follow-up, and overleaping Longitudinal Sample. Baseline data collection occurred between May 22 and June 8, 2020 and survey has been completed by 82,613, and the follow-up occurred between May 26 and June 23, 2021 and has been completed by 21,663 ECE professionals. Cohort 2: Survey links were distributed from June 2021 to August 2021 and of the individuals who click the survey link (N=56,881), 49,245 responded to survey.

Center for Epidemiological Studies – Depression Scale (CES-D-10). ECE professionals were asked the frequency of depression-related symptoms in the past week, with the response scale being 0 = Rarely or none of the time; 1 = Some or a little of the time; 2 = Occasionally or a moderate amount of the time; 3 = All of the time. CES-D-10 scores ranged from 0 to 30. Cut off score for depressive symptoms was 10. Analysis. We conducted weighted, descriptive analyses to estimate nationally representative proportions and 95% confidence intervals (CI) with multiply imputed data. We estimated the prevalence and 95% CIs of depression symptoms among ECE professionals across background characteristics in May-June 2020 (Cohort 1- Baseline), May-June 2021 (Cohort-1 Follow-up), and July-August 2021 (Cohort-2).

Results: Overall, the prevalence of US ECE professionals with clinically relevant depression symptoms was 45.68% (95% CI: 38.14,53.23) in May/June 2020, 39.02% (95% CI: 37.57,40.48) in May/June 2021, and 45.82%, (95% CI: 36.56,55.08) in July/August 2021. Among ECE professionals in this sample, the prevalence of clinically relevant depression symptoms was 44.97% (95% CI=44.07,45.88) in baseline and 39.02% (95% CI=37.57,40.48) in follow-up. Overall, higher prevalence of depression were observed across all demographic categories in baseline compared to follow-up. However, we found similar patterns of depression symptomology across demographic categories for both baseline and follow-up. For instance, prevalence of depression were 45% for female, 41.23 for male, 76.73 for Non-binary/ Transgender/Intersex/Others and 37.30 for participants preferred not to answer in baseline. Similarly, prevalence of depression were 39.19% for female, 34.1% for male, 78.95 for non-binary and 38.58 for participants preferred not to answer in follow-up. With the 62.76% (95% CI: 49.52,76.00) prevalence rate, American Indian or Alaskan Native has the highest prevalence of depression among all racial groups. Prevalence of depression among Hispanic ECE professionals was 51.87% (95 % CI: 41.07,62.67). Large proportion of non-binary/transgender/intersex ECE professionals, 72.37% (95% CI: 60.77,83.97) had depression in Cohort-2. As can be seen in Table 4, with age there was a decrease in proportion of ECE professionals with depression and individuals in 18-24 age group had the highest prevalence rate of 57.14% (95% CI: 42.16,72.12). Similar to Cohort-1, the highest proportions of depression was observed for workers from nanny or in-home child care with 61.61% (95% CI:40.37,82.85). Half of the ECE professionals with below $35,000 and $50,000-74,999 had depression.

Conclusion: This study reports nationally representative estimates of mental health outcomes in the USA's early care and education professionals since the beginning of the COVID-19 pandemic and provides critical evidence from the very first, comprehensive, nationwide ECE workforce dataset. Considering the ongoing children’s mental health crisis, the prevalence of depression among child care and education professionals who work with this population is alarming. Results clearly demonstrate that there is an urgent need to support ECE workforce wellbeing who have limited or no access to mental health consultation.

Ayse Cobanoglu <ayse.cobanoglu@yale.edu>

Sarah Abdallah <sarah.abdallah@yale.edu>

Paula Lopez Ramos <paula.lopezramos@yale.edu>