Attention deficit/hyperactivity disorder (ADHD) is one of the most common child neurodevelopmental disorders. The disorder is typically diagnosed in elementary school, but there is growing evidence for the validity of ADHD in preschoolers, and symptoms likely emerge even earlier than preschool years. Research suggests that ADHD symptoms can be evident in toddlers beyond developmentally appropriate behavior, and symptoms in toddlers are predictive of later impairment. However, few studies have examined the validity of Diagnostic and Statistical Manual of Mental Disorders (DSM) ADHD symptoms in this younger population. The present study examined the 18 DSM ADHD symptoms in a community sample of 2-year-old children by recruiting parents (N = 321) online through Amazon’s Mechanical Turk. Results showed that ADHD symptoms were fairly common in 2-year-old children; a substantial minority (22%) of children met symptom criteria for ADHD. ADHD showed similar construct validity and symptom utility to older children, with the exception of verbal hyperactive-impulsive symptoms. Similar to school-age children, a two-factor model of ADHD, was the best fit. ADHD symptoms showed convergent and divergent validity with a temperament questionnaire; symptoms were related to similar traits such as motor activation and inhibitory control, and not related to traits such as cuddliness or fear. Finally, item response theory analyses showed that items besides verbal symptoms discriminated well between toddlers high and low on ADHD. Results suggest that ADHD symptoms, with the exception of verbal symptoms, demonstrate good validity in 2-year-old children, and provide support for conducting prospective studies to determine whether 2-year-old children showing high levels of ADHD symptoms are at high risk for the development of ADHD.

Thesis (B.Sc)--University of Hong Kong, 1999. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 14, 1999." Also available in print.

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Ninety percent of deaf infants are born to hearing parents, and socio-emotional development is compromised in a substantial subset of these children. While deafness itself does not cause socio-emotional and behavioural dysfunction, its influence on socio-emotional development is profuse and complex. It was proposed that early problems in mother-child joint attention would explain some of the socio-emotional development that lags chronological development in deaf children with hearing mothers. Fifty six 18-to 36-month old children and their mothers were recruited to the study; n = 29 hearing mother-hearing child dyads; n =27 hearing mother-deaf child dyads. A re-conceptualized model of joint attention guided this research and joint attention was restated as a functional construct. Four questions were asked and seven hypotheses were derived from these questions. Results supported six of the seven hypotheses tested. Findings are discussed in terms of developmental relations between joint attention and early socio-emotional development in hearing and deaf children. More specifically, the findings support a developmental psychopathology perspective of development that broadens the "language" argument for problems in deaf children's social development. Overall, a deliberate, rather than intuitive, model of mothering is suggested to be important in the accommodation of hearing mother-deaf child joint attention important for early socio-emotional development. / Thesis / Doctor of Philosophy (PhD)

This research represents phase C in the development of Toddler NutriSTEP® (Nutrition Screening Tool for Every Preschooler). NutriSTEP® is a valid and reliable screening tool designed to assess nutritional risk in preschoolers (3-5 years). A draft toddler (18-35 months) version of NutriSTEP® has recently been developed because of an expressed need. Convenience samples of caregivers were recruited across Ontario to assess the test-retest reliability and construct validity of the tool. Test-retest reliability was assessed based on total score and attribute scores using paired sample t-tests and intraclass correlation coefficients; individual questions were assessed using Wilcoxcon signed rank tests and kappa statistics. Construct validity was assessed through comparison of high-risk groups to Toddler NutriSTEP® scores, as well as through exploratory and confirmatory factor analyses. Toddler NutriSTEP® was found to be test-retest reliable and construct valid, and therefore may be used to assess nutritional risk in Canadian toddlers. / Funded by the Canadian Institutes of Health Research

This research is part of an ongoing program, Nutrition Screening Tool for Every Preschooler (NutriSTEP®). NutriSTEP® is a valid and reliable 17-item, parent-administered, questionnaire for nutritional risk in preschoolers (3-5 years of age). Due to an expressed need across Canada, the specific objective of this research was to create a draft toddler (18-35 month) NutriSTEP®. Based on results from a comprehensive literature review, focus groups (n=6) with 48 parents of toddlers, and input from 13 pediatric nutrition experts, many questions from the original preschooler NutriSTEP® questionnaire were refined or removed, and novel questions were added. Basic changes included combining separate fruit and vegetable intake questions, and adding breast milk and formula as examples of dairy products. In conclusion, a 19 item Toddler NutriSTEP® was created to reflect the differences in nutritional risk between preschoolers and toddlers. Next steps in the development process include refinement, test-retest reliability and criterion validation. / Canadian Institutes of Health Research

Introduction/Background Research indicates nutrition and environment in the first year of a child's life are crucial in their development and growth and can contribute to lower chances of developing obesity and other health concerns. Key factors that can determine these outcomes include the bacteria and resulting short chain fatty acids (SCFAs) present in the gut. This composition may be affected by feeding modality (formula feeding vs breastfeeding), exposure to the mother’s microbiota, weight status of the child, and type of delivery. This research aims to identify the impact of infant feeding modality on toddlers' fecal fermentation profile, and if there are associations between weight status and microbiome, fecal fermentation profile. Methods/ Procedures Participants (n=40) were recruited during well-child pediatric appointments at ETSU’s Pediatric primary care clinic. Researchers explained the requirements of the study and participants were provided with a 90-question food frequency questionnaire (FFQ) for children ages 2-7, including 90 questions and asks about a child's typical intake over the previous 6-month period. The food list was developed from NHANES III dietary recall data. The child’s history was obtained, including current age, birth length and weight, delivery type (C-section or vaginal), feeding method (breast, bottle fed, or both) and duration. The child’s weight and height were obtained, and body mass index (BMI) calculated. Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted using a procedure developed by Schwiertz et al. that was modified. One mL of the SCFA extraction solution, containing Oxalic acid (0.1 mol/L), Sodium Azide (40 mmol/L), and Caproic acid (0.1 mmol/L) (internal standard) was added to 80 mg of a freeze-dried stool sample in a 16 x 100 mm disposable culture tube, and analyzed using a Shimadzu GC2010 gas chromatograph with SigmaAldrich ZB-Wax Plus capillary column. Samples were run in duplicate, and values for each participant were averaged. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results Initial findings showed no significant differences in the SCFA composition of obese vs non-obese toddlers in the sample. However, there were significant differences in the amount of specific SCFAs (isobutyrate, isovaleric acid, and octanoic acid) in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula (p < 0.05). Further analysis will determine if these initial results may be contributed to overall dietary intake, and more specifically fiber intake.

Thirty-two children were assessed for dietary, clinical, biochemical and anthropometric status at 6 months, 1 year and 2 years of age. Development was assessed by the Bayley Scales of Infant Development (BSID) Index. Using a dietary history and record, dietary iron was estimated and compared to the National Food Consumption Survey (1985) and Recommended Dietary Allowances (RDA) 10th edition. Daily iron intake decreased from 13.2 mg at 6 months to 10.3 mg iron at 1 year of age and 7.4 mg iron at 2 years of age. Iron intake and mental development were not related at statistically significant levels at any age. A stepwise multiple regression technique was employed to investigate the extent to which mental and motor development was explained with dietary variables, blood iron parameters and anthropometric measurements. Hematocrit concentration was the only variable which was consistently useful in predicting development at 1 and 2 years of age.

The Fecal Fermentation Profile of Twins and Infants with Opioid Exposure Dawson Brown-Ezell Michelle Johnson PhD, RD, LDN W. Andrew Clark PhD, RD Amy Wahlquist, PhD Introduction: The gut microbiome is believed to have a significant impact on health throughout the lifespan, and the influence of infant nutrition and other environmental factors are of particular interest in its development. The aim of this research project was to learn more about the microbiome and short chain fatty acid (SCFA) composition of toddlers of differing weights, considering birth history, environment, and diet. In East Tennessee, opioid misuse is a growing issue, and a number of participants in this study were exposed in utero. We also hoped to identify related effects on infant’s SCFA composition. Finally, it has been concluded that twins share a variety of traits, but much about their microbiome is unknown. With several pairs of twins in the sample, we aimed to identify any associations with SCFAs in this group. Methods: With informed consent, the child’s history was obtained, including age, birth length and weight, delivery type (C-section or vaginal), and feeding method (breast, bottle fed, or both). The child’s current weight, height, and BMI %ile were determined. Caregivers completed the 90-question Block Questionnaire for Ages 2-7 Kids food frequency questionnaire, and results were analyzed by Berkeley Analytics Inc (dba NutritionQuest). Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted and analyzed by content and concentration. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results: Nine SCFAs were measured in duplicate, and the concentrations averaged. Statistical analysis included comparisons of SCFAs related to factors including weight status, infant feeding modality, twin status, and intrauterine drug exposure, and significance determined with a p value < 0.05. Results did not identify significant differences in individual SCFA concentrations between obese and non-obese toddlers, however concentrations of isobutyrate, isovaleric acid, and octanoic acid were greater in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula. Analysis further revealed a higher mean concentration of caproic and propionic acid in twin subjects. Of particular interest, toddlers with a history of opioid exposure had higher mean concentrations of isovaleric and octanoic acids, but less isocaproic acid when compared to those who were not drug exposed. Further analysis will help determine if these findings may be related to nutrient intake, in particular dietary fiber intake.

High quality infant and toddler (IT) child care has repeatedly been linked to better outcomes for children. However, in the U.S., IT child care has also been plagued by poor quality. Using a mixed-methods design, the purpose of this study was to provide an indepth explanation of quality change in IT classrooms and the myriad of factors that contribute to higher quality. Framed in an ecological model that views quality as the product and interaction of process, structural, and caregiver characteristics, this study addressed the impact of a variety of variables on quality change. The sample was comprised of 86 classrooms nested within 48 centers that participated in Baby Steps, a quality improvement project administered by the Utah Office of Child Care. Quantitative data included ITERS-R scores, wages, turnover, capacity, geographic location, and parent fees collected between 2003 and 2010 as part of the Baby Steps Project. Seven center directors completed semi-structured interviews that provided an insider perspective on their perceptions of the barriers and contributors to improved quality. A mixed model analysis was used to examine quality change over time. Results indicate that classroom quality scores (as measured by the ITERS-R) did increase by the second year of participation in Baby Steps; however, subsequent years of participation did not lead to significantly higher scores. Specialized training also appears to contribute to higher quality but high turnover was associated with lower quality programs. Non-urban programs appeared to be especially receptive to the intervention. Center directors echoed these findings and spoke to the