A look ahead at the children's health and development stories you'll be hearing about next year.
By Richard Rende, Ph.D, and Kara Corridan
How "Obamacare" affects children and families
The Affordable Care Act (ACA) -- a loaded topic if ever there was one. At press time, the much-maligned healthcare.gov website was working 90 percent of the time, compared to 43 percent in October. So it stands to reason that most of the people who are seeking new coverage during this open enrollment period (which ends March 31 for coverage starting in 2014) will be able to get the information they're looking for. But site functionality isn't the biggest issue when it comes to children; it's whether all children will be covered under ACA, and whether families will indeed be able to select a better and more affordable plan. To help cut through the inevitable confusion, the American Academy of Pediatrics (AAP) has created a helpful interactive map linking to state-specific fact sheets that will help parents learn more about the insurance options in their state. The map will also take them to each state's health insurance marketplace.
Come January 1, 2014, a key part of ACA will be implemented: Insurance companies will not be able to deny coverage to anyone because of gender or a pre-existing condition. This is fantastic news not just for parents of children with chronic or life-threatening health issues, but for women as well. When we interviewed Health & Human Services Secretary Kathleen Sebelius in 2012, this is what she had to say about this part of the law: "Right now [September 2012], a lot of women can be charged up to 50 percent more for exactly the same coverage that a man has -- even if that coverage doesn't include maternity care -- because the practice of 'gender rating' is legal until 2014. But after that, insurers will not be able to charge women more for their health coverage. Also, starting in 2014, no one can be denied coverage because they have a pre-existing condition. For women, a pre-existing condition could mean you're a breast cancer survivor, you're a victim of domestic violence, or you've had a Cesarean section in the past. Right now, insurance companies can refuse to insure you or refuse to pay for any kind of complication that may arise in the future from those circumstances. But those rules will change across the board. What I like to say is, 'Being a woman will no longer be a pre-existing condition.'"
Early detection of autism
We've seen great progress in detecting autism in the toddler years and we know that starting interventions leads to significant improvements in social and cognitive functioning. Pediatricians have been vigilant about screening for autism, typically at 18 months and 24 months, with the goal of beginning interventions as early as possible to maximize the positive effects on development. Parents have also become well informed on the early signs of autism, thanks in part to programs like the "Learn the Signs. Act Early" initiative led by the Centers for Disease Control and Prevention and the National Center on Birth Defects and Developmental Disabilities.
The next steps for research, however, hold even more promise. A paper published in 2013 provided evidence that early signs of autism can be detected in the first 6 months of life. The key indicator was observing how babies typically increase their visual attention on people's eyes in the first months of life, whereas babies later diagnosed with autism went on to focus less on people's eyes. This study took a bold step forward by studying these infants over time so that prediction of a formal diagnosis of autism could be confirmed, lending substantial weight to the findings. In addition, a number of the babies had older siblings with autism, and therefore were at an elevated risk -- and the method was able predict which high-risk babies were later diagnosed.
This study is provocative in a number of ways and will stimulate a number of research directions in the next year and beyond. There are three to consider.
- It may provide an important clue that will focus research on the early brain processes that lead to the development of autism. Having a way to demonstrate a measurable process -- decreasing attention to the eyes in infancy -- may provide a platform for directing new research on the underlying neurobiology of the disorder.
- Although this technique holds substantial potential for early detection, it does require specialized equipment and expertise. New studies will be needed to gauge its potential as a screen for early signs of autism. Researchers will also need to figure out whether it is best suited (in the nearer future) for screening infants at high risk (such as those who have an older sibling with autism), rather than all infants.
- The idea of identifying infants at risk for autism will lead to partnerships to design and initiate interventions within the first year of life. The potential here may be profound -- studies consistently show that the earlier an appropriate intervention is started, the more benefits that will accrue developmentally. The idea that we may be able to intervene in infancy raises exciting possibilities for early detection of autism.
Children in poverty
The awful statistic that bears repeating: 1 in 5 children live in poverty. More specifically, roughly 16.1 million kids in the United States now come from families where the total household income is less than the federal poverty level of $23,550 per year for a family of four. Almost half of those children live in deepest poverty, on household earnings of less than $11,775 per year.
Poverty touches every single area of a child's life -- and if a child is born poor, the damage can be especially devastating. Research shows that low-income children as young as 9 months of age show weaker cognitive and social development than their advantaged peers. "These children are dealing with all the repercussions of poverty during the crucial years for early brain development," says Benard Dreyer, M.D., professor of pediatrics at New York University's School of Medicine and cochairman of the Academic Pediatric Association's Task Force on Childhood Poverty. "After these effects take hold in the first three or four years, it's hard to catch up."
We interviewed Dr. Dreyer, among others, for a feature about poverty in our December issue. We reported that more than 30 percent of children in poverty show signs of emotional or behavioral problems. Their physical health suffers, too. Children born into poverty experience dramatically higher rates of infant mortality and low birthweight. As they grow, they are more likely to struggle with hunger and weight problems, as well as chronic medical issues such as asthma and diabetes.
Researchers and pediatricians have become increasingly aware of poverty's role in creating what is known as toxic stress. When children go through intensely difficult experiences for extended periods of time, their stress response is altered, this it actually changes how the brain develops. This is, in part, what prompted the AAP to create a Poverty and Child Health Work Group. This group will examine ways to expand access to affordable health care; broaden access to food, housing, and transportation; promote positive early brain and child development and school readiness and success; and support parents. In the meantime, we can consider helping children and families in poverty, or supporting organizations that do this work, knowing that their future directly affects all of us.
Concussions and other brain injuries
2014 is certain to bring continued discussion on the topic of concussions, because researchers are discovering more about the health risks associated with them, and because parents and coaches are taking them more seriously than ever before. In fact, startling new numbers have just been released showing that between 2010 and 2012, participation in Pop Warner (youth) football dropped by more than 23,000 players. The medical director of Pop Warner, neurosurgeon Julian Bailes, M.D., was quoted on ESPN.com as saying that the number-one cause of the decline was parents' fears of head injuries. Of course, football is just one of many sports that can lead to head injury; soccer, ice hockey, lacrosse, and cheerleading are other activities most likely to involve concussions.
At its annual conference in October, the AAP highlighted how crucial it can be for kids who have had concussions to make a gradual return to school. Put simply, a child who has had a head injury needs to give his brain a true rest, and it can be too taxing for a student to try to learn, memorize, and study under those circumstances. The AAP also released research on a topic that hadn't been examined too closely yet: the likelihood that children with concussion or brain injury will develop depression later on in life. There's plenty of data to prove that adults with head injuries are at risk for depression, and now it's clear that children are prone to be diagnosed, too: A study out of Brown University revealed that they're twice as likely to develop depression than kids who have not suffered from brain injury. You can expect more coverage in the coming months on how to spot a concussion -- did you know that less than 10 percent of concussions involve a loss of consciousness? -- and the safest way to recover from one.
This article was originally published on Parents.com.