Clinical Focus

  • Developmental Behavioral Pediatrics
  • Developmental Delay Disorders
  • Autism Spectrum Disorders

Academic Appointments

Administrative Appointments

  • Chair and Member, Board of Directors, Institute for Human and Social Development, Inc. (1997 - 2006)

Professional Education

  • Fellowship:UCSF Dept of Pediatrics (1986) CA
  • Residency:Children's National Medical Center (1984) DC
  • Internship:Children's National Medical Center (1982) DC
  • Medical Education:George Washington University (1981) DC
  • Board Certification: Pediatrics, American Board of Pediatrics (1986)
  • Board Certification: Developmental Behavioral Pediatrics, American Board of Pediatrics (2002)
  • B.S., U. Maryland, College Park, Biochemistry (1976)
  • M.D., George Washington University, Medicine (1981)

Community and International Work

  • Community-based behavioral health care, Santa Clara County


    outcomes research

    Partnering Organization(s)

    The Children's Health Council

    Populations Served

    children and families


    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

Research interests and activities include (1) the early identification and treatment of behavioral problems, particularly in children with special health care needs; (2) emergent literacy and school readiness; and, (3) community-based mental health/educational program evaluation and outcomes measurement.

Clinical Trials

  • Sapropterin as a Treatment for Autistic Disorder Not Recruiting

    This study is intended to provide a definitive test of the hypothesis that elevating sapropterin (tetrahydrobiopterin, a cofactor for several key brain enzymes)concentrations in the CNS will result in measurable improvements in core symptoms of autism in young individuals, under age 6 years. The study will entail a double-blind, placebo-controlled 16-week intervention.

    Stanford is currently not accepting patients for this trial. For more information, please contact Lynne Huffman, MD, (650) 725-8314.

    View full details

  • Randomized Controlled Study of Donepezil in Fragile X Syndrome Not Recruiting

    Fragile X syndrome (FraX) is the most common known heritable cause of human intellectual disability. Though recent research has revealed much about the genetic and neurobiological bases of FraX, knowledge about specific and effective treatments for affected individuals is lacking. Based on information from both human and animal studies, one cause of intellectual disability in FraX may be related to deficits in a particular brain neurotransmitter system (the "cholinergic" system). Thus, the investigators propose to use a specific medication, donepezil, to augment cholinergic system in adolescents affected by FraX. If found to be effective, the knowledge generated by this research may also be relevant to other developmental disorders that share common disease pathways with FraX.

    Stanford is currently not accepting patients for this trial. For more information, please contact Mai K Manchanda, AB, 650-704-9763.

    View full details


2015-16 Courses


All Publications

  • 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 Web of Science ID 000352195800010

  • 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 Web of Science ID 000308841700010

    View details for PubMedID 22710574

  • 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 Web of Science ID 000304707000036

    View details for PubMedID 22614772

  • 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 Web of Science ID 000285914200011

    View details for PubMedID 21160435

  • 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

  • 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 Web of Science ID 000336714600006

    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 Web of Science ID 000337357400003

    View details for PubMedID 24906034

  • 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 20?mg/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): 1373-91


    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 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 Web of Science ID 000308668400001

    View details for PubMedID 22947882

  • 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 PubMedID 21765594

  • 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

  • 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 Web of Science ID 000278268600013

    View details for PubMedID 20439593

  • 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

  • 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

  • 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 Web of Science ID 000279188000010

    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 Web of Science ID 000263742100011

    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 Web of Science ID 000260202200010

    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 Web of Science ID 000245789800007

    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 Web of Science ID 000237817000009

    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 Web of Science ID 000232119000008

    View details for PubMedID 16167854

  • Heart rate correlates of attachment status in young mothers and their infants JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Zelenko, M., Kraemer, H., Huffman, L., Gschwendt, M., Pageler, N., Steiner, H. 2005; 44 (5): 470-476


    To explore heart rate (HR) correlates of attachment behavior in young mothers and their infants to generate specific hypotheses and to provide pilot data on which studies to test those hypotheses might be based.Using the strange situation procedure, patterns of attachment were assessed in 41 low-income adolescent mothers and their infants. During the procedure, the HRs of the infants and mothers were recorded. The HR changes were analyzed and infant attachment group differences were examined.Infants in all attachment groups demonstrated a similar HR response. There were, however, notably different behavioral reactions in the insecure groups: relatively increased behavioral distress in the insecure/resistant infants and relatively decreased behavioral distress in insecure-avoidant infants. Mothers of insecure-resistant infants demonstrated elevated HRs during reunions and the insecure/resistant dyads demonstrated lower consistency between HR changes in infant and mother than the secure dyads.The results suggest the discrepancy between attachment-related behavioral reactions and HR response in insecurely attached infants. Maternal and dyadic HR changes vary between the attachment groups.

    View details for DOI 10.1097/01.chi.0000157325.10232.b1

    View details for Web of Science ID 000228610000012

    View details for PubMedID 15843769

  • Practitioners' attitudes toward the use of treatment progress and outcomes data in child mental health services EVALUATION & THE HEALTH PROFESSIONS Huffman, L. C., Martin, J., Botcheva, L., Williams, S. E., Dyer-Friedman, J. 2004; 27 (2): 165-188


    This study focused on practitioners' attitudes toward child mental health services data collection and outcomes measurement in university-based and community-based clinics. It is relevant to the burgeoning field of empirically based mental health therapy management because it examines one potential barrier to psychotherapy and pharmacotherapy strategies (i.e., practitioners' attitudes toward outcomes measurement) that are informed by real-time, clinically relevant data. Two site differences were noted regarding the utility of specific questionnaires and the perceived burden of conducting outcomes measurement. At both sites, practitioners held positive attitudes about outcomes measurement. Compared with psychologists and other child mental health specialists, psychiatrists had less favorable attitudes toward outcomes evaluation. Practitioners who rated outcomes evaluation as more important also perceived less burden associated with such evaluation efforts. Increased understanding of the utility of systematic clinical data collection is more likely to occur in an organizational culture in which treatment progress and outcomes measurement is integral to clinical work.

    View details for DOI 10.1177/0163278704264058

    View details for Web of Science ID 000221253500004

    View details for PubMedID 15140293

  • Patterns of agreement between parent and child ratings of emotional and behavioral problems in an outpatient clinical setting: When children endorse more problems JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Martin, J. L., Ford, C. B., Dyer-Friedman, J., Tang, J., Huffman, L. C. 2004; 25 (3): 150-155


    This study examined clinically relevant patterns of agreement between parent and child ratings of child behavior problems and factors associated with these patterns. Subjects were 274 children, ages 11 to 18 years, and their parents. Overall agreement between parent-child ratings was modest. Twenty-five percent of parent-child pairs agreed children's behavior problems were clinically elevated ("both" group), 29% agreed problems were nonclinical ("neither" group), in 39% of pairs only parents reported clinically elevated problems ("parent only" group) and in 8% of pairs only children rated clinically elevated problems ("child only" group). Maternal stress and child age, but not child gender, were associated with parent-child agreement patterns. Children with depressive/mood disorders were more likely to be in the "child only" group than in any other group. This study discusses the importance of paying attention to child reports of elevated behavior problems, particularly when parents report that child behavior problems are not clinically elevated.

    View details for Web of Science ID 000222123300003

    View details for PubMedID 15194898

  • School reintegration for children in different phases of serious illness JOURNAL OF SCHOOL HEALTH Botcheva, L., Hill, K. E., Kane, J., Grites, K., Huffman, L. C. 2004; 74 (2): 68-71

    View details for Web of Science ID 000220512300005

    View details for PubMedID 15077502

  • Use of the pediatric symptom checklist in a low-income, Mexican American population ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Jutte, D. P., Burgos, A., Mendoza, F., Ford, C. B., Huffman, L. C. 2003; 157 (12): 1169-1176


    To evaluate the usefulness of the Pediatric Symptom Checklist (PSC) in identifying behavioral problems in low-income, Mexican American children.A cross-sectional study design was used to examine the PSC as a screening test, with the Child Behavior Checklist (CBCL) as the criterion standard.The study was conducted at a health center in a diverse low-income community. Patients Eligible patients were children and adolescents, 4 to 16 years of age, who were seen for nonemergent, well-child care. Of 253 eligible children during a 9-month study period, 210 agreed to participate in the study. There was a 100% completion rate of the questionnaires. The average age of the children was 7.5 years, and 45% were female. Ninety-five percent of patients were of Hispanic descent (Mexican American); 86% of families spoke only Spanish. Socioeconomic status was low (more than three fourths of families earned <$20 000 annually).The CBCL Total scale determined that 27 (13%) of the children had clinical levels of behavioral problems. With a cutoff score of 24, the PSC screened 2 (1%) of the 210 children as positive for behavioral problems. Using the CBCL as the criterion standard, the PSC sensitivity was 7.4%, and the specificity was 100%. Receiver operator characteristic analysis determined that a PSC cutoff score of 12 most correctly classified children with and without behavioral problems (sensitivity, 0.74; specificity, 0.94).When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.

    View details for Web of Science ID 000186959800007

    View details for PubMedID 14662568

  • Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: A randomized, controlled trial PEDIATRICS Kelly, N. R., Huffman, L. C., Mendoza, F. S., Robinson, T. N. 2003; 111 (1): 21-26


    Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use.To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California.Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.Compared with the control group, the video group showed an increase in knowledge about the PCC's function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.

    View details for Web of Science ID 000180135200020

    View details for PubMedID 12509549

  • Family environment and cognitive abilities in girls with fragile-X syndrome JOURNAL OF INTELLECTUAL DISABILITY RESEARCH Kuo, A. Y., Reiss, A. L., Freund, L. S., Huffman, L. C. 2002; 46: 328-339


    There remains some variance in cognitive ability that is unexplained in children with fragile-X syndrome (FXS). Studies in typically developing children suggest that family environment might be one contributor to this unexplained variance. However, the effect of family environment in relation to cognition in atypical children with FXS has been relatively unexplored to date.The present authors examined the putative genetic and environmental factors associated with cognition in a group of age-matched children consisting of 26 females with FXS and 31 typically developing children. All subjects were administered the Wechsler Intelligence Scale for Children-Revised; and the subjects' parents were administered the Wechsler Adult Intelligence Scale-Revised, and completed the Hollingshead Index of Social Status and the Moos & Moos Family Environment Scale.Using a multiple regression analytic strategy, the present authors found that family environment contributed significantly to cognitive abilities in typically developing girls, but did not have a unique contribution to cognitive abilities in girls with FXS. There was a suggestion that, for girls with FXS, socio-economic status, a measure of sociocultural environment, was correlated with IQ.The present study provides a basis for future research on the environmental contributions to cognitive abilities, particularly work related to verbal cognition.

    View details for Web of Science ID 000175531500005

    View details for PubMedID 12000584

  • Genetic and environmental influences on the cognitive outcomes of children with fragile X syndrome JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Dyer-Friedman, J., Glaser, B., Hessl, D., Johnston, C., Huffman, L. C., Taylor, A., Wisbeck, J., Reiss, A. L. 2002; 41 (3): 237-244


    To measure the genetic and environmental factors influencing the cognitive outcomes in children with fragile X, a common genetic disorder causing cognitive impairments.In-home evaluations were conducted on 120 children (80 boys and 40 girls) with the fragile X full mutation and their unaffected siblings.Multiple regression analyses show that the cognitive outcomes for girls with fragile X are most strongly predicted by the mean IQ of their parents, with a small proportion of the variance accounted for by the quality of their home environment. FMR1 protein (FMRP) was associated with girls' levels of distractibility. Mean parental IQ was associated only with boys' Performance IQs, while FMRP was associated with boys' Full Scale IQs. The quality of boys' home environments accounted for more of the variance in their cognitive outcomes than it did for affected girls.Both biological/genetic factors and environmental factors are significant predictors of IQ in children with fragile X syndrome; however, the influence of specific factors differs between girls and boys. These findings lay the foundation for further investigation into biological and environmental interventions.

    View details for Web of Science ID 000174118400002

    View details for PubMedID 11886017

  • Learning culture and outcomes measurement practices in community agencies AMERICAN JOURNAL OF EVALUATION Botcheva, L., White, C. R., Huffman, L. C. 2002; 23 (4): 421-434
  • The Child Abuse Potential inventory and pregnancy outcome in expectant adolescent mothers CHILD ABUSE & NEGLECT Zelenko, M. A., Huffman, L. C., Brown, B. W., Daniels, K., Lock, J., Kennedy, Q., Steiner, H. 2001; 25 (11): 1481-1495


    The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity.The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed.In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors.The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.

    View details for Web of Science ID 000172247300006

    View details for PubMedID 11766012

  • Identifying characteristics of older and younger females with attention-deficit hyperactivity disorder JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Kato, P. M., Nichols, M. L., Kerivan, A. S., Huffman, L. C. 2001; 22 (5): 306-315


    This study examines the manifestation of attention-deficit hyperactivity disorder (ADHD) among females of varying ages by testing the utility of particular tests to discriminate older from younger females with ADHD. A retrospective clinical chart review was conducted at a community outpatient mental health center for 75 girls from 4 to 19 years of age with a diagnosis of ADHD or subthreshold symptoms of ADHD. Signal detection methods were used to identify which variables best differentiate older (mean age = 12.06, SD = 2.61) from younger (mean age = 7.11, SD = 1.08) girls with ADHD. Girls with comorbid diagnoses of a depressive disorder and higher verbal IQ scores were more likely to be older. Overall, the findings suggest that approaches to diagnosing ADHD among females may need to be modified to include appropriate age-based criteria.

    View details for Web of Science ID 000171906200005

    View details for PubMedID 11718234

  • Poor adolescent expectant mothers: Can we assess their potential for child abuse? JOURNAL OF ADOLESCENT HEALTH Zelenko, M. A., Huffman, L., Lock, J., Kennedy, Q., Steiner, H. 2001; 29 (4): 271-278


    To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers.Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies.Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him.Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers' role.

    View details for Web of Science ID 000171209100006

    View details for PubMedID 11587911

  • Prescribing books for immigrant children - A pilot study to promote emergent literacy among the children of Hispanic immigrants ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Sanders, L. M., Gershon, T. D., Huffman, L. C., Mendoza, F. S. 2000; 154 (8): 771-777


    To assess book-sharing activities within first-generation Hispanic immigrant families, and to assess the effect of pediatricians giving books to their patients.Survey.Convenience sample of 122 predominantly Hispanic immigrant parents of children aged 2 months to 5 years. Of these parents, 56 had received children's books from the pediatrician, and 66 had not.House staff continuity clinic at a university children's hospital.Frequent Book Sharing (FBS) was defined as a parent's reporting more than 3 days per week of sharing books with the child. Main independent variables included the following: (1) exposure to the Reach Out and Read program, defined as having received a children's book from the pediatrician; (2) socioeconomics, as measured by parents' years of education and Medicaid enrollment; (3) acculturation, as defined by 4 questions relating to parents' proficiency with the English language; (4) parent's country of origin; (5) parent literacy, as measured by a parent's reporting more than 3 days per week of reading alone; (6) parent's age; (7) marital status; (8) household size; (9) child's age; (10) child's sex.Ninety percent of the parents were born outside of the United States (71% in Mexico), 85% spoke Spanish in the home, and 63% had completed less than a high-school education. Seventy-five percent of children's medical insurance was provided by Medi-Cal (Medicaid), and 9% of children were uninsured. Sixty-seven percent spoke exclusively Spanish at home, and 84% of parents want their children to learn to read in both English and Spanish. High FBS was reported among parents whose children had received books from the physician when compared with parents whose children had received no books. The odds ratio (OR) was 3.62 (95% confidence interval [CI], 1.40-9.37; P<.05). Also associated with FBS were parents reading frequently to themselves (OR = 9.52; 95% CI, 2.09-43.27; P<.05) and national origin outside Mexico (OR = 5.54; 95% CI, 1.59-19.27; P<.05). These findings were independent of parent's educational level, parent's employment, parent's age, acculturation, and family size.Pediatricians can promote literacy development among Hispanic immigrant children through the provision of free books at well-child visits. Our findings also suggest the independent effects of adult literacy and child age. Further research is needed to understand the effect of pediatric literacy programs on Hispanic immigrant children, their bilingual environments, and their readiness for school entry. Arch Pediatr Adolesc Med. 2000;154:771-777

    View details for Web of Science ID 000088655000003

    View details for PubMedID 10922272

  • Cortisol and social stressors in children with fragile X: A pilot study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wisbeck, J. M., Huffman, L. C., Freund, L., Gunnar, M. R., Davis, E. P., Reiss, A. L. 2000; 21 (4): 278-282


    Evidence of neuroendocrine dysfunction, behavioral features of social anxiety and avoidance, and neuroanatomical abnormalities suggest that abnormal hypothalamic-pituitary-adrenal (HPA) function may be a component of the fragile X (fra X) syndrome. In this preliminary study, salivary cortisol levels of males (n = 8, mean age = 13.5 yr) and females (n = 7, mean age = 13.9 yr) with the fra X full mutation were studied for 3 days. Day 1 was an experimental day, during which subjects experienced a Social Stressor task midmorning. Days 2 and 3 were routine days, during which the subjects were engaged in their typical activities. Saliva samples were collected before breakfast, lunch, dinner, and bedtime. On the experimental day, the prelunch sample collection occurred 30 and 90 minutes after the Social Stressor task. Compared with children's norms, the combined group of males and females with fra X had significantly higher cortisol levels in the prelunch and the prebedtime samples for the routine days. Comparisons between the two fra X groups for the experimental day revealed similar diurnal patterns for cortisol level. However, compared with females with fra X, males with fra X had significantly higher cortisol levels at two points during the day: 30 minutes after the social stressor and at bedtime. These preliminary data suggest that individuals with fra X have abnormal HPA function. Understanding the relations among HPA dysfunction, abnormalities in brain structure and/or function, and maladaptive behavior and cognition in fra X could inform the design of early interventions using pharmacological or environmental measures designed to normalize neuroendocrine function.

    View details for Web of Science ID 000088913700004

    View details for PubMedID 10972251

  • Mothers' and fathers' perceptions of three year olds' attachment behavior JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS DelCarmen-Wiggins, R., Huffman, L. C., Pedersen, F. A., Bryan, Y. E. 2000; 21 (2): 97-106


    This investigation reports on the antecedents and cross-sectional predictors of young children's attachment security based on Q-sort methodology, with particular consideration of the convergence of parental reports. Mothers' and fathers' ratings of child temperament and child behavior problems, as well as each parent's construction of the marital relationship and his/her affective state, were examined in relation to Q-sort assessments of mother-child and father-child attachment security. Generally, a moderate degree of convergence between maternal and paternal perceptions of attachment security was found; this association was stronger than the correlations reported based on studies using the Strange Situation procedure at 12 to 18 months of age. Antecedent relationships between ratings of parental affective symptoms, as well as ratings of marital quality and security of attachment, were stronger for fathers than for mothers. These findings may suggest closer links for fathers than for mothers between parental nurturing responses and psychological state, or they may reveal a stronger subjective bias for fathers inherent in the Q-sort method.

    View details for Web of Science ID 000086537900003

    View details for PubMedID 10791477

  • Infant temperament and cardiac vagal tone: Assessments at twelve weeks of age CHILD DEVELOPMENT Huffman, L. C., Bryan, Y. E., del Carmen, R., Pedersen, F. A., Doussard-Roosevelt, J. A., Porges, S. W. 1998; 69 (3): 624-635


    Sixty 12-week-old infants participated in a laboratory study to explore the relations between temperament and cardiac vagal tone. Temperament was evaluated via laboratory observations and maternal ratings. Cardiac vagal tone, measured as the amplitude of respiratory sinus arrhythmia, was quantified from beat-to-beat heart period data collected during a resting baseline period and during the laboratory assessment of temperament. Specific hypotheses were investigated relating temperament to both basal cardiac vagal tone and changes in cardiac vagal tone during social/attention challenges. Infants with higher baseline cardiac vagal tone were rated in the laboratory as showing fewer negative behaviors and were less disrupted by the experimental procedure. Infants who decreased cardiac vagal tone during the laboratory assessment were rated on maternal report temperament scales as having longer attention spans, and being more easily soothed.

    View details for Web of Science ID 000074836900010

    View details for PubMedID 9680676

  • Epilogue: Bridging the gap between research on attachment and psychopathology JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY DELCARMEN, R., Huffman, L. 1996; 64 (2): 291-294


    Clinicians and researchers are beginning to acknowledge the importance of integrating a developmental perspective into the understanding of clinical disorders. The application of findings from basic attachment research to this understanding of psychopathology is a prototype for interdisciplinary research. However, major gaps continue to exist between basic research on attachment processes and clinical issues of assessment, classification, and treatment of mental disorders from infancy through adolescence. This epilogue highlights the importance of more integrative research. As a reflection of growth in this direction, National Institute of Mental Health funding patterns are reviewed, and promising areas for future research are suggested. The field is well positioned for conceptual advancement if more integrative approaches are used.

    View details for Web of Science ID A1996UH15400007

    View details for PubMedID 8871413



    1. Folic acid deficiency has been associated with diverse neuropsychiatric symptoms. 2. This paper discusses the impact of folate on brain development, maturation and function and reviews the role of folate in psychiatric disorders, particularly childhood disorders. 3. A brief case report examines the use of folate in the treatment of attentional problems in a child with fragile X syndrome.

    View details for Web of Science ID A1994NX41900002

    View details for PubMedID 7938557

  • INFANT CRY ACOUSTICS AND MATERNAL RATINGS OF TEMPERAMENT INFANT BEHAVIOR & DEVELOPMENT Huffman, L. C., Bryan, Y. E., Pedersen, F. A., Lester, B. M., Newman, J. D., DELCARMEN, R. 1994; 17 (1): 45-53