Child and Family Research Institute

BackgroundThe prevalence of autism spectrum disorder has risen in recent decades. Given the growing evidence that prenatal fluoride exposure may be neurotoxic, we examined associations between prenatal fluoride exposure and parent-reported autistic behaviors in preschool-aged children.MethodsWe studied 453 mother-child pairs using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, a prospective Canadian birth cohort. Autistic behaviors were assessed in children at 3 to 4 years using the Social Responsiveness Scale-Second Edition (SRS-2) Preschool Form, where a higher score indicates more autistic behaviors. We estimated prenatal fluoride exposure using three methods: (i) maternal urinary fluoride adjusted for specific gravity (MUFSG), from spot urine samples collected at each trimester and the mean calculated across samples, (ii) daily maternal fluoride intake, based on self-reported consumption of tap water, coffee, and tea during the first and third trimesters, and (iii) water fluoride concentration in tap water. We used multivariable linear regression models to estimate associations between the SRS-2 scale T-scores and each fluoride exposure separately. We used multivariable logistic regression to estimate the association between each prenatal fluoride exposure and an elevated SRS-2 total T-score (i.e., 90th percentile or higher). Potential effect modification of MUFSG was examined by child sex, daily folic acid supplementation, and plasma total folate in pregnancy.ResultsThe mean SRS-2 total T-score for children aged 3 to 4 years was 45.3 (SD = 6.1, range = 34 to 85). The median MUFSG concentration was 0.43 mg/L (interquartile range = 0.33 mg/L). MUFSG was not significantly associated with the SRS-2 total T-score in multivariable linear regression (β = -0.16; 95% CI, -1.70, 1.39) or logistic regression (OR = 0.76; 95% CI, 0.29, 1.96). Similarly, estimated daily fluoride intake and water fluoride concentration were not associated with the SRS-2 total T-score. No effect modification was observed.ConclusionsThere was no evidence of an association between prenatal fluoride exposure and autistic behaviors in preschool-aged children, in contrast to previous MIREC research findings on lead and phthalates. Given that this cohort has relatively few children with high SRS-2 scores, further research is needed in other groups of children to more fully explore this association.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12940-025-01237-9.

The Attendance, Wellness, and Engagement (AWE) Model of Workplace Satisfaction is an innovative approach to promoting a sustainable, healthy, and engaged workforce. Implemented at Louis Brier Home and Hospital, the AWE Model encapsulates a people strategy aimed at nurturing a supportive and fulfilling work environment. Attendance promotion is accomplished by acknowledging absences while providing a comprehensive support system to address personal challenges faced by healthcare workers. The wellness component is underscored by increasing resource utilization, offering on-site health services, and cultivating social groups to enhance holistic well-being. Additionally, engagement is characterized by staff recognition rituals, community-building initiatives, and celebratory events. Importantly, this article presents a compelling position that the AWE Model creates a positive impact on reducing absenteeism, enhancing staff satisfaction, and transforming organizational culture. As health leaders grapple with workforce challenges, the AWE Model serves as a pragmatic framework to cultivate environments where employees regularly attend work healthy and engaged.

BackgroundNational legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers.MethodsChildcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents.ResultsNo statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions’ regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups.ConclusionsAlthough we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children’s sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children’s developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

BackgroundAutistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings.MethodsThe 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020–2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers’ perception of the program’s acceptability and level of satisfaction, as well as their child’s social and emotional regulation skills and related mental health challenges.ResultsA total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child’s emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39).ConclusionsAs online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming.Trial registrationThis study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

ABSTRACT A strong and cohesive interdisciplinary support team is critical to the success of children’s mental health live-in treatment program. Kinark Child and Family Services, a leading child and youth mental health organization in Ontario, Canada, assessed the degree to which its community-based live-in treatment programs align with identified best practices and used the findings to inform the implementation of an interdisciplinary team that delivers a unified clinical approach to treatment and care. This paper reviews the results of the assessment, focusing specifically on interdisciplinary teamwork and the collaboration, consultation, and training that is crucial for staff working in live-in treatment programs. The benefits of this collaboration on the therapeutic milieu for complex children and youth cannot be overstated as clients are supported by multiple professionals throughout their treatment journey, including child and youth care practitioners, clinical therapists, psychologists, case managers, and nurses. Training in dialectical behavior therapy (DBT) is provided to all staff to ensure that all members of the patient’s interdisciplinary team offer a consistent approach in the delivery and support of individualized treatment plans. We contend that our training approach for interdisciplinary staff in our live-in treatment programs, including comprehensive training in DBT, is beneficial for clients and families. Consideration for future program evaluation and interdisciplinary training initiatives are presented.

Background:Early life exposure to phthalates may be associated with reduced cognition. However, it is unknown if disproportionate exposure to phthalates contributes to racial disparities in children’s intellectual abilities.Methods:We used data from 253 mother-child pairs in Cincinnati, OH (the Health Outcomes and Measures of the Environment study, 2003–2006). We measured urinary concentrations of 11 phthalate metabolites twice during pregnancy and up to six times in childhood. We evaluated children’s cognitive abilities at ages 5 and 8 years. Using mediation models, we quantified covariate-adjusted direct and indirect effects of race on children’s Full-Scale Intelligence Quotient (IQ) scores for individual phthalate metabolite concentrations during gestation and childhood.Results:Average IQ scores among Black children (n = 90) were 7.0 points lower (95% confidence interval [CI] = −12, −1.8) than among White children (n = 145) after adjustment for socioeconomic factors. Urinary monobenzyl phthalate and monoethyl phthalate (MEP) concentrations during gestation and childhood were higher among Black than White children. We did not observe evidence that phthalate concentrations mediated the race-IQ association, with the exception of MEP. Childhood MEP concentrations partially mediated the race-IQ association. For instance, each 10-fold increase in MEP concentrations at age 2 years contributed to a 1.9-point disparity in IQ scores between Black and White children (95% CI = −4.7, 0.7). Other phthalate metabolite concentrations during pregnancy or childhood did not mediate the race-IQ association.Conclusions:Despite observing racial disparities in exposure to some phthalates and IQ, we found little evidence that phthalates contribute to IQ disparities.

ContextAntenatal hyperglycemia is associated with increased risk of future adverse health outcomes in both mother and child. Variations in offspring’s epigenome can reflect the impact and response to in utero glycemic exposure, and may have different consequences for the child.ObjectiveWe examined possible differences in associations of basal glucose status and glucose handling during pregnancy with both clinical covariates and offspring cord tissue DNA methylation.Research Design and MethodsThis study included 830 mother-offspring dyads from the Growing Up in Singapore Towards Healthy Outcomes cohort. The fetal epigenome of umbilical cord tissue was profiled using Illumina HumanMethylation450 arrays. Associations of maternal mid-pregnancy fasting (fasting plasma glucose [FPG]) and 2-hour plasma glucose (2hPG) after a 75-g oral glucose challenge with both maternal clinical phenotypes and offspring epigenome at delivery were investigated separately.ResultsMaternal age, prepregnancy body mass index, and blood pressure measures were associated with both FPG and 2hPG, whereas Chinese ethnicity (P = 1.9 × 10-4), maternal height (P = 1.1 × 10-4), pregnancy weight gain (P = 2.2 × 10-3), prepregnancy alcohol consumption (P = 4.6 × 10-4), and tobacco exposure (P = 1.9 × 10-3) showed significantly opposite associations between the 2 glucose measures. Most importantly, we observed a dichotomy in the effects of these glycemic indices on the offspring epigenome. Offspring born to mothers with elevated 2hPG showed global hypomethylation. CpGs most associated with the 2 measures also reflected differences in gene ontologies and had different associations with offspring birthweight.ConclusionsOur findings suggest that 2 traditionally used glycemic indices for diagnosing gestational diabetes may reflect distinctive pathophysiologies in pregnancy, and have differential impacts on the offspring’s DNA methylome.

Objective: The ongoing coronavirus 2019 (COVID-19) pandemic is disproportionally impacting the adult population. This study describes the experiences after repurposing a PICU and its staff for adult critical care within a state mandated COVID-19 hospital and compares the outcomes to adult patients admitted to the institution's MICU during the same period.Design: A retrospective chart review was performed to analyze outcomes for the adults admitted to the PICU and MICU during the 27-day period the PICU was incorporated into the institution's adult critical care surge plan.Setting: Tertiary care state University hospital.Patients: Critically ill adult patients with proven or suspected COVID-19.Interventions: To select the most ideal adult patients for PICU admission a tiered approach that incorporated older patients with more comorbidities at each stage was implemented.Measurements and Main Results: There were 140 patients admitted to the MICU and 9 patients admitted to the PICU during this period. The mean age of the adult patients admitted to the PICU was lower (49.1 vs. 63.2 p = 0.017). There was no statistically significant difference in the number of comorbidities, intubation rates, days of ventilation, dialysis or LOS. Patients selected for PICU care did not have coronary artery disease, CHF, cerebrovascular disease or COPD. Mean admission Sequential Organ Failure Assessment (SOFA) score was lower in patients admitted to the PICU (4 vs. 6.4, p = 0.017) with similar rates of survival to discharge (66.7 vs. 44.4%, p = 0.64).Conclusion: Outcomes for the adult patients who received care in the PICU did not appear to be worse than those who were admitted to the MICU during this time. While limited by a small sample size, this single center cohort study revealed that careful assessment of critical illness considering age and type of co-morbidities may be a safe and effective approach in determining which critically ill adult patients with known or suspected COVID-19 are the most appropriate for PICU admission in general hospitals with primary management by its physicians and nurses.