Importance Perinatal depression is common in sub-Saharan Africa, yet treatment gaps are substantial. Cognitive behavioral therapy (CBT) is effective but relies on written materials. Objective To evaluate the efficacy of a culturally adapted CBT intervention delivered by lay counselors to women with perinatal depression in rural Sierra Leone. Design, Setting, and Participants This study was an individually randomized, outcomes assessor- and investigator-blinded, clinical trial of an adapted CBT intervention vs enhanced usual care. The trial was conducted in 6 government-run antenatal clinics in Pujehun District, Sierra Leone, which has limited infrastructure, low literacy, high maternal undernutrition, and no perinatal mental health services. Participants were drawn from a concurrent antenatal nutritional supplementation trial between November 2023 and April 2025. Eligible participants were pregnant and postpartum women who were undernourished and had depression (scoring ≥9 on the adapted Patient Health Questionnaire-9 [aPHQ-9]). Intervention Participants were randomized 1:1 to receive 6 weekly sessions of CBT adapted for delivery without written materials or only enhanced usual care. All participants received enhanced usual care, which consisted of antenatal nutritional supplementation, monthly malaria chemoprophylaxis, and 2 doses of azithromycin. Main Outcomes and Measures The primary outcome was aPHQ-9 score at 8 weeks. Secondary outcomes included clinically meaningful symptom reduction (decrease of >3 points) and remission (aPHQ-9 score <5). Results Among 881 women screened, 155 (median [IQR] age, 19 [18 to 22] years) were randomized to CBT (80 women) or control (75 women) groups. Postintervention data were available for 140 of 153 eligible participants (91.5%). Median aPHQ-9 scores at postintervention were lower in the CBT group than the control group (median difference, –4; 95% CI, –5 to –3; P < .001). Clinically meaningful symptom reductions were more common with CBT vs control (72 participants [96.0%] vs 36 participants [55.4%]; odds ratio, 19.33; 95% CI, 6.33 to 84.59; P < .001), and 59 CBT participants (78.6%) achieved remission compared with 22 participants (33.8%) in the control group (odds ratio, 7.21; 95% CI, 3.39 to 15.33; P < .001). Attenuated effects persisted through 9 months after pregnancy (median difference in aPHQ9 for intervention vs control, −1; 95% CI, −2 to 0; P = .02). Conclusions and Relevance In this study, a culturally adapted CBT intervention delivered by lay counselors reduced depressive symptoms approximately 8 weeks after enrollment compared with enhanced usual care. These findings suggest that CBT adapted for low-literacy settings may offer a scalable model for treatment where mental health professionals are scarce. Trial Registration ClinicalTrials.gov Identifier: NCT05949190

Importance:Perinatal depression is common in sub-Saharan Africa, yet treatment gaps are substantial. Cognitive behavioral therapy (CBT) is effective but relies on written materials. Objective:To evaluate the efficacy of a culturally adapted CBT intervention delivered by lay counselors to women with perinatal depression in rural Sierra Leone. Design, Setting, and Participants:This study was an individually randomized, outcomes assessor- and investigator-blinded, clinical trial of an adapted CBT intervention vs enhanced usual care. The trial was conducted in 6 government-run antenatal clinics in Pujehun District, Sierra Leone, which has limited infrastructure, low literacy, high maternal undernutrition, and no perinatal mental health services. Participants were drawn from a concurrent antenatal nutritional supplementation trial between November 2023 and April 2025. Eligible participants were pregnant and postpartum women who were undernourished and had depression (scoring ≥9 on the adapted Patient Health Questionnaire-9 [aPHQ-9]). Intervention:Participants were randomized 1:1 to receive 6 weekly sessions of CBT adapted for delivery without written materials or only enhanced usual care. All participants received enhanced usual care, which consisted of antenatal nutritional supplementation, monthly malaria chemoprophylaxis, and 2 doses of azithromycin. Main Outcomes and Measures:The primary outcome was aPHQ-9 score at 8 weeks. Secondary outcomes included clinically meaningful symptom reduction (decrease of >3 points) and remission (aPHQ-9 score <5). Results:Among 881 women screened, 155 (median [IQR] age, 19 [18 to 22] years) were randomized to CBT (80 women) or control (75 women) groups. Postintervention data were available for 140 of 153 eligible participants (91.5%). Median aPHQ-9 scores at postintervention were lower in the CBT group than the control group (median difference, -4; 95% CI, -5 to -3; P < .001). Clinically meaningful symptom reductions were more common with CBT vs control (72 participants [96.0%] vs 36 participants [55.4%]; odds ratio, 19.33; 95% CI, 6.33 to 84.59; P < .001), and 59 CBT participants (78.6%) achieved remission compared with 22 participants (33.8%) in the control group (odds ratio, 7.21; 95% CI, 3.39 to 15.33; P < .001). Attenuated effects persisted through 9 months after pregnancy (median difference in aPHQ9 for intervention vs control, -1; 95% CI, -2 to 0; P = .02). Conclusions and Relevance:In this study, a culturally adapted CBT intervention delivered by lay counselors reduced depressive symptoms approximately 8 weeks after enrollment compared with enhanced usual care. These findings suggest that CBT adapted for low-literacy settings may offer a scalable model for treatment where mental health professionals are scarce. Trial Registration:ClinicalTrials.gov Identifier: NCT05949190.

The human gut microbiome is linked to child malnutrition, yet traditional microbiome approaches lack resolution. We hypothesized that complete metagenome-assembled genomes (cMAGs), recovered through long-read (LR) DNA sequencing, would enable pangenome and microbial genome-wide association study (GWAS) analyses to identify microbial genetic associations with child linear growth. LR methods produced 44-64× more cMAGs per gigabase pair (Gbp) than short-read methods, with PacBio (PB) yielding the most accurate and cost-effective assemblies. In a Malawian longitudinal pediatric cohort, we generated 986 cMAGs (839 circular) from 47 samples and applied this database to an expanded set of 210 samples. Machine learning identified species predictive of linear growth. Pangenome analyses revealed microbial genetic associations with linear growth, while genome instability correlated with declining length-for-age Z score (LAZ). This resource demonstrates the power of comparing cMAGs with health trajectories and establishes a new standard for microbiome association studies.

There is limited information concerning the presence of empirically derived, person-centered latent cognitive profiles in youth with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) and whether these profiles are diagnostically useful. The aim of this study was to identify empirically driven cognitive subgroups in youth with ASD or ADHD and examine predictors of those profiles. A retrospective chart review was conducted with patients seen at a developmental assessment clinic who were identified with ASD or ADHD aged 2 to 16 years (n = 1,679, Mage = 8.4, SDage = 3.1). A Latent Profile Analysis with Stanford-Binet-Fifth Edition composites resulted in 14 profiles, which were roughly parallel to each other across various levels of cognitive functioning. Several profiles were characterized by a relatively large discrepancy between the Nonverbal IQ and Verbal IQ. Younger age and higher IQ were significant predictors of those with scattered profiles, whereas diagnoses (i.e., ASD or ADHD), sex, and emotional-behavioral functioning were not.

BACKGROUND:Integrated primary care (IPC) is hypothesized to improve outcomes by increasing the use of mental health interventions. We aimed to conduct a meta-analytic evaluation of the effect of IPC models on the use of mental health services compared with usual or enhanced usual primary care. METHODS:We searched the Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS databases for studies published from January 1, 1998, to December 15, 2024. A total of 9852 nonduplicate records were retrieved and 12 met inclusion criteria. We included published, peer-reviewed, randomized, and nonrandomized trials that evaluated an IPC intervention and included a comparator condition. We excluded trials with fewer than 10 participants in the treatment or comparator arms. Two independent reviewers screened abstracts, evaluated full texts, and extracted data. We conducted a multilevel meta-analysis to determine the odds ratios (ORs) of receiving treatment for participants in IPC vs comparator conditions. RESULTS:IPC resulted in increased odds of receiving any intervention (OR, 12.23; 95% CI, 3.64-41.07), a minimum dose of intervention (OR, 10.92; 95% CI, 3.28-36.32), and full course of intervention (OR, 19.17; 95% CI, 3.02-121.53) compared with usual and enhanced usual care. CONCLUSION:IPC significantly increased the reach of mental health services. Our study limitations included observing interstudy heterogeneity, identifying relatively few studies meeting inclusion criteria, and the authors not clearly articulating the integrated model employed. Additional research is needed to identify the specific elements of various IPC models that most contribute to increased access to and use of services.

BACKGROUND:Environmental enteric dysfunction and linear growth faltering are common among children with moderate acute malnutrition (MAM) in low-income countries. Eggs contain high-quality protein and bioactive compounds that may improve gut integrity and growth. OBJECTIVES:This study aims to determine if daily supplementation with whole egg powder compared with corn flour for 24 wk reduces small intestinal permeability and improves linear growth in children with MAM. METHODS:This individually randomized, outcomes-assessor and investigator-blinded, controlled trial enrolled participants aged 6-30 mo with MAM in Pujehun District, Sierra Leone. Participants received either 15 g/d whole egg powder or nearly isoenergetic corn flour for 24 wk. All children received Supercereal Plus for 6 wk, daily micronutrient supplementation, and malaria chemoprophylaxis every 6 wk. Primary outcomes were change in length-for-age z-score (ΔLAZ) at 12 and 24 wk and percent urinary lactulose excretion (%L) at 12 and 24 wk. RESULTS:Of 461 enrolled children, 338 (73%) were eligible for ≥1 primary outcome analysis at 12 wk and 272 (59%) at 24 wk. No differences were observed in ΔLAZ at 12 wk [difference = 0.01; 95% confidence interval (CI): -0.09, 0.11; P = 0.79] or 24 wk (difference = 0.08; 95% CI: -0.05, 0.21; P = 0.22). Over 90% of participants had increased intestinal permeability, and there were no differences in %L excretion at 12 wk (median of differences: 0.02; 95% CI: -0.03, 0.07; P = 0.44) or 24 wk (median of differences = 0.0; 95% CI: -0.05, 0.06; P = 0.90). No significant differences were observed in the rates of weight, length, or mid-upper arm circumference gain. CONCLUSIONS:Supplementation with whole egg powder for 24 wk, while providing ample amounts of essential amino acids, did not improve linear growth or reduce small intestinal permeability when compared with corn flour in children with MAM. This trial was registered at clinicaltrials.gov as NCT06002438.

Purpose: To evaluate changes over time in oral health fatalism (OHF) and oral health self-efficacy (OHSE) in the context of an intervention, in caregivers of children with autism spectrum disorder (ASD). Methods: This secondary analysis used questionnaire data from a parent study of 118 Medicaid-eligible families of children with ASD enrolled in a longitudinal, multi-site randomized clinical trial testing the efficacy of a novel parent training (PT) intervention relative to psychoeducational toolkit for improving home oral hygiene and dental health. OHF and OHSE belief endorsements were evaluated at baseline, three months, and six months. Results: At baseline, 25 percent of caregivers disagreed with the OHF-endorsing statement "Most children eventually develop dental cavities," and 11 percent did not report confidence with OHSE statements. At six months, 34 percent did not endorse OHF and five percent did not report confidence with OHSE. Using the generalized linear mixed model, the percent change from baseline to six months in caregivers disagreeing with OHF and endorsing OHSE was significant (P<0.05). A repeated mea- sures analysis of variance test determined the relationship between the effects of treatment and time on OHF and OHSE. No difference was found in OHF and OHSE beliefs over time between groups (P>0.05); however, a significant effect was found on OHF change over time within subjects (P<0.05). Conclusions: There was no statistically significant difference in endorsement of OHF or OHSE between groups at six months. However, within all subjects, OHF beliefs became less endorsed and OHSE confidence improved over time.

School feeding provides nutrition, brings order to the school day, and enhances student participation. School feeding in low-income countries is often sporadic due to coordination challenges among multiple stakeholders. To assess the reliability of school feeding in Mion district, a food-insecure area in northern Ghana, Project Peanut Butter (PPB) studied ready-to-use school meals (RUSMs) and micronutrient-fortified home-grown school food (HGSF). The school meals were initially provided daily in elementary schools and then extended to junior high schools. The key elements of functional programming were qualitatively compared: costs, ingredient and nutrient content, food preparation, food distribution, and consumer engagement. The cost of ingredients and nutrient content were similar between RUSM and HGSF. Safe and efficient food preparation, distribution, and storage were more readily achieved by RUSM. Consumer engagement is essential for acceptance, but can pose a challenge and disruption contingent upon the degree of ownership the community asserts over food rations. This was seen when pre-school age children were sent to collect food rations from the elementary schools in numbers that exceeded the student enrollment. Overall, the use of a RUSM in a resource-constrained setting allowed for greater safety and reliability of school meals at a similar cost.

Undernutrition in pregnancy remains a substantial problem worldwide, disproportionately affecting females living in low- and middle-income countries where food insecurity and limited access to high-quality nutrition exacerbate maternal and fetal health risks. Undernutrition during this critical time in the lifecycle can have adverse effects on both the pregnant female and her offspring. Despite the widespread recognition of this issue, current international guidelines provide insufficient direction on optimal nutritional management strategies. Most clinical trial evidence has yielded inconclusive results. This perspective synthesizes evidence on current management strategies in addressing macronutrient and micronutrient deficiencies in pregnancy. Additionally, we examine the critical role of inflammation in moderating the effectiveness of nutritional interventions and discuss emerging strategies that integrate infection control with nutrition to optimize maternal and neonatal outcomes. Given the limitations of existing management strategies, there is an urgent need for more comprehensive, evidence-based guidelines to improve pregnancy outcomes for undernourished females worldwide.

Objective To evaluate the effects of behavioral health interventions delivered within pediatric integrated primary care models on clinical outcomes.Methods We searched Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS for studies published from January 1, 1998, to September 20, 2023. We included studies that evaluated onsite behavioral health integration in pediatric primary care using a comparator condition (usual, enhanced usual care, or waitlist). Outcome data on symptom change, impairment/quality of life, health indicator, and behavior change were extracted using Covidence software. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed Risk of bias analysis was conducted using the Cochrane Risk of Bias tool. We used multilevel meta-analysis to synthesize multiple outcomes nested within studies. Open Science Foundation pre-registration: #10.17605/OSF.IO/WV7XP.Results In total, 33 papers representing 27 studies involving 6,879 children and caregivers were included. Twenty-four studies were randomized controlled trials and three were quasi-experimental designs. Seventeen papers reported on treatment trials and 16 reported on prevention trials. We found a small overall effect size (SMD = 0.19, 95% confidence interval [0.11, 0.27]) supporting the superiority of integrated primary care to usual or enhanced usual care. Moderator analyses suggested similar effectiveness between co-located and integrated models and no statistically significant differences were found between treatment and prevention trials.Conclusions Results suggest that integrated primary care is superior to usual and enhanced usual care at improving behavior, quality of life, and symptoms. Integrated primary care research needs improved standards for reporting to promote better synthesis and understanding of the literature.

BACKGROUND:Treatment of functional constipation (FC) in children with autism spectrum disorder (ASD) is challenging due to sensory and behavioral issues. We aimed to understand whether antegrade continence enemas (ACEs) are successful in the treatment of FC in children with ASD. METHODS:A single-institution retrospective review was performed in children diagnosed with ASD and FC who underwent appendicostomy or cecostomy placement from 2007 to 2019. Descriptive statistics regarding soiling and complications were calculated. RESULTS:There were 33 patients included, with a median age of 9.7 years at the time of ACE initiation. The average intelligence quotient was 63.6 (SD = 18.0, n = 12), the average behavioral adaptive score was 59.9 (SD = 11.1, n = 13), and the average total Child Behavioral Checklist score was 72.5 (SD = 7.1, n = 10). Soiling rates were significantly lower following ACE initiation (42.3% vs. 14.8%, p = 0.04). Behavioral issues only prevented 1 patient (3.0%) from proper ACE use. Eleven patients (36.6%) were able to transition to laxatives. There were significant improvements in patient-reported outcomes measures and quality of life. CONCLUSION:Placement of an appendicostomy or cecostomy for management of FC in children with severe ASD was successful in treating constipation and improving quality of life.

Objectives:Children with functional constipation (FC) and autism spectrum disorder (ASD) often face sensory and behavioral conditions that prevent giving oral medical therapy to improve constipation and incontinence. We aimed to assess whether children with ASD and FC who had difficulty in taking oral medications could benefit from gastrostomy tube (GT) placement. Methods:A single-institution retrospective review was performed in children diagnosed with ASD and FC from 2020 to 2023. Children were considered candidates for GT if they suffered from constipation that adversely affected daily function and refused adequate oral medical therapy. Data were collected on ASD severity and FC symptoms before GT and after GT placement. Results:There were nine patients who underwent GT placement. Median age was 7.4 years (interquartile range [IQR]: 4.8-9.7). Of the five with available ASD evaluations, four had extremely low intelligence quotient and extremely low adaptive skills; only one child of the nine was verbal. Before GT placement, most patients had Bristol 1 or 2 consistency stool (66.7%); following placement, most had Bristol 5 or 6 consistency stool (66.7%). Seven children strained with bowel movements before GT; only one child strained after GT. There were no tube dislodgements or site infections. Gastrointestinal quality of life scores improved for both constipation (+38.5, IQR: 27.5-54.3) and medication administration (+31.5, IQR: 0.0-75.0). Conclusions:GT placement may be a viable option in children with FC and ASD with minimal complications, improvement in constipation, and improvement in quality of life. Further prospective study will ensure generalizability of these results.

This 24-week single-blind trial tested a modular approach for young autistic children (MAYAC) that was delivered for fewer hours per week and modified based on child progress and parental input compared to comprehensive behavioral intervention treatment as usual (CBI, TAU). Participants were autistic children, ages 18-60 months of age. MAYAC was initially 5 h of intervention per week, one of which was parent training and the other four direct therapy focusing on social communication and engagement, but additional modules could be added for up to 10 h per week. Comprehensive behavior intervention was delivered for ≥15 h per week. Outcome measures included the Vineland Adaptive Behavior Scales; VABS, the Ohio Autism Clinical Improvement Scale - Autism Severity; OACIS - AS and the Pervasive Developmental Disorder Behavior Inventory - Parent; PDDBI-P. Implementation and parent satisfaction measures were also collected. Fifty-six children, mean age of 34 months, were randomized. Within-group analysis revealed significant improvements from baseline to week 24 for both MAYAC (p < 0.0001) and CBI, TAU (p < 0.0001) on the VABS. The noninferiority test was performed to test between group differences and MAYAC was not inferior to CBI, TAU on the VABS (p = 0.0144). On the OACIS - AS, 48.0% of MAYAC and 45.5% of CBI were treatment responders there were no significant changes on the PDDBI-P, for either group. Treatment fidelity was high for both groups (>95%) as was parent satisfaction. Findings from this small trial are promising and suggest MAYAC may be an alternative for some young autistic children and their families to CBI, TAU.

Breastfeeding provides optimal infant nutrition; however, <50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study’s primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p < 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p < 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.

Accurate assessment of cognitive development of young children is a vital component of developmental evaluations. Direct assessment of developmental skills is not always feasible, but there is limited information on the agreement between direct assessment and caregiver-reported cognitive skills. There is limited information regarding the accuracy of the parent-reported Developmental Profile 4 (DP-4) in comparison to the widely-used developmental measure, the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). The purpose of the current study was to evaluate whether a standardized parent interview can effectively identify children at risk for cognitive developmental delays. We compared the agreement between the Bayley-4 Cognitive and the Developmental Profile 4 (DP-4) in young children being evaluated in-person for early developmental delays. 182 children (134 with an autism diagnosis), ages 6–42 months, completed both assessments. Results showed that Bayley-4 Cognitive scores had a moderately strong correlation with DP4-Cognitive scores (r = 0.70, p < 0.001). A cutoff of 70 or 69 on the DP-4 Cognitive was determined as ideal for identifying developmental delay based on diagnosis of global developmental delay or the Bayley-4 Cognitive. Our analyses revealed good agreement between DP-4 and Bayley-4 Cognitive scores, even after controlling for confounding variables such as degree of ASD characteristics, age, and sex. These results suggest that caregiver-report measures can be a valid and useful tool in the assessment of young children, particularly when direct developmental assessment is not feasible.

BACKGROUND:Bovine milk is a beneficial ingredient in teh treatment of malnutrition. OBJECTIVES:Our objectives were to determine the effect of dietary milk protein and milk carbohydrate on the intestinal permeability, fecal 16S rRNA gene configuration, and fecal metabolomics of children with moderate malnutrition. METHODS:This was a randomized, double-blind, controlled trial among 413 children with wasting in rural Sierra Leone who received 1 of the following 4 supplementary foods, which differed in sources of protein and carbohydrate: milk protein and milk carbohydrate (MPMC), milk protein and vegetable carbohydrate (MPVC), vegetable protein and milk carbohydrate (VPMC), or a control group consuming entirely vegetable-based food (VPVC). After 4 wk, urine and stool were collected from participants enrolled with mid-upper arm circumference of <12.1 cm. Urine was analyzed for lactulose excretion (%L). Stool samples were subjected to both 16S rRNA gene analysis to assess β-diversity and untargeted metabolomic abundance. RESULTS:Among the 386 children who completed permeability testing, the mean difference (95% CI) in %L excretion as compared with VPVC was 0.01 (-0.05, 0.07) for MPMC, 0.05 (-0.01, 0.11) for MPVC, and 0.01 (-0.05, 0.07) for VPMC. Of the 374 children who provided a stool sample that was analyzed, the β-diversity among bacterial taxa was similar between dietary groups (P > 0.05 for all comparisons). No significant differences between dietary groups were seen among the 20 most abundant bacterial taxa. Among the 5769 unique metabolomic features identified, greater flavonoid levels in VPVC were seen. CONCLUSIONS:Abnormal intestinal permeability do not improve with 4 wk of supplementary feeding. Fecal rRNA do not differ with consumption of different diets. This trial was registered at clinicaltrials.gov as NCT04216043.

ABSTRACTA simplified, combined protocol treats children with moderate acute malnutrition (MAM), defined by mid‐upper arm circumference (MUAC) of < 125 and ≥ 115 mm and no oedema, with 1 daily sachet of ready‐to‐use therapeutic food (RUTF) and those with severe acute malnutrition (SAM), defined by MUAC < 115 mm and/or oedema, with two daily sachets of RUTF. This protocol was previously shown to result in non‐inferior recovery compared to standard treatment that used higher, weight‐based RUTF dosing among children with SAM and ready‐to‐use supplementary food (RUSF) for MAM in a cluster‐based randomised controlled trial in Kenya and South Sudan. We conducted a secondary analysis of this trial to compare linear growth among children admitted with MUAC < 115 mm. Linear and ponderal growth were calculated from admission to discharge and visualised using aggregate growth curves. HAZ change adjusted for admission characteristics was negative across the course of treatment but similar across arms [−0.21 ± 0.18 SE in the standard arm, −0.24 ± 0.18 SE in simplified; difference (95% confidence interval) 0.03 (−0.12, 0.18)]. The unadjusted mean ± SE linear growth velocity from admission to discharge was 1.8 ± 0.7 mm/week in the standard arm compared to 1.7 ± 0.7 mm/week in the simplified arm [difference = 0.09 (−0.36, 0.53)] and similar in adjusted analysis. MUAC and weight gain velocities were not significantly different by treatment arm. Reducing the RUTF dose prescribed to children during SAM treatment does not appear to affect linear growth or other growth velocities during treatment.

Scatter and heterogeneity in cognitive profiles is thought to be common in autism spectrum disorder (ASD), which may indicate differences in the construct of IQ. However, less research has investigated IQ scatter in attention-deficit/hyperactivity disorder (ADHD). Scatter is also thought to negatively impact the predictive validity of IQ summary scores, although there is research refuting this notion. Abbreviated IQ tests, such as the Stanford-Binet fifth edition (SB-5) abbreviated battery IQ (ABIQ), may be especially susceptible to the influence of scatter. We tested the measurement invariance of the SB-5 as well as the predictive validity of the ABIQ in predicting FSIQ in 1679 youth (21% female) ages 2-16 years with a clinical diagnosis of ASD or ADHD. Results indicated the SB-5 is measuring IQ the same way in ASD and ADHD. There were no differences between diagnostic groups in scatter between ABIQ (i.e., routing) subtests. Additionally, scatter was not related to dimensional autistic traits. Higher degree of scatter was associated with poorer predictive validity of the ABIQ and a higher likelihood of overestimating FSIQ, regardless of diagnosis. Overall, we found more similarities than differences between the ASD and ADHD groups. Our results show that the SB-5 ABIQ is generally a strong predictor of FSIQ in youth with neurodevelopmental disorders. However, the use of the SB-5 ABIQ in research and clinical applications, without consideration of scatter on routing subtests, is potentially problematic.