Nathan J Blum

William Penn University, Filadelfia, Pennsylvania, United States

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Publications (45)143.47 Total impact

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    ABSTRACT: Objective: Examine the validity and clinical utility of the Behavioral Health Checklist (BHCL), a screening tool with 2 forms (4-7, 8-12 years) developed for use with children of diverse backgrounds. Method: At pediatric primary care appointments, the parents of 1274 children completed a demographic form, the BHCL, and the Child Behavior Checklist (CBCL). Concurrent validity was examined by conducting correlations between the BHCL and the diagnostic scales of the CBCL. Diagnostic prediction was examined by conducting logistic regression analyses and plotting receiver operating characteristics (ROC) curves. Clinical utility was investigated by examining sensitivity, specificity, and kappa corrections for total predictive power. Results: The pattern of correlations with the CBCL provided evidence of convergent and discriminant validity for both versions of the BHCL. ROC curve plots provided clear evidence of predictive validity (area under curve values ranged from .84 to .96 across factors and both age-determined versions). Cut-points achieving sensitivity and specificity values of at least .70 were identified for each BHCL factor for each version. Conclusion: The BHCL was demonstrated to have strong construct and predictive validity. The predictive validity of each version was demonstrated across genders, socioeconomic status, and racial groups (black or African American and white). The BHCL has promise as a developmentally and culturally effective behavioral health screener for use in pediatric primary care practices.
    No preview · Article · Feb 2016 · Journal of Developmental & Behavioral Pediatrics

  • No preview · Article · Feb 2015 · Journal of Developmental & Behavioral Pediatrics
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    ABSTRACT: To describe the developmental-behavioral pediatricians (DBPs), patients, and clinical practices used in the diagnostic assessments of attention-deficit/hyperactivity disorder (ADHD) within all 12 academic medical centers comprising Developmental-Behavioral Pediatrics Research Network (DBPNet). Between December 2011 and June 2012, all DBPs who evaluated children with ADHD or autism spectrum disorders were asked to complete a diagnostic encounter survey form for up to 10 consecutive new cases that resulted in the diagnosis of ADHD or autism spectrum disorder. Fifty-two clinicians returned one or more forms for children diagnosed with ADHD (n = 211). DBPs were generally experienced full-time academics. Children were 76.3% male, 62.3% white, 24.5% African American, and 20.7% Hispanic. Mean child age was 8.0 + 3.1 years. DBPs reviewed parent ratings of behavior in 84.4% and teacher ratings in 69.2% of cases. They reviewed or completed at least one developmental assessment in 79.2% of cases: intelligence (60.2%), academic (57.8%), fine motor or visual motor (39.3%), speech/language (34.6%), or adaptive skills (28.9%). They made the diagnosis of coexisting conditions in 82.7% of cases, including learning disabilities (31.8%), speech/language disorders (31.8%), anxiety (14.2%), externalizing disorders (10.9%), and sleep disorders (9.5%). Among 146 children not medicated before the visit, stimulant medications were initiated in 15 children (10.2%). Within DBPNet, DBPs were highly likely to complete comprehensive assessments of ADHD that went beyond the requirements of primary care practice guidelines. They typically identified coexisting developmental and learning conditions. They did not typically prescribe medication at the end of diagnostic encounters. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Nov 2014 · Academic Pediatrics
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    ABSTRACT: To describe the development and psychometric evaluation of the Core Competency Measure (CCM), an instrument designed to assess professional competencies as defined by the Maternal Child Health Bureau (MCHB) and targeted by Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs. The CCM is a 44-item self-report measure comprised of six subscales to assess clinical, interdisciplinary, family-centered/cultural, community, research, and advocacy/policy competencies. The CCM was developed in an iterative fashion through participatory action research, and then nine cohorts of LEND trainees (N = 144) from 14 different disciplines completed the CCM during the first week of the training program. A 6-factor confirmatory factor analysis model was fit to data from the 44 original items. After three items were removed, the model adequately fit the data (comparative fit indices = .93, root mean error of approximation = .06) with all factor loadings exceeding .55. The measure was determined to be quite reliable as adequate internal consistency and test-retest reliability were found for each subscale. The instrument's construct validity was supported by expected differences in self-rated competencies among fellows representing various disciplines, and the convergent validity was supported by the pattern of inter-correlations between subscale scores. The CCM appears to be a reliable and valid measure of MCHB core competencies for our sample of LEND trainees. It provides an assessment of key training areas addressed by the LEND program. Although the measure was developed within only one LEND Program, with additional research it has the potential to serve as a standardized tool to evaluate the strengths and limitations of MCHB training, both within and between programs.
    Preview · Article · Jun 2014 · Maternal and Child Health Journal
  • Heidi M. Feldman · Nathan J. Blum · Amy Gahman · Justine Shults

    No preview · Article · Feb 2014 · Journal of Developmental & Behavioral Pediatrics
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    ABSTRACT: Research is needed to identify challenges to developmental screening and strategies for screening in an urban pediatric setting. Parents of young children and clinicians at four urban pediatric practices participated in focus groups prior to implementation of screening. Participants were queried regarding attitudes, social norms, and barriers to developmental screening. Using information from the focus groups, workflow strategies were developed for implementing screening. Referral rates and satisfaction with screening were gathered at the conclusion. Six focus groups of parents and clinicians were conducted. Major themes identified included 1) parents desired greater input on child development and increased time with physicians, 2) physicians did not fully trust parental input, 3) physicians preferred clinical acumen over screening tools, and 4) physicians lacked time and training to conduct screening. For the intervention, developmental screening was implemented at the 9-, 18-, 24-, and 30-month well visits using the Ages & Stages Questionnaire-II and the Modified Checklist for Toddlers. 1397 (98% of eligible) children under 36 months old were enrolled, and 1184 (84%) were screened at least once. 1002 parents (85%) completed a survey at the conclusion of the screening trial. Most parents reported no difficulty completing the screens (99%), felt the screens covered important areas of child development (98%), and felt they learned about their child's strengths and limitations (88%). Developmental screening in urban low-income practices is feasible and acceptable, but requires strategies to capture parental input, provide training, facilitate referrals, and develop workflow procedures and electronic decision support.
    Full-text · Article · Jan 2014 · BMC Pediatrics
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    ABSTRACT: IntroductionAttention deficit/hyperactivity disorder (ADHD) is one of the most common childhood mental health disorders, affecting 4–12% of school age children.1 Racial and ethnic disparities in ADHD care exist in that minority children are less likely to be identified and treated for ADHD than Caucasian children.2–4 For example, in one study examining children diagnosed with ADHD, 76% of Caucasian children were reported to take medication, compared to 56% of African-American children and 53% of Latino children.4Family, practitioner, and community factors contribute to these disparities. Research has demonstrated that African-American parents are less knowledgeable about ADHD, less likely to apply this label to their child’s behavior, and less likely to trust health professionals than Caucasian parents.5–7 Ethnic minority parents may also be more concerned about the stigma of the diagnosis and more hesitant to seek mental health care.4,8,9Primary care physicians (PCPs) provide much of
    Full-text · Article · Jan 2014 · The Journal of Behavioral Health Services & Research

  • No preview · Article · Jan 2014
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    ABSTRACT: To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. The parents of 4-12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children's hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care.
    Full-text · Article · Aug 2013 · Journal of Pediatric Psychology
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    ABSTRACT: Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers that can be applied in both primary care and school settings are described. The paper has a primary focus on children with ADHD, but the principles and strategies described are applicable to children with a range of mental health and health conditions.
    No preview · Article · Mar 2013 · Advances in School Mental Health Promotion
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    ABSTRACT: To achieve consensus regarding important clinical, translational, and health services research questions for the field of developmental-behavioral pediatrics (DBP). Twenty-seven developmental-behavioral pediatricians, 16 psychologists, and 12 parents participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point Likert scale. Questions were rated as consensus important questions if they had a median score of 7 and the 25th percentile was at least 6 or the coefficient of variation ≤30 (suggesting consensus). Questions were rated as potentially important if they had a median of 7, but a coefficient of variation >30 or if specific stakeholder group ratings suggested importance. After providing participants the Round II results, potentially important questions were rated a second time (Round III). In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, 10 additional questions were rated as consensus important questions. Of the 39 consensus important questions, 20 were efficacy or comparative effectiveness studies and 40% related to autism spectrum disorders. This Delphi process identified a set of high priority clinical, translational, and health services research topics for DBP that can guide research to advance the field and improve care and outcomes for children with DBP conditions.
    No preview · Article · Jun 2012 · Journal of developmental and behavioral pediatrics: JDBP
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    ABSTRACT: Accumulating evidence highlights the importance of using psychosocial approaches to intervention for children with attention-deficit/hyperactivity disorder (ADHD) that target the family and school, as well as the intersection of family and school. This study evaluated the effectiveness of a family-school intervention, Family-School Success (FSS), designed to improve the family and educational functioning of students in Grades 2-6 who meet criteria for ADHD combined and inattentive types. Key components of FSS were conjoint behavioral consultation, daily report cards, and behavioral homework interventions. FSS was provided over 12 weekly sessions, which included 6 group sessions, 4 individualized family sessions, and 2 school-based consultations. Participating families were given the choice of placing their children on medication; 43% of children were on medication at the time of random assignment. Children (n = 199) were randomly assigned to FSS or a comparison group controlling for non-specific treatment effects (Coping With ADHD Through Relationships and Education [CARE]). Outcomes were assessed at post-intervention and 3-month follow-up. The analyses controlled for child medication status. FSS had a significant effect on the quality of the family-school relationship, homework performance, and parenting behavior. The superiority of FSS was demonstrated even though about 40% of the participants in FSS and CARE were on an optimal dose of medication and there were significant time effects on each measure. This relatively brief intervention produced effect sizes comparable to those of the more intensive Multimodal Treatment Study of Children With ADHD (MTA) behavioral intervention.
    Full-text · Article · Apr 2012 · Journal of Consulting and Clinical Psychology
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    ABSTRACT: Racial differences are documented in the timing and type of autism spectrum disorder (ASD) diagnosis among white and African American children. Differences in clinical presentation by race may contribute to these disparities. This study explores documented differences in core ASD symptoms and associated behavioral features among African American and white children. This project is a secondary data analysis from the Pennsylvania Autism and Developmental Disabilities Surveillance Program and utilized methodology that evaluates existing records, reviews, and codes for DSM-IV criteria for ASD and 12 associated behavioral features. The sample comprised 343 children meeting surveillance case definition for ASD, from 3 population-based cohorts of children in Philadelphia County. A higher frequency of white children compared to African American children with ASD have documented DSM-IV criteria of inflexible adherence to nonfunctional routines/rituals (92% vs 81%; p = .005) and persistent preoccupation with parts of objects (67% vs 50%; p = .002). A higher frequency of white children with ASD compared to African American children with ASD have documented abnormal motor development (74% vs 60%; p = .008) and odd responses to sensory stimuli (76% vs 51%; p < .001). There were no significant differences in externalizing behaviors or reciprocal social interaction. This study suggests differences in the types of ASD symptoms and associated behavioral features exhibited by African American as compared to white children with ASD. Further research is needed to determine if these differences contribute to disparities in the timing or type of ASD diagnosis.
    No preview · Article · Jan 2012 · Disability and Health Journal
  • Nathan J Blum
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    ABSTRACT: Developmental-behavioral pediatrics was formally recognized as a subspecialty of pediatrics in 1999 with one of the goals being to promote research in the field. However, research has generally been a small component of most developmental-behavioral pediatricians' activities. In an effort to expand research in the field, the Developmental-Behavioral Pediatrics Research Network (DBPNet) was funded through a cooperative agreement with the Health Resources and Services Administration, Maternal Child Health Bureau. This funding supports the development of an infrastructure to support multisite research that aims to optimize the health and functional status of children with developmental and behavioral concerns and disorders. This article describes the need for a developmental-behavioral pediatrics research network, the development of the infrastructure for DBPNet, and the mechanisms for investigators to collaborate with the Network.
    No preview · Article · Jan 2012 · Journal of developmental and behavioral pediatrics: JDBP
  • David S Stein · Nathan J Blum · William J Barbaresi
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    ABSTRACT: Developmental and behavioral disorders including intellectual disability, learning disabilities, and attention-deficit/hyperactivity disorder are highly prevalent, chronic health conditions. Despite being versed in caring for children with these conditions, pediatricians might be less prepared for challenging questions from families about the long-term course of these conditions and what can be done to improve outcomes. Through this state-of-the-art review, we provide clinicians with an understanding of the course of these conditions and adult outcomes in several areas including vocational, social, and health domains. We also provide a review of the most current research examining factors that predict or mediate adult outcomes for people with intellectual disability, learning disabilities, and attention-deficit/hyperactivity disorder. On the basis of the current literature, we offer practice recommendations aimed at optimizing adult outcomes for those with these disorders.
    No preview · Article · Aug 2011 · PEDIATRICS
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    ABSTRACT: This study investigated whether components of attention and executive functioning improve when children with attention-deficit-hyperactivity disorder (ADHD) are treated with osmotic-release oral system (OROS) methylphenidate. Thirty children (24 males, six females; mean age 8y 6mo, SD 1y 11mo; range 6y 5mo -12y 6mo) with ADHD combined type participated in a double-blind, placebo-controlled crossover trial with the child's clinically most effective dose as identified with a systematic open-label titration procedure. After 1 week on each treatment (placebo and OROS methylphenidate), a neuropsychological battery that assessed sustained attention, selective attention, attentional control, response inhibition, and working memory was administered. This battery included the Gordon Diagnostic System, seven subtests of the Test of Everyday Attention for Children, and two tests of working memory. Performance on two of three tests of response inhibition improved on OROS methylphenidate compared with placebo (p<0.01). Performance on one of two tasks assessing attentional control and one of five measures assessing sustained attention demonstrated clear improvement. There was no improvement on the two tasks assessing selective attention or the two tasks assessing working memory. When OROS methylphenidate was used to treat children with ADHD at the clinically most effective dose, general improvement was noted on tasks requiring response inhibition; response to treatment in other domains was either variable or not demonstrated.
    Full-text · Article · May 2011 · Developmental Medicine & Child Neurology
  • Martin T Stein · Nathan J Blum · Meghan Korey Lukasik
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    ABSTRACT: CASE: Mark is a 7 year old with severe mental retardation and self-injurious behavior. The behaviors include hitting his face with his fist and banging his head against the wall, floor, or table. These behaviors occurred intermittently in the past. During the past 6 months, they have increased in frequency and intensity and caused bruising and swelling of his forehead. The behaviors have occurred in both the home and school environment, but seem to be more frequent and intense at home. Mark's parents state that occasionally the behaviors occur when Mark is so frustrated that he can't do something that he wants to do, but more frequently they occur for "no reason at all." Mark could be watching TV or playing with a toy and begin head banging. His parents have managed the behavior by verbal reprimands. If that is not effective, they will hold Mark to prevent him from hitting himself or move him onto his bed with pillows against the wall. These procedures are very disruptive to the family now that the behavior is occurring at least a couple times on most days. Mark is not on any medications. He has not had seizures. He has had ear infections and constipation in the past and was treated for gastroesophageal reflux as an infant. He sleeps 9 hours each night without snoring. There has been no change in his appetite or sleep. His parents estimate that he has about 20 words that he uses communicatively. Mark lives at home with both parents and 2 younger siblings. For the past 2 years, he has attended the same life skills class with 8 students, a teacher and 2 assistants. Mark's mother had postpartum depression after the birth of his 5-year-old brother. The physical examination does not demonstrate any change in his growth percentiles. The skin on the right side of his face is erythematous as he was hitting it prior to the examination. There is no sign of otitis media.
    No preview · Article · Apr 2010 · Journal of developmental and behavioral pediatrics: JDBP
  • Nathan J Blum · Lynne M Bird · Martin T Stein
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    ABSTRACT: CASE: A 10-month-old boy was seen for the first time for a health supervision visit by a pediatrician. A brief review of the child's medical history did not reveal any specific problems. On physical examination, the pediatrician found an alert, smiling child, but she was surprised by the following observations: unable to sit without support, absent pincer grasp, no audible language, unilateral exotropia, and microcephaly. Expansion of the medical history revealed an uneventful full-term prenatal course and normal vaginal delivery. The mother denied use of alcohol or other drugs/medications during the pregnancy. She did not have a recent history of any infections, unexplained fevers, or high risks for sexually transmitted disease. The baby cried spontaneously and the parents reported no resuscitation efforts. There were early feeding problems associated with a poor suck and gastroesophageal reflux. The parents were healthy and this was their first child. Family history was negative for early problems in child development or any neurological conditions. Parents were high school graduates without any learning problems; they were both employed in retail sales with a steady employment history. The pediatrician then took a second look at the child and discovered truncal hypotonia, extremity hypertonia, tongue protrusion, and a broad mouth. She concluded that the child had a global developmental delay, including delays in motor, language, and social development.
    No preview · Article · Apr 2010 · Journal of developmental and behavioral pediatrics: JDBP
  • Patty Huang · Nathan J Blum

    No preview · Article · Jan 2010 · Journal of developmental and behavioral pediatrics: JDBP
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    ABSTRACT: Physical disabilities may affect a child passenger's fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007-2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0-15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0-8 and 9-15 years, respectively). A greater proportion of children with SPHCN aged 0-8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9-15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0-8 years: OR 1.27, 95% CI: 0.48-3.33; children aged 9-15 years: OR 1.51, 95% CI: 0.38-6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0-8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.
    No preview · Article · Nov 2009 · Maternal and Child Health Journal

Publication Stats

639 Citations
143.47 Total Impact Points

Institutions

  • 2004-2014
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2002-2014
    • The Children's Hospital of Philadelphia
      • • Department of Pediatrics
      • • Division of Child Development and Rehabilitation Medicine
      Filadelfia, Pennsylvania, United States
  • 1996-2000
    • University of Pennsylvania
      • Department of Medicine
      Philadelphia, Pennsylvania, United States