803 - Externalizing Behaviors in Young Children with MEDB Disorders: An Analysis of ECHO Reports from Community Providers

Publication Number: 803.4582

Shreya Daniel, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Megan E. Bone, Kennedy Krieger Institute, Baltimore, MD, United States; Belinda Chen, Kennedy Krieger Institute, Baltimore, MD, United States; Janna Steinberg, Kennedy Krieger Institute, Baltimore, MD, United States; Mary L. Leppert, Kennedy Krieger Insitute/Johns Hopkins School of Medicine, Baltimore, MD, United States

Background: As the population of children with mental, emotional, developmental, and behavioral (MEDB) disorders is increasing, community providers are providing more diagnostic and ongoing care to this population, especially in underserved areas. ECHO (Extensions for Community Health Outcomes) is an evidence-based collaborative teaching program where community-based providers submit their most challenging cases to a team of multi-specialty experts for consultation, case discussion, and education.

Objective: This study aims to identify trends in symptoms in ECHO case reports as a first step in developing targeted educational interventions for community providers.

Design/Methods: The study team conducted a series of ECHO programs targeting providers serving children ages 0-8 with MEDB disorders in several different regions of the United States. We included providers serving military children and providers in underserved rural areas. We collected data from cases submitted to ECHO programs from 2021 to 2024 and pooled the data, excluding duplicate or incomplete submissions.

Results: Providers across 17 different professions submitted case reports on 59 children between the ages of 1.33 and 13.67 years old who had symptoms of at least 1 MEDB disorder. The average age was 5.71 years. Behavioral concerns emerged as the most prominent subset of data, with all but one report (98.3%) detailing a behavioral concern. 62.3% of the total reported behaviors were externalizing and 37.7% were internalizing. The most common behavioral symptoms reported were aggression, sleep disruption, and tantrums. 49% of patients had comorbid medical symptoms, most commonly gastrointestinal. 44.1% of cases were coded as developmental, behavioral, and emotional, 40.7% as developmental and behavioral, and 11.9% as behavioral and emotional. 64% of patients had been prescribed at least one medication. The most common interventions were individual counseling or therapy, early intervention services, and speech therapy.

Conclusion(s): ECHO participants frequently requested consultation on children with externalizing behaviors and those with multiple comorbid symptoms. Aggression, sleep disruption, and tantrums were the most frequent symptoms brought for consultation. Future research should develop and evaluate the efficacy of more tailored educational interventions in order to better meet the specific needs of providers. Education specific to the management of commonly reported symptoms like aggression, sleep disruption, and tantrums should be included in future programs.