OBJECTIVE -To quantify the magnitude and pattern of cognitive difficulties in pediatric type 1 diabetes as well as the effects associated with earlier disease onset and severe hypoglycemia.RESEARCH DESIGN AND METHODS -Pediatric studies of cognitive function since 1985 were identified for study inclusion using MEDLINE and PsycInfo. Effect size (ES, Cohen's d) between the diabetic and control groups, expressed in SD units, were calculated within cognitive domains to standardize meta-analysis test performance. RESULTS -The meta-analysis sample of 2,144 children consisted of 1,393 study subjects with type 1 diabetes and 751 control subjects from 19 studies. Overall, type 1 diabetes was associated with slightly lower overall cognition (ES Ϫ0.13), with small differences compared with control subjects across a broad range of domains, excluding learning and memory, which were similar for both groups. Learning and memory skills, both verbal and visual (Ϫ0.28 and Ϫ0.25), were more affected for children with early-onset diabetes (EOD) than late-onset diabetes (LOD), along with attention/executive function skills (Ϫ0.27). Compared with nondiabetic control subjects, EOD effects were larger, up to one-half SD lower, particularly for learning and memory (Ϫ0.49). Generally, seizures were associated with a negligible overall cognition ES of Ϫ0.06, with slight and inconsistent cognitive effects found on some measures, possibly reflecting the opposing effects of poorer versus better metabolic control.CONCLUSIONS -Pediatric diabetes generally relates to mildly lower cognitive scores across most cognitive domains. Cognitive effects are most pronounced and pervasive for EOD, with moderately lower performance compared with control subjects. Seizures are generally related to nominal, inconsistent performance differences.

Abstract8.6% suicidal ideation (SI) was found among 349 urban 6 -9 year olds in the top tercile of aggressivedisruptive behavior. SI was associated with more self-reported depression, ODD, conduct problems, and ADHD symptoms (ES 0.70 -0.97) and 3.5 -5 times more clinically significant symptoms. Parents rated more symptoms in older children associated with SI compared to parents of similar age children without SI, including greater somatic and behavior problems in 8 -9 year olds with SI. Parent ratings did not differentiate SI and non-SI in 6 -7 year olds. SI frequently co-occurred with thoughts about death. Children described anger, dysphoria and interpersonal conflict as motivators/ triggers for SI and worries about safety/health as motivator/triggers for thoughts about death, suggesting that problems managing emotionally challenging situations are a specific factor in initiating SI. Universal and indicated interventions for children to strengthen emotional selfregulation and behavioral control are recommended to complement the current emphasis on suicide prevention among adolescents. Keywords suicidal ideation; urban children; emotional triggers; externalizing problemsThe burden of suicide mortality has shifted increasingly towards younger aged individuals in the last half-century, and suicide is the third leading cause of death for young people ages 10 -24 in the U.S. (Lubell, Kegler, & Karch, 2007). Although there are few deaths from suicide before adolescence, suicidal ideation in 4 th grade was associated with a 1.5 times greater likelihood of making a suicide attempt by age 19 in a large urban cohort (Ialongo et al., 2004). In another epidemiological cohort, children with suicidal ideation before adolescence had higher rates of mood and substance use disorders as adults compared to those whose suicidal ideation began during adolescence (Steinhausen & Winkler, 2004). These associations suggest that targeting early risk factors for suicidal behavior may be an important suicide prevention strategy (Brown, Wyman, Brinales, & Gibbons, 2007). However, little is known about suicidal thinking and behavior in young children.A developmental approach provides a useful framework for examining suicidal behavior across childhood. According to this approach, the manner in which children experience and express specific features of psychopathology depends on their cognitive, physiological, and social developmental level (Cicchetti & Toth, 1998 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript symptom of depression across ages, but the manner in which children express dysphoria varies by age (Weiss & Garber, 2003). Developmental level can also influence the causes and consequences of psychopathology; cognitive factors such as a pessimistic explanatory style for negative life events, for example, may be more predictive of mood disorders for older than younger children (Nolen-Hoeksema, Girgus, & Seligman, 1992). A developmental approach also focuses attention on mechanisms of transmission of risk fac...