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3. Swadling C, Griffiths P. Is modified cow’s milk formula effective in reducing symptoms of infant colic? Br J Community Nurs. 2003;8(1):24-27. 4. Hill DJ, Roy N, Heine RG, et al. Effect of a low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. Pediatrics. 2005;116(5): e709-e715.

In Reply We thank Dr Sanaie and colleagues for their interest in our article.1 Dr Sanaie argues we used a nonmentioned oil as placebo that could have changed the gut behavior and enhanced or decreased the frequency of infantile colic, regurgitation, and functional constipation. However, we adopted a mentioned pharmaceutical oily suspension of sunflower and medium-chain triglyceride oil containing probiotic bacteria in the intervention group and an equal oily suspension without probiotic bacteria in the placebo group. The only difference in oil between the groups was the presence of live bacteria. It is likely that probiotic supplementation had the majority of functional gastrointestinal disorders because the same oil was used for the 2 different formulations. We agree with Dr Sanaie about maternal diet as an influential factor associated with colic crying2 and no intervention on maternal diet had been done during our probiotic supplementation in breast-fed infants. However, our study included both breast-fed and formulafed infants and no statistical differences were found in results comparing these subpopulations in infants supplemented with probiotic bacteria. Finally, Dr Sanaie is doubtful of the accuracy and validity of the information provided by parents because these aspects may be too subjective and were not reported daily in a medical record by a physician. The diagnosis of the disorders was always performed by an expert pediatric gastroenterologist following the Rome III criteria.3 In this approach, the subjective evaluation of symptoms by parent or caretaker is fundamental in physicians’ clinical practice, depending on reports and interpretations of the parents. The use of a diary recorded by parents has been used in several previous studies.4,5 Moreover, a recent article by Sung et al6 indicates clinical diaries reviewed by an expert pediatrician is a reliable method in clinical trial protocol for infantile colic. Flavia Indrio, MD Antonio Di Mauro, MD Giuseppe Riezzo, MD Author Affiliations: Department of Pediatrics, Aldo Moro University of Bari, Bari, Italy (Indrio, Di Mauro); Laboratory of Experimental Physiopathology, National Institute for Digestive Diseases, I.R.C.C.S. Saverio de Bellis, Castellana Grotte, Italy (Riezzo). Corresponding Author: Flavia Indrio, MD, Department of Pediatrics, University of Bari, Ospedale, Giovanni XXIII Via Amendola 276 70125, Bari, Italy (f.indrio @alice.it). Conflict of Interest Disclosures: None reported. 1. Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014;168(3):228-233. 2. Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary management of infantile colic: a systematic review. Matern Child Health J. 2012;16(6):1319-1331. 3. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130(5):1519-1526. 778

4. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-e533. 5. Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics. 2008;122(6):e1268e1277. 6. Sung V, Hiscock H, Tang M, et al. Probiotics to improve outcomes of colic in the community: protocol for the Baby Biotics randomised controlled trial. BMC Pediatr. 2012;12:135.

Regarding Review of Psychopathology in Children and Adolescents Who Are Deaf or Hard of Hearing To the Editor Theunissen and colleagues1 undertook a challenging task in their review of literature examining psychopathology in children and adolescents who are deaf or hard of hearing. The Results section of their review spoke to the complex role that language modality (eg, spoken compared with sign language) plays regarding the prevalence of psychopathology. The authors stated in their article that a number of studies “showed that sign language was significantly associated with more psychopathology.” The authors cited these studies regarding deaf signing children and adolescents, referencing statements such as “the prevalence of psychopathology in this group was very high, ranging from 40% to 77%.” Several of these cited studies used the Child Behavior Checklist as a measure of possible clinical psychopathology. The Child Behavior Checklist is a questionnaire that asks parents to report observed symptoms (eg, isolation, aggression, or school behavior problems) that can indicate possible underlying psychopathology. It is validated as a screening instrument and has excellent use as a triage tool to guide practitioners to in-depth diagnostic testing when necessary2 but is not a stand-alone diagnostic measure, which the authors did acknowledge in their Discussion section. However, the studies were cited in a manner that implied a direct connection between diagnosed psychopathology (the use of “significantly associated” in this context) and the use of sign language. Despite the statements in the Discussion section, this could potentially mislead a reader with no background in sign language or experience with the presentation of psychopathology in deaf individuals. Many deaf individuals in mental health programs have significant language problems.3 Deaf sign language users who have delayed developmental access to language can have expressive dysfluency that clinicians, particularly those without significant experience working with deaf individuals, may misinterpret as psychopathology. Sign language errors that can occur as a result of language deprivation include impoverished vocabulary, inability to sequence events in time, spatial disorganization, syntax errors, and gestures or pantomimes as substitution for lack of formal vocabulary,4 all of which can be inappropriately assessed as language disturbance due to psychopathology. I applaud Theunissen and colleagues for a thoughtful and thorough review; however, it may have inadvertently left the

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reader with the impression that sign language use has been associated with formally diagnosed psychopathology when in fact this is not supported by cited data. Rachel St. John, MD

2. Rishel CW, Greeno C, Marcus SC, Shear MK, Anderson C. Use of the Child Behavior Checklist as a diagnostic screening tool in community mental health. Res Soc Work Pract. 2005;15:195-203. doi:10.1177/1049731504270382. 3. Glickman N. Cognitive Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges. New York, NY: Routledge; 2009. 4. Crump C, Glickman N. Mental health interpreting with language dysfluent deaf clients. J of Interpretation. 2012;21(1):21-36.

Author Affiliation: Family Focused Center for Deaf and Hard of Hearing Children, Department of Otolaryngology, University of Texas Southwestern Medical Center/Children’s Medical Center, Dallas, Dallas. Corresponding Author: Rachel St. John, MD, Family Focused Center for Deaf and Hard of Hearing Children, Department of Otolaryngology, University of Texas Southwestern Medical Center/Children’s Medical Center, Dallas, 2350 Stemmons Fwy, F6208, Dallas, TX 75207 (rachel.stjohn@utsouthwestern .edu). Conflict of Interest Disclosures: None reported. 1. Theunissen SC, Rieffe C, Netten AP, et al. Psychopathology and its risk and protective factors in hearing-impaired children and adolescents: a systematic review. JAMA Pediatr. 2014;168(2):170-177.

CORRECTION Incorrect Information in Abstract : In the article titled “Determination of Tobacco Smoke Exposure by Plasma Cotinine Levels in Infants and Children Attending Urban Public Hospital Clinics” published in the September 2012 issue of Arch Pediatr Adolesc Med (2012;166[9]:851-856. doi:10.1001/archpediatrics.2012 .170), incorrect information appeared. In the last sentence of the Results section of the Abstract, “(geometric mean difference, 6.07 ng/mL [95% CI, 4.37 to 8.43 ng/mL]) ” should be replaced with “(multiplicative factor change in cotinine, 6.01 ng/mL [95% CI, 4.49-8.05 ng/mL]).” This article was corrected online.

Call for Papers JAMA Pediatrics will devote an entire issue in spring 2015 to implementation science research in child health, both in the United States and abroad. We are interested in rigorous studies that test hypotheses about methods to translate research in those steps between efficacy trials and population health. This will include studies on the most effective strategies to change professional behavior; create informed, activated consumers; and guide the behavior of administrators and health care organizations and policy makers. Manuscripts submitted before October 2014 will have the best chance of acceptance. Full details on submission and author guidelines are available at http://archpedi.jamanetwork.com.

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Regarding review of psychopathology in children and adolescents who are deaf or hard of hearing.

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