{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:43:18Z","timestamp":1791538998667,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["1R01HD09013801A1"],"award-info":[{"award-number":["1R01HD09013801A1"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine factors contributing to attrition in a telehealth, caregiver\u2010mediated behavioral intervention for young children with tuberous sclerosis complex (TSC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This randomized waitlist\u2010control trial (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200959) included children (12\u201339\u2009months) with TSC and their caregivers. A convergent parallel mixed\u2010methods design investigated factors influencing attrition. Quantitative analyses used negative binomial regression to explore predictors of session completion; qualitative data were thematically analyzed and integrated with quantitative patterns to complement and expand findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Negative binomial regression did not yield a significant overall model and explained limited variance. Two candidate predictors showed exploratory associations with fewer completed sessions: higher seizure severity (incidence rate ratio [IRR]\u00a0=\u00a00.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.046) and COVID\u2010era enrollment (IRR\u00a0=\u00a00.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.046). Distance to site and socioeconomic risk were not associated with attrition. Qualitative data reinforced medical crises as primary reasons for attrition and expanded on perceived benefit and other factors contributing to overall caregiver burden.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>In this clinical trial, socioeconomic, ethnic, and geographic factors were not associated with attrition, although the study was underpowered to detect small or moderate effects. Families of children facing complex developmental disability may nonetheless require additional adaptation and support to sustain engagement in telehealth caregiver\u2010mediated interventions. Mixed\u2010methods integration highlighted the multifaceted nature of attrition and the need for more precise measures to understand it.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dmcn.70384","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:32:08Z","timestamp":1785461528000},"page":"1621-1629","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Attrition in a telehealth caregiver\u2010mediated behavioral intervention for children with tuberous sclerosis complex: A mixed\u2010methods study"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-5784","authenticated-orcid":false,"given":"Carly Hyde","family":"Tillis","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Kasari","sequence":"additional","affiliation":[{"name":"Department of Education University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8008-6865","authenticated-orcid":false,"given":"Nicole","family":"McDonald","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Vobecky","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neurology Children\u2019s Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Pizzano","sequence":"additional","affiliation":[{"name":"Graduate School of Psychology California Lutheran University  Thousand Oaks California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Panganiban","sequence":"additional","affiliation":[{"name":"Department of Education University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Gharapetian","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise Y.","family":"Tran","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Children's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3431-4713","authenticated-orcid":false,"given":"Elizabeth A.","family":"Thiele","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafali","family":"Jeste","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145445512465307"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u2010006x.65.3.453"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dcn.2022.101081"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcv2.12140"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10802\u2010008\u20109281\u20101"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx262"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/07317107.2011.545011"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803\u2010022\u201005616\u2010w"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362361315598634"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4913"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105311415558"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14995"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3928\/0090\u20104481\u201020020601\u201009"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38210.827917.7C"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073807309250"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.26815\/acn.2025.01032"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016\u20104040"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023\u2010018\u20100870\u2010y"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715000264"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073810361789"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003002"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1352\/1944\u20107558\u2010130\u20101\u201063"},{"key":"e_1_2_9_24_1","volume-title":"Vineland\u20103: Vineland adaptive behavior scales","author":"Sparrow SS","year":"2016"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0039080"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.infbeh.2024.101952"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s11689\u2010019\u20109302\u20100"},{"key":"e_1_2_9_28_1","doi-asserted-by":"crossref","unstructured":"SadownikA.Bronfenbrenner: Ecology of Human Development in Ecology of Collaboration. In.2023. p.83\u201395.https:\/\/doi.org\/10.1007\/978\u20103\u2010031\u201038762\u20103_4","DOI":"10.1007\/978-3-031-38762-3_4"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467\u20108624.1990.tb02889.x"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2008.01.007"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749\u20106632.2009.05336.x"},{"key":"e_1_2_9_32_1","doi-asserted-by":"crossref","unstructured":"MontieloverallP.Designing and Conducting Mixed Methods Research. ByJohn W.CreswellandVicki L.Plano Clark.Thousand Oaks CA:Sage Publications 2007.274pp. $79.95 (cloth); $39.95 (paper) ISBN: 1\u20134129\u20132791\u20109; ISBN: 1\u20134129\u20132792\u20107. Library & Information Science Research \u2010 LIBR INFORM SCI RES. 2007 Sep 30;29:434\u20136.https:\/\/doi.org\/10.1016\/j.lisr.2007.02.003","DOI":"10.1016\/j.lisr.2007.02.003"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100043\u20101761503"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10567\u2010005\u20104753\u20100"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1009414904228"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.3126\/nje.v10i3.31622"}],"container-title":["Developmental Medicine &amp; Child Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dmcn.70384","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dmcn.70384","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dmcn.70384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:33:59Z","timestamp":1791495239000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dmcn.70384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/dmcn.70384"],"URL":"https:\/\/doi.org\/10.1111\/dmcn.70384","archive":["Portico"],"relation":{},"ISSN":["0012-1622","1469-8749"],"issn-type":[{"value":"0012-1622","type":"print"},{"value":"1469-8749","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"assertion":[{"value":"2025-07-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}