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Harvey H. Diagnostic procedures of paediatric speech and language therapists in the UK: Enabling and obstructive factors. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1454-1467. [PMID: 36999884 DOI: 10.1111/1460-6984.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. AIM To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. METHODS & PROCEDURES Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi-structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. OUTCOMES & RESULTS Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. CONCLUSIONS & IMPLICATIONS Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision-making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma. WHAT THIS PAPER ADDS What is already known on the subject Inconsistency in terminology for paediatric language diagnoses has been broadly discussed, mostly in reference to variation within research literature. The Royal College of Speech and Language Therapists' (RCSLT) position statement on developmental language disorder (DLD) and language disorder made recommendations for SLTs to use these terms in clinical practice. There is some evidence that SLTs face challenges in operationalizing diagnostic criteria in practice, particularly given financial and resource constraints. What this paper adds to existing knowledge SLTs disclosed several issues that either supported or were obstructive to the practice of diagnosing paediatric clients and delivering this information to families. Whilst most SLTs faced constraints related to the practicalities and demands of clinical practice, a number also held reservations about the impact of a lifelong diagnosis for young clients. These issues resulted in considerable avoidance of formal diagnostic terminology, in favour of description or informal terminology. What are the potential or actual clinical implications of this work? If diagnoses are not given, or if SLTs are using informal diagnostic terms as an alternative strategy, clients and families may experience reduced opportunities to yield benefits associated with a diagnosis. Clinical guidance that specifically addresses the prioritization of time and provides directives for clinical action in instances of uncertainty may support SLTs to feel confident in giving diagnoses.
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Affiliation(s)
- Hannah Harvey
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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2
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Cleary M, West S, Mclean L. From 'Refrigerator Mothers' to Empowered Advocates: The Evolution of the Autism Parent. Issues Ment Health Nurs 2023; 44:64-70. [PMID: 36049183 DOI: 10.1080/01612840.2022.2115594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A historical perspective offers a chance to reflect on unfolding narratives. The emergence of the diagnosis of autism attracted some positions of blame for "refrigerator mothers". With ensuing neuroscience and developmental research and more nuanced biopsychosocial models, this gave way to notions of strong neurological contributions to the disorder and the positive role of parents supporting the regulation of their child. The notion of co-regulation then emerges with collective agency by parents to offer advocacy and support for those with ASD and their parents and an important role in educating society around the needs and value of those with ASD.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Loyola Mclean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW, Australia.,Royal North Shore Hospital, Sydney, NSW, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, NSW, Australia.,Western Clinical School, The University of Sydney, Camperdown, NSW, Australia
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3
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Public knowledge and stigma of autism spectrum disorder: Comparing China with the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1531-1545. [DOI: 10.1177/1362361319900839] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autism spectrum disorder in China differs considerably from autism spectrum disorder in the West in terms of prevalence estimates, education opportunities, and life outcomes of autistic people. The lack of autism spectrum disorder awareness could be a key factor underlying the disparities. To date, there has been no evaluation of autism spectrum disorder knowledge among the general public of China. Using the Autism Stigma and Knowledge Questionnaire developed for use in diverse cultural contexts, this study uncovered profoundly different public views about autism spectrum disorder in China compared with the United States. Determined by cognitive diagnosis modeling, 86%–91% of the surveyed U.S. citizens ( N = 1127) achieved adequate autism spectrum disorder knowledge in diagnosis/symptoms, etiology, and treatment, whereas for the Chinese citizens ( N = 1254) the percentages were only 57%–65%. Moreover, 14% of the participants from the United States were classified to endorse autism spectrum disorder stigma; in comparison, 38% of the Chinese participants endorsed autism spectrum disorder stigma. The Chinese citizens displayed knowledge deficits primarily in the areas of autism spectrum disorder core symptoms, comorbid intellectual impairment, and prognosis. Sociodemographic factors associated with the Chinese citizen’s misconceptions included gender, ethnicity, social economic factors, among others. These results have important implications for increasing public awareness and promoting community participation for autistic individuals in China. Lay abstract ASD in China differs considerably from ASD in the West in terms of prevalence estimates, education opportunities and life outcomes of autistic people. The lack of ASD awareness could be a key factor underlying these disparities. We asked 1127 U.S. citizens and 1254 Chinese citizens about their autism knowledge using the Autism Stigma and Knowledge Questionnaire (ASK-Q).The results indicated profoundly different public views about ASD in China compared to the U.S. Specifically, only 57%-65% of the Chinese citizens demonstrated adequate ASD knowledge compared to 86%-91% in the U.S. citizens. Fourteen percent of the U.S. citizens were shown to hold stigma beliefs towards ASD; in comparison, 38% of the Chinese citizens indicated ASD stigma. The Chinese citizens displayed misconceptions about ASD related to symptoms, causes, and possible long-term outcomes. In China but not in the U.S., male citizens and citizens with lower social economic status were more likely to have misconceptions about ASD than others were. The findings of this research can help increase public awareness about ASD and create a more inclusive environment for autistic people in China.
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Abstract
Evidence suggests that improved health outcomes and reducing the hospital length of stay of individuals with autism require working in partnership between parents and health care professionals. Parents' ability to cope in their daily caregiving responsibilities to their child with autism and assessment of their hospital experience can have an impact on their participation with the care team. Nurses working in the inpatient setting can provide support to parents during their encounter with them. This article presented some of the helpful approaches that can help in building positive relationships with parents that may help facilitate addressing the needs of their child with autism. Suggestions that nurses can implement to support the parents cope with their daily challenges are presented. The approaches were discussed in relation to literature and suggestions from parents of individuals with autism spectrum disorder.
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5
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Eidson T, Hess A, Hess T, Kelly A. Family Engagement in the Autism Treatment and Learning Health Networks. Pediatrics 2020; 145:S30-S34. [PMID: 32238529 DOI: 10.1542/peds.2019-1895f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Family involvement in the Autism Intervention Research Network on Physical Health, the Autism Treatment Network, and the Autism Learning Health Network, jointly the Autism Networks, has evolved and grown into a meaningful and robust collaboration between families, providers, and researchers. Family involvement at the center of the networks includes both local and national network-wide coproduction and contribution. Family involvement includes actively co-authoring research proposals for large grants, equal membership of network committees and workgroups, and formulating quality improvement pathways for local recruitment efforts and other network initiatives. Although families are involved in every aspect of network activity, families have been the driving force of specifically challenging the networks to concentrate research, education, and dissemination efforts around 3 pillar initiatives of addressing comorbidities of anxiety, attention-deficit/hyperactivity disorder, and irritability in autism during the networks' upcoming funding cycle. The expansion of the networks' Extension for Community Healthcare Outcomes program is an exciting network initiative that brings best practices in autism care to community providers. As equal hub members of each Extension for Community Healthcare Outcomes team, families ensure that participants are intimately cognizant of family perspectives and goals. Self-advocacy involvement in the networks is emerging, with plans for each site to have self-advocacy representation by the spring of 2020 and ultimately forming their own coproduction committee. The Autism Treatment Network, the Autism Intervention Research Network on Physical Health, and the Autism Learning Health Network continue to be trailblazing organizations in how families are involved in the growth of their networks, production of meaningful research, and dissemination of information to providers and families regarding emerging work in autism spectrum disorders.
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Affiliation(s)
- Timothy Eidson
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Amy Hess
- Division of Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,Center for Autism Services and Transition, The Ohio State University, Columbus, Ohio
| | - Thomas Hess
- Division of Policy and Strategic Direction, Ohio Department of Developmental Disabilities, Columbus, Ohio
| | - Amy Kelly
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Devereux Advanced Behavioral Health, Villanova, Pennsylvania
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6
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Boshoff K, Gibbs D, Phillips RL, Wiles L, Porter L. A meta-synthesis of how parents of children with autism describe their experience of advocating for their children during the process of diagnosis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e143-e157. [PMID: 30548710 DOI: 10.1111/hsc.12691] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
The diagnostic process for children with autism can be complex for parents to navigate as they advocate for their child in order to obtain answers to their concerns, and receive the subsequent support they need. Gaining an understanding of parents' experiences during this process, will assist service providers in supporting families adequately. This systematic review was undertaken to consolidate in-depth qualitative data from parents of their experience of advocating for their child with autism, during the process of diagnosis. A qualitative meta-synthesis was conducted, whereby fifteen databases were systematically searched. Twenty-two studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesised into themes through the steps of review, meta-aggregation, integration, and interpretation. The date range of the included studies spans 1999-2016. The voices of 1,178 parents are presented in this review describing their experiences in two overarching themes: "Pathway to diagnosis-Confusion and not feeling heard"; and "Pursuing diagnosis-Resilience and commitment." Each one of these main themes had sub-themes. Our findings highlight the intense emotional journey for parents during identification of their initial concerns and the formal process of diagnosis, and their perceptions of not being supported by others on this journey. This review illustrates the significant impact that positive experiences with first-line professionals have during the process of diagnosis, and how these experiences lay the foundation for all future relationships with other service providers. As a result, awareness of parents' experiences will assist service providers to reconsider their communication style, information sharing, provision of support and to incorporate parents' contributions in facilitating a more streamlined and more supportive process of diagnosis.
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Affiliation(s)
- Kobie Boshoff
- School of Health Sciences, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Deanna Gibbs
- Nursing, Midwifery & Allied Health Professions, Barts Health NHS Trust, London, UK
| | - Rebecca L Phillips
- ANU Medical School, Centre for Health Stewardship, The Australian National University, Canberra, Australia
| | - Louise Wiles
- School of Health Sciences, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa Porter
- University of South Australia, Adelaide, South Australia, Australia
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Dawson-Squibb JJ, Davids EL, Harrison AJ, Molony MA, de Vries PJ. Parent Education and Training for autism spectrum disorders: Scoping the evidence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:7-25. [DOI: 10.1177/1362361319841739] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Empowering families of children with autism spectrum disorder through education and training is best practice. A wide range of Parent Education and Training programmes are delivered around the globe, but there is limited knowledge about the characteristics of these programmes, or about the research methods and outcomes used to evaluate them, particularly in countries outside the United States. We, therefore, performed a scoping review of all peer-reviewed Parent Education and Training publications outside the United States. A search was conducted between March and May 2017. Four reviewers extracted data and performed a mixed-methods quality appraisal of publications. Thirty-seven publications representing 32 unique programmes were identified. Publications described a highly diverse range of Parent Education and Training programmes across 20 countries and all continents except South America. The majority were group-based, but varied significantly in goals, modalities and duration. The majority of studies (86.4%) reported positive outcomes in relation to the core study objectives and only two studies reported some negative findings. Quality appraisal rated only 27% of studies to have met all the methodological quality criteria. Implementation factors such as manualisation, fidelity and cost were commented on infrequently. In spite of the clear need for Parent Education and Training programmes, our findings show that the research evidence-base in autism spectrum disorder outside the United States is relatively small, non-representative and in need of methodological quality improvements.
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Affiliation(s)
| | - Eugene L Davids
- Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
| | | | | | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
- Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, University of Cape Town, South Africa
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8
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Parenting behavior and the development of children with autism spectrum disorder. Compr Psychiatry 2019; 90:21-29. [PMID: 30658339 DOI: 10.1016/j.comppsych.2018.11.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorders (ASD) are neurodevelopmental disorders in which multiple genetic and environmental factors play roles. Symptoms of deficits in social communication and restrictive, repetitive behavioral patterns emerge early in a child's development. While parents do not cause these difficulties, impairments in social relatedness can strain parent child interactions and parental stress can have negative transactional effects that impede children development. Conversely, as with typically developing children, parental behavior can also enhance development in ASD and parents play a role in many interventions. In this review we examine parental contributions to the development of children with ASD, focusing on social communication and emotion regulation. We address parent and family characteristics that may impede development so they can be identified in families and interventions developed to target them.
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9
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Russell G, Mandy W, Elliott D, White R, Pittwood T, Ford T. Selection bias on intellectual ability in autism research: a cross-sectional review and meta-analysis. Mol Autism 2019; 10:9. [PMID: 30867896 PMCID: PMC6397505 DOI: 10.1186/s13229-019-0260-x] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background Current global estimates suggest the proportion of the population with autism spectrum disorder (ASD) who have intellectual disability (ID) is approximately 50%. Our objective was to ascertain the existence of selection bias due to under-inclusion of populations with ID across all fields of autism research. A sub-goal was to evaluate inconsistencies in reporting of findings. Methods This review covers all original research published in 2016 in autism-specific journals with an impact factor greater than 3. Across 301 included studies, 100,245 participants had ASD. A random effects meta-analysis was used to estimate the proportion of participants without ID. Selection bias was defined as where more than 75% of participants did not have ID. Results Meta-analysis estimated 94% of all participants identified as being on the autism spectrum in the studies reviewed did not have ID (95% CI 0.91–0.97). Eight out of ten studies demonstrated selection bias against participants with ID. The reporting of participant characteristics was generally poor: information about participants’ intellectual ability was absent in 38% of studies (n = 114). Where there was selection bias on ID, only 31% of studies mentioned lack of generalisability as a limitation. Conclusions We found selection bias against ID throughout all fields of autism research. We recommend transparent reporting about ID and strategies for inclusion for this much marginalised group. Electronic supplementary material The online version of this article (10.1186/s13229-019-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ginny Russell
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - William Mandy
- 2UCL Research Department of Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT UK
| | - Daisy Elliott
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Rhianna White
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Tom Pittwood
- 4Brain in Hand, Innovations Centre, University of Exeter, Exeter, EX4 4QJ UK
| | - Tamsin Ford
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
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10
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Monahan AB. The Regulatory Failure to Define Essential Health Benefits. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:529-577. [PMID: 30802163 DOI: 10.1177/0098858818821136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Basic principles of economics suggest that health insurers should seek to avoid covering sick individuals and attempt to minimize the amount they have to spend if, despite the insurer's best efforts, such individuals enroll in coverage. The drafters of the Affordable Care Act recognized this natural tendency of insurers and put in place multiple provisions aimed at avoiding such behavior. One such tool was the requirement that all health insurers in the individual and small group markets cover an identical, comprehensive set of benefits known as the Essential Health Benefits ("EHBs"). EHBs were designed to ensure that consumers are able to access comprehensive coverage, but also to prevent insurers from trying to avoid high-risk enrollees by designing plans that appeal only to the healthy. Congress did not, however, statutorily define the full package of benefits, instead delegating primary authority for that task to the Department of Health & Human Services ("HHS"). This article argues that HHS has implemented the EHB requirements in a manner that appears structurally incapable of achieving the goals of the statute. By utilizing a vague definition of benefits, allowing benefit substitutions, and failing to limit use of service-level selection tools, HHS has permitted insurers to compete for low-risk insureds, avoid paying for certain high-cost treatments, and prevented consumers from making fully informed purchasing decisions.
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Affiliation(s)
- Amy B Monahan
- Melvin C. Steen Professor, University of Minnesota Law School. I am grateful for the feedback and comments received at faculty workshops at Duke University, Washington University, and the University of Minnesota. My thanks also go to the anonymous peer reviewers for the American Journal of Law & Medicine, whose helpful comments improved this article
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Fletcher-Watson S, Adams J, Brook K, Charman T, Crane L, Cusack J, Leekam S, Milton D, Parr JR, Pellicano E. Making the future together: Shaping autism research through meaningful participation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:943-953. [PMID: 30095277 PMCID: PMC6512245 DOI: 10.1177/1362361318786721] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Participatory research methods connect researchers with relevant communities to
achieve shared goals. These methods can deliver results that are relevant to
people’s lives and thus likely to have a positive impact. In the context of a
large and growing body of autism research, with continued poor implementation,
and some evidence of community dissatisfaction, there is a powerful case for
participatory autism research. In order to develop a framework for such
collaborative working, a UK seminar series was organised and co-produced by
autistic and non-autistic people with academic, practitioner and lived
expertise. This article reports on the outcomes from the series, identifying
five topics relevant to building a community of practice in participatory
research: Respect, Authenticity, Assumptions, Infrastructure and Empathy. Each
topic is connected to a specific example from within and beyond research, to
inspire new practices in the field. We call for the development of participatory
research skills among the autism research community and the facilitation of
greater autistic leadership of, and partnership in, research. Such work, if
delivered to a high standard, is likely to lead to better translation into
practice and improved outcomes for autistic people and those who support
them.
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Affiliation(s)
| | | | | | | | | | | | | | - Damian Milton
- 8 Participatory Autism Research Collective, UK.,9 University of Kent, UK
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12
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Reyes NM, Lindly OJ, Chavez AE, Folan A, Macias K, Smith KA, Reynolds A, Zuckerman K. Maternal beliefs about autism: A link between intervention services and autism severity in White and Latino mothers. RESEARCH IN AUTISM SPECTRUM DISORDERS 2018; 51:38-48. [PMID: 35198038 PMCID: PMC8862686 DOI: 10.1016/j.rasd.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Variation in parental beliefs about Autism Spectrum Disorder (ASD) may impact subsequent service use profiles. This study aimed to examine (1) variation in beliefs about ASD among English language proficient White (EP-W) mothers, English language proficient Latino (EPL) mothers, and limited English language proficient Latino (LEP-L) mothers of children with ASD; (2) variation in beliefs about ASD in the context of the child's ASD severity, among EP White mothers, EP Latino others, and LEP Latino mothers; and (3) potential links between maternal beliefs about ASD and children's current ASD treatment. This multi-site study included 305 English or Spanish-speaking parents of children with ASD, ages 2-10 years, who completed a survey about their beliefs about their child's ASD, their child's ASD severity, and treatments used by their children. Results showed that mothers in the EP-W, EP-L, and LEP-L groups differed in their beliefs about viewing ASD as a mystery. Only maternal views of ASD severity in the EP-W group were linked to their beliefs about ASD. Finally, maternal beliefs about ASD having major consequences on their child's life, and ASD being a mystery were strongly associated with a child's use of ASD intervention services. These findings provide new knowledge of how maternal beliefs about ASD vary in linguistically diverse groups, how a child's ASD severity may influence such beliefs, and how maternal beliefs correlate with the amount of therapy children with ASD receive. Future research should address how these beliefs or views are formed, what factors influence them, or whether they are malleable. Understanding parents' beliefs or views of having a child with ASD can potentially help us increase use of ASD intervention services in families of children with ASD.
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Affiliation(s)
- Nuri M. Reyes
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Olivia J. Lindly
- Massachusetts General Hospital & Harvard Medical School, Department of Pediatrics, Boston, MA, United States
| | - Alison E. Chavez
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Ann Folan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
- School of Education & Human Development, University of Colorado Denver, United States
| | - Kristy Macias
- Division of General Pediatrics, University of Southern California University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Kathryn A. Smith
- Division of General Pediatrics, University of Southern California University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ann Reynolds
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Katherine Zuckerman
- Division of General Pediatrics, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, United States
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR, United States
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Dinora P, Bogenschutz M, Lynch K. Factors That May Influence Parent Treatment Decision Making for Young Children with Autism Spectrum Disorder. ACTA ACUST UNITED AC 2017; 16:377-395. [DOI: 10.1080/1536710x.2017.1392395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Parthenia Dinora
- Partnership for People with Disabilities, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matthew Bogenschutz
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kathleen Lynch
- Partnership for People with Disabilities, Virginia Commonwealth University, Richmond, Virginia, USA
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Boshoff K, Gibbs D, Phillips RL, Wiles L, Porter L. Parents' voices: 'why and how we advocate'. A meta-synthesis of parents' experiences of advocating for their child with autism spectrum disorder. Child Care Health Dev 2016; 42:784-797. [PMID: 27445227 DOI: 10.1111/cch.12383] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 01/24/2023]
Abstract
Parenting a child with autism spectrum disorder (ASD) can be stressful, and accessing services can add to this stress. Self-efficacy, agency and advocacy are important for parents when accessing and using services. To develop insight into parental advocacy, a meta-synthesis was undertaken to consolidate the literature focussing on parents' experiences of advocating for their child with ASD. A qualitative meta-synthesis was conducted. Fifteen databases were systematically searched by using key terms related to ASD, children, parents/carers, advocacy and qualitative studies. Twenty-four studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta-aggregation, integration and interpretation. Two overarching concepts emerged, illustrating both the challenging nature of advocacy and the associated personal and societal benefits. These two concepts are supported by eight themes: a life-long, all-encompassing challenge; advocacy as a parental coping strategy; advocacy involving working to create a future; balancing roles and needs; isolation versus support; personal impacts of advocacy; benefits of advocacy; and the barriers to advocacy. The experience of advocacy for parents with a child with ASD is complex and intensive, presenting both personal and societal benefits, as well as challenges for parents. In supporting individuals with ASD and family well-being, service providers need to have an understanding of the advocating role of parents and ensure that opportunities exist for their voices to be heard during service delivery.
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Affiliation(s)
- K Boshoff
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia.
| | - D Gibbs
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - R L Phillips
- Centre for Health Stewardship, The Australian National University, Canberra, NSW, Australia
| | - L Wiles
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - L Porter
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Abstract
Research on autism and environmental risk factors has expanded substantially in recent years. My analysis draws attention to the regimes of perceptibility that shape how the environment is materialized in post-genomic science. I focus on how more complex narratives of autism's causes and social anxieties surrounding child development have helped situate autism risk in women's bodies before and during pregnancy. This has resulted in what I call the maternal body as environment in autism science. I show that this figure involves three characteristics: the molecularization of the environment, an individualization of risk, and the internalization of responsibility. I argue that these three features point to a new spatial and temporal politics of risk and responsibility that may heighten social and medical surveillance of women's bodies and decisions, eclipsing larger questions about the uneven distribution of exposures in society and more holistic understandings of health that include neurodiversity. I conclude by considering what the maternal body as environment signals for women, social justice, and the politics of environmental health in the post-genomic era.
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Affiliation(s)
- Martine Lappé
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, Columbia University, New York, NY, USA
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Gore Langton E, Frederickson N. Parents' experiences of professionals' involvement for children with extreme demand avoidance. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2016; 64:16-24. [PMID: 34141287 PMCID: PMC8115513 DOI: 10.1080/20473869.2016.1204743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives: Pathological demand avoidance (PDA) is characterized by an extreme difficulty in tolerating everyday demands, with a range of 'socially manipulative' strategies used to avoid demands. Children also display poor social identity, impulsivity, and obsessive behavior. While research and knowledge about PDA is slowly growing, families continue to encounter considerable difficulties in ensuring their children's needs are understood and met by health and education services. This study explored what parents of children with extreme demand avoidance valued about professionals' input. Methods: Parents of 42 children who scored above the cut-off on a standardized measure with validated sensitivity and specificity for PDA responded to questionnaire items asking them to identify professionals' involvement and helpfulness. They were also asked what had characterized the most helpful professional involvement. Thematic analysis was used to identify the key themes in parents' responses. Results: Families tended to have high levels of professional involvement. Most professionals were experienced as helpful by the majority of parents. Three main themes were identified as characterizing helpful involvement: enabling access to services and resources, concrete outcomes such assessments and management strategies, and professional-level factors such as skills and qualities. Conclusions: Parents felt positive about practitioners who had listened to their experiences, made efforts to understand the child, and provided or arranged for help. Parents found involvement most helpful when it resulted in comprehensive assessment, appropriate intervention, practical advice and management strategies, and a focus on the well-being of all family members. The overall ratings of helpfulness are encouraging, and the specific feedback about what is most helpful could be of value in shaping services.
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Affiliation(s)
- Emma Gore Langton
- Educational Psychology Group, Department of Psychology, University College London, 26 Bedford Way, LondonWC1H 0AP, UK
| | - Norah Frederickson
- Educational Psychology Group, Department of Psychology, University College London, 26 Bedford Way, LondonWC1H 0AP, UK
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Harrison AJ, Long KA, Manji KP, Blane KK. Development of a Brief Intervention to Improve Knowledge of Autism and Behavioral Strategies Among Parents in Tanzania. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:187-201. [PMID: 27268474 DOI: 10.1352/1934-9556-54.3.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite the global presence of autism spectrum disorder (ASD), a paucity of treatment services exists in Tanzania and other low- and middle-income countries. The effect of delayed or low-quality treatments is enduring and contributes to lifelong variability in ASD-related functional impairments. Service disparities in Tanzania derive in part from a widespread lack of national ASD knowledge. Historically, in Western countries, parents have played a major role in increasing ASD awareness, advancing research, and encouraging empirically supported treatments. In the absence of established treatment services, parents of children with ASD have also learned to implement behavioral interventions to reduce the widening skills gaps. This article describes the development of an intervention designed to inform parents in Tanzania about ASD and empirically supported behavioral strategies. Preliminary data, collected from a clinical implementation with 29 Tanzanian families of children diagnosed with ASD or general developmental delays, support the initial feasibility and acceptability of this intervention. This brief intervention may help to ameliorate treatment disparities due to insufficient regional knowledge, language barriers, or limited service availability and may help improve functional outcomes among Tanzanian children with ASD.
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Affiliation(s)
- Ashley Johnson Harrison
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kristin A Long
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karim P Manji
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karyn K Blane
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
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18
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Zwicker JD, Emery JCH. Autism research funding allocation: can economics tell us if we have got it right? Autism Res 2014; 7:704-11. [PMID: 25288440 DOI: 10.1002/aur.1423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/05/2014] [Indexed: 11/07/2022]
Abstract
There is a concern that the allocation of autism spectrum disorder (ASD) research funding may be misallocating resources, overemphasizing basic science at the expense of translational and clinical research. Anthony Bailey has proposed that an economic evaluation of autism research funding allocations could be beneficial for funding agencies by identifying under- or overfunded areas of research. In response to Bailey, we illustrate why economics cannot provide an objective, technical solution for identifying the "best" allocation of research resources. Economic evaluation has its greatest power as a late-stage research tool for interventions with identified objectives, outcomes, and data. This is not the case for evaluating whether research areas are over- or underfunded. Without an understanding of how research funding influences the likelihood and value of a discovery, or without a statement of the societal objectives for ASD research and level of risk aversion, economic analysis cannot provide a useful normative evaluation of ASD research.
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Affiliation(s)
- Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
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Elsabbagh M, Yusuf A, Prasanna S, Shikako-Thomas K, Ruff CA, Fehlings MG. Community engagement and knowledge translation: progress and challenge in autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 18:771-81. [PMID: 25128332 DOI: 10.1177/1362361314546561] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The last decade has seen significant growth in scientific understanding and public awareness of autism. There is still a long road ahead before this awareness can be matched with parallel improvements in evidence-based practice. The process of translating evidence into community care has been hampered by the seeming disconnect between the mainstream scientific research agenda and the immediate priorities of many communities. The need for community engagement in the process of translating knowledge into impact has been recognized. However, there remains little consensus or empirical data regarding the process of such engagement and how to measure its impact. We shed light on a number of engagement models and tools, previously advocated in health research, as they apply to autism research. Furthermore, we illustrate the utility of such tools in supporting identification of knowledge gaps and priorities, using two community-based case studies. The case studies illustrate that information generated from research is indeed relevant and critical for knowledge users in the community. Simple and systematic methods can support the translation and uptake of knowledge in diverse communities, therefore enhancing engagement with research and bridging research findings with immediate community needs.
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Affiliation(s)
| | | | | | | | - Crystal A Ruff
- Toronto Western Hospital, Canada University of Toronto, Canada
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21
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Verhoeff B. Stabilizing autism: A Fleckian account of the rise of a neurodevelopmental spectrum disorder. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2014; 46:65-78. [PMID: 24816029 DOI: 10.1016/j.shpsc.2014.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 06/03/2023]
Abstract
Using the conceptual tools of philosopher of science Ludwik Fleck, I argue that the reframing of autism as a neurodevelopmental spectrum disorder is constrained by two governing 'styles of thought' of contemporary psychiatry. The first is the historically conditioned 'readiness for directed perception' of, and thinking in terms of, ontologically distinct diseases. The clinical gaze of mental health professionals, the bureaucratic needs of health administration, the clinical and scientific utility of disease categories, and the practices of autism-oriented advocacy groups all imply a bias toward thinking about autism and related disorders as ontologically distinct psychiatric and scientific entities. Second, within the 'neuromolecular style of thought', mental disorders are more and more located at the neurobiological levels of the brain. In autism research, one of the biggest challenges is the identification of autism's neurobiological singularity. However, at a moment when biological and categorical approaches toward autism face serious empirical difficulties, a balance is established that holds together these two styles of thought. With a need to account for some of the most persistent uncertainties and conflicts in autism research, namely ubiquitous heterogeneity and a failure to identify disease specific biomarkers, the reframing of autism as a neurodevelopmental spectrum disorder satisfies the scientific, institutional and socio-political needs for stability and homogenization.
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Affiliation(s)
- Berend Verhoeff
- Theory and History of Psychology Department, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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22
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Milner LC, Cho MK. Focusing on Cause or Cure?: Priorities and Stakeholder Presence in Childhood Psychiatry Research. AJOB Empir Bioeth 2014; 5:44-55. [PMID: 24729931 DOI: 10.1080/21507716.2013.811315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biomedical research is influenced by many factors, including the involvement of stakeholder groups invested in research outcomes. Stakeholder involvement in research efforts raise questions of justice as their specific interests and motivations play a role in directing research resources that ultimately produce knowledge shaping how different conditions (and affected individuals) are understood and treated by society. This issue is highly relevant to child psychiatry research where diagnostic criteria and treatment strategies are often controversial. Biological similarities and stakeholder differences between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) provide an opportunity to explore this issue by comparing research foci and stakeholder involvement in these conditions. METHODS A subset of ADHD and ASD research articles published between 1970-2010 were randomly selected from the PubMed database and coded for research focus, funding source(s), and author-reported conflicts of interest (COIs). Chi-square analyses were performed to identify differences between and within ADHD and ASD research across time. RESULTS The proportion of ADHD research dedicated to basic, description, and treatment research was roughly similar and remained stable over time, while ASD research showed a significant increase in basic research over the past decade. Government was the primary research funder for both conditions, but for-profit funders were a notable presence in ADHD research, while joint-funding efforts between non-profit and government funders were a notable presence in ASD research. Lastly, COIs were noted more frequently in ADHD than in ASD research. CONCLUSIONS Our study shows significant differences in research foci and funding sources between the conditions, and identifies the specific involvement of for-profit and non-profit groups in ADHD and ASD, respectively. Our findings highlight the relationship between stakeholders outside the research community and research trajectories and suggest that examinations of these relationships must be included in broader considerations of biomedical research ethics.
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Affiliation(s)
- Lauren C Milner
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305
| | - Mildred K Cho
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305, Tel: (650) 725-7993,
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Yudell M, Tabor HK, Dawson G, Rossi J, Newschaffer C. Priorities for autism spectrum disorder risk communication and ethics. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 17:701-22. [PMID: 22917844 PMCID: PMC8487592 DOI: 10.1177/1362361312453511] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Autism spectrum disorders are an issue of increasing public health significance. The incidence of autism spectrum disorders has been increasing in recent years, and they are associated with significant personal and financial impacts for affected persons and their families. In recent years, a large number of scientific studies have been undertaken, which investigate genetic and environmental risk factors for autism, with more studies underway. At present, much remains unknown regarding autism spectrum disorder risk factors, but the emerging picture of causation is in many cases complex, with multiple genes and gene-environment interactions being at play. The complexity and uncertainty surrounding autism spectrum disorder risk factors raise a number of questions regarding the ethical considerations that should be taken into account when undertaking autism spectrum disorder risk communication. At present, however, little has been written regarding autism spectrum disorder risk communication and ethics. This article summarizes the findings of a recent conference investigating ethical considerations and policy recommendations in autism spectrum disorder risk communication, which to the authors' knowledge is the first of its kind. Here, the authors discuss a number of issues, including uncertainty; comprehension; inadvertent harm; justice; and the appropriate roles of clinicians, scientists, and the media in autism spectrum disorder risk communication.
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Abstract
This editorial discusses the importance of autism research, noting areas of progress and ongoing challenges and focusing on studies of the etiology, pathophysiology, and treatment of autism spectrum disorders.
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Golnik A, Maccabee-Ryaboy N, Scal P, Wey A, Gaillard P. Shared decision making: improving care for children with autism. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 50:322-331. [PMID: 22861133 DOI: 10.1352/1934-9556-50.4.322] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We assessed the extent to which parents of children with autism spectrum disorder report that they are engaged in shared decision making. We measured the association between shared decision making and (a) satisfaction with care, (b) perceived guidance regarding controversial issues in autism spectrum disorder, and (c) perceived assistance navigating the multitude of treatment options. Surveys assessing primary medical care and decision-making processes were developed on the basis of the U.S. Department of Health and Human Service's Consumer Assessment of Healthcare Providers and Systems survey. In May 2009, after pilot testing, we sent surveys to 203 parents of children from ages 3 to 18 with International Classification of Diseases-9 and parent-confirmed autism spectrum disorder diagnoses. The response rate was 64%. Controlling for key demographic variables, parents of children with autism spectrum disorder reporting higher levels of shared decision making reported significantly greater satisfaction with the overall quality of their child's health care (p ≤ .0001). Parents reporting higher levels of shared decision making were also significantly more likely to report receiving guidance on the many treatment options (p = .0002) and controversial issues related to autism spectrum disorder (p = .0322). In this study, shared decision making was associated with higher parent satisfaction and improved guidance regarding treatments and controversial issues within primary care for children with autism spectrum disorder.
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Golnik A, Scal P, Wey A, Gaillard P. Autism-Specific Primary Care Medical Home Intervention. J Autism Dev Disord 2011; 42:1087-93. [DOI: 10.1007/s10803-011-1351-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Pellicano E, Stears M. Bridging autism, science and society: moving toward an ethically informed approach to autism research. Autism Res 2011; 4:271-82. [PMID: 21567986 DOI: 10.1002/aur.201] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 04/01/2011] [Indexed: 01/03/2023]
Abstract
Recent developments in the science of autism have provoked widespread unease among autism activists. Drawing on the findings of a major international gathering of researchers, ethicists, and activists, this paper presents the first major analysis of the ethical questions arising from this unease. We outline the scientific developments that have provoked the most discomfort, analyze the response to these developments from within and without the autism community, and trace the current state of the ethical debate. Having done so, we contend that these ethical questions are unlikely to be resolved as they depend on fundamentally conflicting assumptions about the nature and desirability of neurocognitive difference. We conclude by arguing for a new range of democratic mechanisms that could enable the scientific community, autistics, and other concerned parties to respond collectively to such entrenched ethical disputes.
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Affiliation(s)
- Elizabeth Pellicano
- Centre for Research in Autism and Education, Department of Psychology and Human Development, Institute of Education, London, UK.
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Abstract
As a clinical category and a sociocultural phenomenon, autism occupies a prominent albeit ambiguous place in ongoing social science and humanities debates about empathy, intersubjectivity, intentionality, epistemological certainty, and moral agency. Autism is used as a counterexample to feeling empathy and understanding other people's beliefs and intentions. Alternatively, it is given as evidence of the limitless potential and neurodiversity of the human mind. This review examines the field of autism research relevant to anthropology of the senses. It considers the production of knowledge about autism as a clinically relevant category at the intersection of sense as culturally organized competence in meaning making and the senses as a culturally normative and institutionally ratified sensory and perceptual endowment. In such a distinction, both sense and the senses are paths toward and objects of the empirical understanding of autism.
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Affiliation(s)
- Olga Solomon
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California 90089
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Affiliation(s)
- Jeffrey P Baker
- Department of Pediatrics, Trent Center for Bioethics, Humanities, and History of Medicine, Box 3040 DUMC, Durham, NC 27710, USA.
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30
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Golnik AE, Ireland M. Complementary alternative medicine for children with autism: a physician survey. J Autism Dev Disord 2009; 39:996-1005. [PMID: 19280328 DOI: 10.1007/s10803-009-0714-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 02/13/2009] [Indexed: 12/14/2022]
Abstract
Previous studies suggest over half of children with autism are using complementary alternative medicine (CAM). In this study, physicians responded (n = 539, 19% response rate) to a survey regarding CAM use in children with autism. Physicians encouraged multi-vitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%) and discouraged withholding immunizations (76%), chelation (61%), anti-infectives (57%), delaying immunizations (55%) and secretin (43%). Physicians encouraging CAM were more likely to desire CAM training, inquire about CAM use, be female, be younger, and report greater autism visits, autism education and CAM knowledge. Physicians were more likely to desire CAM training, inquire about CAM and view CAM as a challenge for children with autism compared to children with other neurodevelopmental and chronic/complex conditions.
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Affiliation(s)
- Allison E Golnik
- Division of General Pediatrics, Department of Pediatrics, University of Minnesota, 717 Delaware Street SE, 3rd Floor (west), Room 370E, Minneapolis, MN 55414, USA.
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Abstract
BACKGROUND Primary care physicians can enhance the health and quality of life of children with autism by providing high-quality and comprehensive primary care. OBJECTIVE To explore physicians' perspectives on primary care for children with autism. METHODS National mail and e-mail surveys were sent to a random sample of 2325 general pediatricians and 775 family physicians from April 2007 to October 2007. RESULTS The response rate was 19%. Physicians reported significantly lower overall self-perceived competency, a greater need for primary care improvement, and a greater desire for education for children with autism compared with both children with other neurodevelopmental conditions and those with chronic/complex medical conditions. The following barriers to providing primary care were endorsed as greater for children with autism: lack of care coordination, reimbursement and physician education, family skeptical of traditional medicine and vaccines, and patients using complementary alternative medicine. Adjusting for key demographic variables, predictors of both higher perceived autism competency and encouraging an empirically supported therapy, applied behavior analysis, included having a greater number of autism patient visits, having a friend or relative with autism, and previous training about autism. CONCLUSIONS Primary care physicians report a lack of self-perceived competency, a desire for education, and a need for improvement in primary care for children with autism. Physician education is needed to improve primary care for children with autism. Practice parameters and models of care should address physician-reported barriers to care.
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Affiliation(s)
- Allison Golnik
- University of Minnesota, Department of Pediatrics, Division of General Pediatrics, 717 Delaware St SE, 3rd Floor (West), Room 370E, Minneapolis, MN 55414, USA.
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Inglese MD, Elder JH. Caring for children with autism spectrum disorder. Part I: prevalence, etiology, and core features. J Pediatr Nurs 2009; 24:41-8. [PMID: 19159834 DOI: 10.1016/j.pedn.2007.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 11/28/2007] [Accepted: 12/23/2007] [Indexed: 01/13/2023]
Abstract
Autism spectrum disorder (ASD) affects 1 in 150 children and has been gaining national attention over the past decade. Given the prevalence of this disorder, there is a high probability that pediatric nurses will care for a child with ASD, regardless of the setting in which they work. Children with ASD traverse the primary care outpatient setting, schools, subspecialty clinics, and inpatient units. A basic understanding of the current issues regarding prevalence and etiology, coupled with knowledge of the core features of ASD, will help pediatric nurses in all settings and at various practice levels better care for these children.
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Affiliation(s)
- Melissa Dodd Inglese
- University of Florida, College of Nursing, Psychiatry, Gainesville, FL 32610, USA
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Singh J, Illes J, Lazzeroni L, Hallmayer J. Trends in US autism research funding. J Autism Dev Disord 2009; 39:788-95. [PMID: 19148735 DOI: 10.1007/s10803-008-0685-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
This study shows that the number of autism research grants funded in the US from 1997 to 2006 significantly increased 15% per year. Although the majority of projects were concentrated in basic science (65%) compared to clinical (15%) and translational research (20%), there is a significant decrease in the proportion of basic research grants per year and a significant increase in the proportion of translational projects per year. The number of translational projects funded by the National Alliance for Autism Research and Cure Autism Now increased significantly, whereas the number of clinical projects significantly increased for the National Institutes of Health. In conclusion, this study demonstrates the shifting landscape of autism research from basic science to clinical and translational research.
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Affiliation(s)
- Jennifer Singh
- Stanford Center for Biomedical Ethics, Center for Integration of Research on Genetics and Ethics, Stanford University, Palo Alto, CA, USA
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