1
|
Nicholas DB, Zulla RT, Cielsielski J, Zwaigenbaum L, Conlon O. COVID-19 Pandemic Experiences of Families in Which a Child/Youth Has Autism and Their Service Providers: Perspectives and Lessons Learned. J Autism Dev Disord 2024:10.1007/s10803-024-06402-6. [PMID: 38767817 DOI: 10.1007/s10803-024-06402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The impacts of the COVID-19 pandemic on autistic children/youth and their families and on service providers are not yet well-understood. This study explored the lived experiences of families with an autistic child and service providers who support them regarding the impacts of the pandemic on service delivery and well-being. METHODS In this qualitative study, families and service providers (e.g., early intervention staff, service providers, school personnel) supporting autistic children/youth were interviewed. Participants were recruited from a diagnostic site and two service organizations that support autistic children/youth. RESULTS Thirteen parents and 18 service providers participated in either an individual or group interview. Findings indicate challenges associated with pandemic restrictions and resulting service shifts. These challenges generally imposed negative experiences on the daily lives of autistic children/youth and their families, as well as on service providers. While many were adversely affected by service delivery changes, families and service agencies/providers pivoted and managed challenges. Shifts have had varied impacts, with implications to consider in pandemic planning and post-pandemic recovery. CONCLUSION Results highlight the need for autism-focused supports, as well as technology and pandemic preparedness capacity building within health, therapeutic and educational sectors in order to better manage shifts in daily routines during emergencies such as a pandemic. Findings also offer instructive consideration in service delivery post-pandemic.
Collapse
Affiliation(s)
- David B Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada.
| | - Rosslynn T Zulla
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
| | - Jill Cielsielski
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olivia Conlon
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
| |
Collapse
|
2
|
Smith JV, McQuaid GA, Wallace GL, Neuhaus E, Lopez A, Ratto AB, Jack A, Khuu A, Webb SJ, Verbalis A, Pelphrey KA, Kenworthy L. Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241249878. [PMID: 38725306 DOI: 10.1177/13623613241249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
LAY ABSTRACT Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
Collapse
Affiliation(s)
- Jessica V Smith
- Children's Research Institute, Children's National Hospital, USA
| | | | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, USA
| | - Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Andrea Lopez
- Children's Research Institute, Children's National Hospital, USA
| | - Allison B Ratto
- Children's Research Institute, Children's National Hospital, USA
| | - Allison Jack
- Department of Psychology, George Mason University, USA
| | - Alexis Khuu
- Children's Research Institute, Children's National Hospital, USA
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Alyssa Verbalis
- Children's Research Institute, Children's National Hospital, USA
| | | | - Lauren Kenworthy
- Children's Research Institute, Children's National Hospital, USA
| |
Collapse
|
3
|
Shapter S, Carroll A, Roberts K. Clinician Opinions Regarding the Usefulness of the BOSA for ASD Assessment in a Service for Children Aged Under 12 Years. J Autism Dev Disord 2024:10.1007/s10803-023-06207-z. [PMID: 38565777 DOI: 10.1007/s10803-023-06207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 04/04/2024]
Abstract
The COVID-19 pandemic and the subsequent social distancing policies forced healthcare teams to drastically alter the way they deliver services. This was particularly challenging for clinicians involved in diagnosing autism spectrum disorder (ASD), as assessment tools and methods required face-to-face social interactions between clinicians and children. To address this, the Brief Observation of Symptoms of Autism (BOSA) was developed to ensure that people suspected of ASD can receive diagnostic assessments during the pandemic. This project aimed to explore clinicians' opinions on the BOSA, particularly regarding the usefulness of the assessment for clinicians to clarify diagnostic outcomes of ASD assessments. Both quantitative and qualitative data was gathered within an NHS community paediatric team. This included a questionnaire for clinicians to complete, and data from the BOSA assessments done in the service. Thematic analysis and descriptive statistics revealed that many clinicians felt that the BOSA can be beneficial in certain cases, such as selective mutism, and found the BOSA particularly helpful for observing parent-child interactions. These findings highlighted important information that the Autism Diagnostic Observation Schedule Second Edition (ADOS-2) does not give opportunities to observe. Clinicians reported that at times, the BOSA materials, brevity and parental administration created barriers to gathering information for diagnostic decisions. As may be expected, clinicians showed a clear preference for the more familiar and validated ADOS-2. However, the study highlights perceived limitations of the ADOS-2 and strengths of the BOSA, with recommendations made for future practice and research.
Collapse
Affiliation(s)
- Sophie Shapter
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Amy Carroll
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Kate Roberts
- Oak Tree Centre, Cambridgeshire Community Services NHS Trust, Huntingdon, PE29 7HN, UK
| |
Collapse
|
4
|
Smith JV, Menezes M, Brunt S, Pappagianopoulos J, Sadikova E, O Mazurek M. Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236112. [PMID: 38456360 DOI: 10.1177/13623613241236112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
LAY ABSTRACT The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.
Collapse
Affiliation(s)
- Jessica V Smith
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Michelle Menezes
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Sophie Brunt
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Jessica Pappagianopoulos
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| |
Collapse
|
5
|
Byrne K, Sterrett K, Holbrook A, Kim SH, Grzadzinski R, Lord C. Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version. J Autism Dev Disord 2024; 54:1009-1023. [PMID: 36547793 PMCID: PMC9772597 DOI: 10.1007/s10803-022-05877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
The current study investigated the utility of the Brief Observation of Social Communication Change-Phrase Speech Young Fluent (BOSCC-PSYF) as an outcome measure of treatment response by analyzing the measure's psychometric properties and initial validity. The BOSCC coding scheme was applied to 345 administrations from 160 participants diagnosed with autism. Participants included individuals of any age with phrase speech, or individuals under the age of 8 years with complex sentences. All were receiving behavioral intervention throughout the study. Test-retest and inter-rater reliability were good for the Early Communication and Social Reciprocity/Language domains, and fair for the Restricted and Repetitive Behavior domain. Significant changes occurred over time in the Early Communication and Social Reciprocity/Language domains, and Core Total scores. The BOSCC-PSYF may provide a low-cost, flexible, and user-friendly outcome measure that reliably measures changes in broad social communicative behaviors in a short period of time.
Collapse
Affiliation(s)
| | - Kyle Sterrett
- University of California, Los Angeles, California, USA
| | | | | | | | | |
Collapse
|
6
|
Hong JS, Perrin J, Singh V, Kalb L, Cross EA, Wodka E, Richter C, Landa R. Psychometric Evaluation of the Autism Spectrum Rating Scales (6-18 Years Parent Report) in a Clinical Sample. J Autism Dev Disord 2024; 54:1024-1035. [PMID: 36571625 PMCID: PMC9791153 DOI: 10.1007/s10803-022-05871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
ASD is a neurodevelopmental disorder impacting 1 in 44 children and early identification of children with ASD is critical for the intervention. Several screening measures have been developed for early identification, including the Autism Spectrum Rating Scales, 6-18 years Parent Report (ASRS). The ASRS has been understudied, and the current study assessed the validity of the ASRS in a clinical sample of 490 children at a tertiary ASD-specialty clinic. Results indicated that the ASRS demonstrated favorable sensitivity, but poor specificity. True positive screening results were more likely to occur for children with a multiracial background, while they were less likely to occur for children with a high social capital. Overall, though the ASRS has clinical utility as a screening measure, it did not perform effectively to differentiate ASD from Non-ASD clinical disorders.
Collapse
Affiliation(s)
- Ji Su Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Jeremy Perrin
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
| | - Luke Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Elizabeth A Cross
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
| | - Ericka Wodka
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chana Richter
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, 21211, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
7
|
Ozonoff S, Gangi D, Corona L, Foster T, Hill MM, Honaker M, Maqbool S, Ni R, Nicholson A, Parikh C, Stone C, Spitler AK, Swanson A, Vehorn A, Wagner L, Weitlauf A, Warren Z. Measuring Developmental Delays: Comparison of Parent Report and Direct Testing. J Autism Dev Disord 2024:10.1007/s10803-024-06292-8. [PMID: 38407697 DOI: 10.1007/s10803-024-06292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Developmental assessment is part of a comprehensive autism evaluation. During in-person evaluations, developmental assessment is completed via direct testing by an examiner. In telehealth evaluations, developmental assessment relies on caregiver-report instruments. This study examined correspondence between caregiver report and direct testing of developmental skills. METHODS Participants were 93 children, aged 18-42 months, undergoing evaluation for possible autism spectrum disorder (ASD). Caregivers were interviewed with the Developmental Profile, 4th edition (DP-4) via telehealth platform and children were tested in person 2-4 weeks later using the Mullen Scales of Early Learning (MSEL). RESULTS Correlations between the DP-4 and MSEL were high (ranging from 0.50 to 0.82) across standard scores, age equivalents, and functional categories, as well as across individual subtests and overall composite scores. CONCLUSION The high convergent validity found in this study suggests that the DP-4 provides a suitable proxy for direct developmental testing using the MSEL in the context of telehealth evaluations for ASD in young children, delivering a good estimate of both developmental functioning and presence of delays. TRIAL REGISTRATION Data were obtained from registered clinical trial NCT05047224, date of registration 2021-09-07.
Collapse
Affiliation(s)
- Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA.
| | - Devon Gangi
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Laura Corona
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tori Foster
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monique Moore Hill
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Makayla Honaker
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shyeena Maqbool
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Rachel Ni
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Amy Nicholson
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chandni Parikh
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Caitlin Stone
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Kathleen Spitler
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Swanson
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Liliana Wagner
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Weitlauf
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
8
|
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges in social interaction and communication and the presence of restricted interests and repetitive behaviors. The importance of early detection of ASD and subsequent early intervention is well documented. Efforts have been made over the years to clarify ASD diagnostic criteria and develop predictive, accurate screening tools and evidence-based, standardized diagnostic instruments to aid in the identification of ASD. In this article, we review the most recent changes in ASD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, summarize evidence-based instruments for ASD screening and diagnostic evaluations as well as the assessment of co-occurring conditions in ASD, the impact of COVID-19 on ASD assessment, and directions for future research in the field of ASD assessment.
Collapse
Affiliation(s)
- Yue Yu
- University of California, Davis, Sacramento, USA
| | | | | |
Collapse
|
9
|
Hodge A, Sutherland R, Ong N, Chan E, Barnett D, Bennett B, Boulton K, Francis D, Guastella A, Papanicolaou A, Tomsic G, Williamsz M, Silove N. Telehealth assessment of autism in preschoolers using the TELE-ASD-PEDS: A pilot clinical investigation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-17. [PMID: 38105699 DOI: 10.1080/17549507.2023.2270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
PURPOSE Appropriate early intervention is beneficial but dependent on accurate and timely diagnoses. This has been affected by long waiting lists for face-to-face clinical services, in part due to pandemic lockdowns, with telehealth introduced in many services to continue clinical services. This pilot clinical study investigated the feasibility of integrating a specially-designed telepractice autism assessment tool into a tertiary diagnostic service. METHOD Eighteen boys (2;4-5;1) participated in the study. Assessment was undertaken as per standard practice (parent interview, questionnaires, review of reports), with an additional telepractice assessment, included in place of face-to-face assessment, to provide clinicians with an observation of the children's communication, behaviours, and interests. Ten parents provided feedback via semi-structured interviews. RESULT The TELE-ASD-PEDS was a feasible assessment tool in terms of administration, clinical experience, and information gained through the assessment process. Parents reported mostly positive experiences of the TELE-ASD-PEDS and made suggestions for improvements for future use of this tool. CONCLUSION It is possible to obtain useful information about a child's autism-specific behaviours using the activities in the TELE-ASD-PEDS. This information can be combined with clinical history from parents using the DSM-5 framework to provide a gold standard assessment for autism.
Collapse
Affiliation(s)
- Antoinette Hodge
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Rebecca Sutherland
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
- The School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Esther Chan
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Diana Barnett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Beverley Bennett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Kelsie Boulton
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Deanna Francis
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Black Dog Institute, University of New South Wales, Sydney, Australia, and
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Adam Guastella
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Angela Papanicolaou
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Gail Tomsic
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Marcia Williamsz
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie Silove
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| |
Collapse
|
10
|
Khairetdinov OZ, Rubakova LI. Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review. CONSORTIUM PSYCHIATRICUM 2023; 4:55-64. [PMID: 38249532 PMCID: PMC10795948 DOI: 10.17816/cp12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.
Collapse
Affiliation(s)
- Oleg Z. Khairetdinov
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | - Luciena I. Rubakova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| |
Collapse
|
11
|
Morrier MJ, Schwartz AJ, Rice CE, Platner A, Ousley OY, Kassem S, Krishnan AV, Lord C, Smith CJ, Oberleitner R. Validation of an Enhanced Telehealth Platform for Toddlers at Increased Likelihood for a Diagnosis of Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023:10.1007/s10803-023-06116-1. [PMID: 37740876 DOI: 10.1007/s10803-023-06116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
Use of telehealth assessments for toddlers at increased likelihood of autism spectrum disorder (ASD) began prior to the global COVID-19 pandemic; however, the value of telehealth assessments as an alternative to in-person assessment (IPA) became clearer during the pandemic. The Naturalistic Observation Diagnosis Assessment (NODA™), previously demonstrated as a valid and reliable tool to evaluate asynchronous behaviors for early diagnosis, was enhanced to add synchronous collection of behaviors to assist clinicians in making a differential diagnosis of ASD. This study was conducted to validate the information gathered through NODA-Enhanced (NODA-E™) as compared to a gold standard IPA. Forty-nine toddlers aged 16.0-32.1 months of age, recruited through community pediatric offices and a tertiary ASD clinic, participated in both NODA-E and IPA assessments. There was high agreement between the two assessment protocols for overall diagnosis (46 of 49 cases; 93.6%; κ = .878), specific diagnostic criteria for social communication and social interaction (SCI; range 95.9-98%; κ = .918-.959), and for two of four criteria specified for restricted and repetitive behaviors (RRB; range 87.8-98%; κ = .755 and .959). There was lower agreement for two subcategories of RRBs (range 65.3-67.3%; κ = .306 and .347). NODA-E is a tool that can assist clinicians in making reliable and valid early ASD diagnoses using both asynchronous and synchronous information gathered via telehealth and offers an additional tool within a clinician's assessment toolbox.
Collapse
Affiliation(s)
- Michael J Morrier
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA.
| | - Allison J Schwartz
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Catherine E Rice
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Amanda Platner
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Opal Y Ousley
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Sara Kassem
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | | | - Catherine Lord
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
12
|
Jones W, Klaiman C, Richardson S, Lambha M, Reid M, Hamner T, Beacham C, Lewis P, Paredes J, Edwards L, Marrus N, Constantino JN, Shultz S, Klin A. Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism. JAMA Netw Open 2023; 6:e2330145. [PMID: 37669054 PMCID: PMC10481232 DOI: 10.1001/jamanetworkopen.2023.30145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child's development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later. Objective To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years. Design, Setting, and Participants In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking-based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019. Main Outcomes and Measures Prespecified primary end points were the sensitivity and specificity of the eye-tracking-based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking-based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability. Results Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children's individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively. Conclusions and Relevance In two diagnostic studies of children younger than 3 years, objective eye-tracking-based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment.
Collapse
Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Meena Lambha
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Morganne Reid
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Taralee Hamner
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Chloe Beacham
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Peter Lewis
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jose Paredes
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Edwards
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natasha Marrus
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - John N. Constantino
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
- Now with Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
- Now with Division of Behavioral and Mental Health, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| |
Collapse
|
13
|
Johnson NL, Fial A, Van Hecke AV, Whitmore K, Meyer K, Pena S, Carlson M, Koth KA. A Scoping Review of Diagnosis of Autism Spectrum Disorder in Primary Care. J Pediatr Health Care 2023; 37:519-527. [PMID: 37178094 DOI: 10.1016/j.pedhc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION This scoping review was performed to collect, examine, and present literature on interventions promoting the diagnosis of Autism Spectrum Disorder (ASD) in U.S. primary health care settings. METHOD The literature searched was from 2011-2022, in the English language, in PubMed, CINAHL, Psych INFO, Cochrane, and Web of Science, for persons with autism or ASD aged ≤ 18 years. RESULTS Six studies met the search criteria, including a quality improvement project, a feasibility study, a pilot study, and three primary care provider (PCP) intervention trials. Measured outcomes included: accuracy of diagnosis (n = 4), practice change maintenance (n = 3), time to diagnosis (n = 2), specialty clinic appointment wait time (n = 1), PCP comfort making ASD diagnosis (n = 1), and increased ASD diagnosis (n = 1). DISCUSSION Results inform future implementation of PCP ASD diagnosis for the most obvious cases of ASD and research evaluating PCP training, using longitudinal measures of PCP knowledge of ASD and intention to diagnose.
Collapse
|
14
|
Male I, Farr W, Bremner S, Gage H, Williams P, Gowling E, Honey E, Gain A, Parr J. An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1119288. [PMID: 37350848 PMCID: PMC10283036 DOI: 10.3389/fresc.2023.1119288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/02/2023] [Indexed: 06/24/2023]
Abstract
Background Demand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?. Method Case notes of 20 children (1-16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs. Results 488 children (aged 21-195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41-1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs. Conclusion Typical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity.
Collapse
Affiliation(s)
- Ian Male
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - William Farr
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Bremner
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Heather Gage
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Peter Williams
- School of Mathematics, University of Surrey, Guildford, United Kingdom
| | - Emma Gowling
- Geriatrics, Queen Alexandra Hospital, Cosham, United Kingdom
| | - Emma Honey
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
| | - Aaron Gain
- Public Health, University of Brighton, Brighton, UK
| | - Jeremy Parr
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Faculty of Medical Sciences, Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| |
Collapse
|
15
|
Bishop SL, Lord C. Commentary: Best practices and processes for assessment of autism spectrum disorder - the intended role of standardized diagnostic instruments. J Child Psychol Psychiatry 2023; 64:834-838. [PMID: 37005008 DOI: 10.1111/jcpp.13802] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments.
Collapse
Affiliation(s)
- Somer L Bishop
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
16
|
Sohl K, Levinstein L, James A, Greer S, Boles K, Curran AB, Mahurin M, Mazurek MO, Nanclares V. ECHO (Extension for Community Healthcare Outcomes) Autism STAT: A Diagnostic Accuracy Study of Community-Based Primary Care Diagnosis of Autism Spectrum Disorder. J Dev Behav Pediatr 2023; 44:e177-e184. [PMID: 36978232 DOI: 10.1097/dbp.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Children can be reliably diagnosed with autism spectrum disorder (ASD) by a highly trained clinician as early as 12 to 24 months of age, but recent estimates indicate that the average age of diagnosis is 4.4 years. We hypothesized that trained primary care physicians and practitioners can reliably and accurately diagnose children 14 to 48 months with unambiguous symptoms of ASD. METHODS Through this diagnostic accuracy study, 20 patients diagnosed with ASD by clinicians trained through the ECHO (Extension for Community Healthcare Outcomes) Autism STAT program participated in an independent gold-standard evaluation at a regional autism center. Caregiver perceptions of the diagnostic process were also assessed. RESULTS Of the 20 patients who received a diagnosis of ASD by a trained clinician and completed the study, 19 diagnoses were confirmed by a gold-standard evaluation. Caregivers indicated that undergoing diagnosis in their local community rather than an autism specialty center was helpful (4.8/5 on a 5-point Likert scale, n = 19). Results of this study demonstrate that primary care clinicians can be trained to reliably diagnose ASD in children 14 to 48 months with unambiguous symptoms. CONCLUSION Diagnosis in the primary care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. Given the potential impact of increasing access to high-quality diagnostic services, the role of primary care clinicians in the diagnosis of ASD should be further evaluated.
Collapse
Affiliation(s)
- Kristin Sohl
- University of Missouri, School of Medicine, Columbia, MO
- Department of Child Health, University of Missouri, Columbia, MO
| | | | - Alexandra James
- University of Missouri, School of Medicine, Columbia, MO
- Department of Child Health, University of Missouri, Columbia, MO
| | - Sophia Greer
- University of Missouri, School of Medicine, Columbia, MO
| | - Katrina Boles
- Department of Child Health, University of Missouri, Columbia, MO
| | | | - Melissa Mahurin
- Department of Child Health, University of Missouri, Columbia, MO
| | - Micah O Mazurek
- University of Virginia, School of Education and Human Development, Charlottesville, VA
| | | |
Collapse
|
17
|
Hamp N, DeHaan SL, Cerf CM, Radesky JS. Primary Care Pediatricians' Perspectives on Autism Care. Pediatrics 2023; 151:190353. [PMID: 36550067 DOI: 10.1542/peds.2022-057712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We aimed to explore pediatric primary care provider (PCP) experiences and needs around identification and management of autism spectrum disorder (ASD) in toddlers for the purpose of planning improved supports and services for ASD in the medical home. METHODS We recruited 28 PCPs to participate in semistructured interviews via Zoom. Probe questions elicited opinions about current screening and referral procedures, experiences obtaining services for patients, effective communication with parents, physician emotional experience when introducing ASD concerns, practice-based sources of disparities, and larger needs for ASD management in the primary care setting. Interview transcripts were analyzed qualitatively by a multispecialty research team for recurrent themes using grounded theory analysis. RESULTS Participants were 89% women, ranging in clinical experience from <1 year to >27 years, representing 8 diverse pediatric primary care clinic sites at a Midwest academic medical center. Dominant themes relating to PCPs' cognitive, emotional, and environmental experience of caring for patients with ASD were identified, which reflected the trajectory of ASD identification (the parent lens; the "A" word), referral (the autism labyrinth; provider disempowerment; parent activation as a source of inequities), and long-term management (the "black box"; provider emotional investment). CONCLUSIONS Existing literature and results from this study suggest a need for targeted improvements in primary care to: (1) increase PCP capacity and confidence in communicating concerns of ASD with families; (2) refer for timely diagnostic evaluations in trusted and easy-to-navigate care systems; and (3) increase family activation and capacity to follow up on ASD evaluation and treatment services.
Collapse
Affiliation(s)
- Nicole Hamp
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Sarah L DeHaan
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Celina M Cerf
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jenny S Radesky
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
18
|
Kraft C, Chamanadjian C, Aylward BS. Autism Spectrum Disorder: The New Asthma? Clin Pediatr (Phila) 2022:99228221144146. [PMID: 36539943 DOI: 10.1177/00099228221144146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While autism spectrum disorder (ASD) has traditionally been diagnosed in specialty care, rising prevalence rates have strained specialist capacity and created significant diagnostic bottlenecks. With long wait times for specialist evaluations, pediatricians are increasingly being asked to play a greater role in identifying, diagnosing, and managing ASD within the medical home. In this commentary we draw parallels between the challenges pediatricians faced two decades ago learning how to manage pediatric asthma in the medical home, to those faced today in the field of primary care ASD management. Reflecting on the lessons learnt in primary care asthma management may help us construct a roadmap towards a higher and more consistent standard of ASD primary care for patients and their families.
Collapse
Affiliation(s)
- Colleen Kraft
- University of Southern California, Los Angeles, CA, USA.,Cognoa, Inc., Palo Alto, CA, USA
| | | | - Brandon S Aylward
- Cognoa, Inc., Palo Alto, CA, USA.,RTI Health Advance, Research Triangle Park, NC, USA
| |
Collapse
|
19
|
Age-Based Tracks: A Method to Tailor Autism Diagnostic Evaluation in Large-Scale Autism Specialty Centers. J Clin Med 2022; 11:jcm11216332. [DOI: 10.3390/jcm11216332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
This paper describes a proposed model of diagnostic evaluation for autism spectrum disorder (ASD) at a large-scale ASD specialty center. Our center has implemented age-based diagnostic tracks within an interdisciplinary team evaluation approach to assessing ASD. Data were collected as part of a program evaluation and included responses from provider surveys as well as patient medical record reviews. The results from 803 patients were included. The diagnostic outcomes, time for evaluation, and appropriateness of referral were analyzed in patients referred to the Younger (n = 155) and Older (n = 648) diagnostic tracks. In 92.8% of cases referred to the clinic’s standard team evaluation model, the provider teams were able to make a diagnostic decision within the allotted evaluation time. The results from an additional diagnostic pathway, termed the Autism Psych Team (APT), within the older track were also presented. The intake providers had the option to triage older patients to this pathway when they anticipated that the patient might be diagnostically complex. Most patients (45.1%) triaged to the APT were referred due to psychiatric complexity. In 96% of APT cases, the APT providers felt the patient was an appropriate referral. Overall, these results suggest a method to efficiently triage patients to diagnostic models equipped to serve them within a high-volume ASD center.
Collapse
|
20
|
Ono T, Sakurai T, Kasuno S, Murai T. Novel 3-D action video game mechanics reveal differentiable cognitive constructs in young players, but not in old. Sci Rep 2022; 12:11751. [PMID: 35864114 PMCID: PMC9304325 DOI: 10.1038/s41598-022-15679-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Video game research predominantly uses a “one game-one function” approach—researchers deploy a constellation of task-like minigames to span multiple domains or consider a complex video game to essentially represent one cognitive construct. To profile cognitive functioning in a more ecologically valid setting, we developed a novel 3-D action shooter video game explicitly designed to engage multiple cognitive domains. We compared gameplay data with results from a web-based cognitive battery (WebCNP) for 158 participants (aged 18–74). There were significant negative main effects on game performance from age and gender, even when controlling for prior video game exposure. Among younger players, game mechanics displayed significant and unique correlations to cognitive constructs such as aim accuracy with attention and stealth with abstract thinking within the same session. Among older players the relation between game components and cognitive domains was unclear. Findings suggest that while game mechanics within a single game can be deconstructed to correspond to existing cognitive metrics, how game mechanics are understood and utilized likely differs between the young and old. We argue that while complex games can be utilized to measure distinct cognitive functions, the translation scheme of gameplay to cognitive function should not be one-size-fits-all across all demographics.
Collapse
Affiliation(s)
- Tomihiro Ono
- Department of Psychiatry, Kyoto University Hospital, Yoshida konoe cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan. .,BonBon Inc., Kyoto, Japan.
| | - Takeshi Sakurai
- BonBon Inc., Kyoto, Japan.,Department of Drug Discovery Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
21
|
Expectations and Concerns about the Use of Telemedicine for Autism Spectrum Disorder: A Cross-Sectional Survey of Parents and Healthcare Professionals. J Clin Med 2022; 11:jcm11123294. [PMID: 35743364 PMCID: PMC9224762 DOI: 10.3390/jcm11123294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has recently been used for diagnosis and interventions inpatients with autism spectrum disorder (ASD), traditionally performed in-person, but little attention has been paid to user expectations prior to its use. The aim of this study is to compare the expectations and concerns of 50 healthcare professionals and 45 parents of children with ASD regarding the use of telemedicine for diagnostic or treatment purposes. Parents have higher expectations for the use of telemedicine as an alternative (p = 0.0223) and supplement (p = 0.0061) to in-person diagnosis of ASD, as well as a supplement to traditional intervention (p ≤ 0.0001). In addition, while they also have greater hope for improvement in family routines (p = 0.0034) and parenting skills in child management (p = 0.0147), they express greater concern about the need for active parental involvement/supervision during telemedicine services (p = 0.015) and changes in the behaviour of the child with ASD during telemedicine services (p = 0.049). On the other hand, healthcare professionals are more concerned about barriers such as lack of devices (p = 0.000), unfamiliarity with the technology (p = 0.000), poor quality of internet connection (p = 0.006), and severity of ASD (p = 0.000). To achieve promising healthcare for ASD patients, the telemedicine service should try to meet the needs and preferences of both healthcare professionals and parents, as well as identify and, if possible, reduce perceived barriers.
Collapse
|
22
|
Spain D, Stewart GR, Mason D, Robinson J, Capp SJ, Gillan N, Ensum I, Happé F. Autism Diagnostic Assessments With Children, Adolescents, and Adults Prior to and During the COVID-19 Pandemic: A Cross-Sectional Survey of Professionals. Front Psychiatry 2022; 13:789449. [PMID: 35573336 PMCID: PMC9096098 DOI: 10.3389/fpsyt.2022.789449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Access to timely high quality autism diagnostic assessments has traditionally been patchy; many individuals wait months, if not years, for an appointment. The onset of the COVID-19 pandemic has likely impacted autism diagnostic services. This study investigated professionals' experiences of, and thoughts about: (1) how autism diagnostic assessments were conducted before the pandemic; (2) adaptations to service provision because of the pandemic; and (3) challenges, risks, advantages and opportunities associated with autism assessments conducted via online platforms (telehealth). Method Fifty-two professionals, based in different autism diagnostic services and working with children, adolescents and/or adults, completed an online cross-sectional survey in August and September 2020. This comprised demographic questions (about professionals' roles and experiences), and closed and open questions about service provision and telehealth autism assessments. Results There was substantial variation in how autism assessments were conducted prior to and during the pandemic; for example, in relation to the number of professionals involved in the assessment and types of structured, semi-structured and unstructured measures used to conduct this. Fifty-two percent of participants (n = 27) reported some service disruption (e.g., full closure, substantial reduction in provision, and/or pausing of in person appointments). Waiting times for assessment had become longer for 58% of services (n = 30), due to pandemic-related disruption. Six themes emerged from thematic analysis of open responses: (1) the autism diagnostic pathway, pre-pandemic; (2) initial impact of the pandemic on service delivery; (3) conducting autism assessments during the pandemic; (4) working remotely; (5) improving service design and delivery; and (6) post-diagnostic support. Views about the accessibility, validity, and reliability of conducting telehealth autism assessments were polarized. Some participants considered this efficient, flexible, and adequate; others viewed this as unethical and inappropriate. What constitutes good practice in telehealth autism assessments remains unclear, but there is a general openness to using this method (potentially in a hybrid telehealth-in person model), provided rigor and standardization are enhanced. Conclusions The pandemic has potentially compounded existing bottlenecks to the autism diagnostic pathway. Future research should seek to improve timeliness, standardization, accessibility and robustness of this pathway, and the validity and reliability of telehealth autism assessments.
Collapse
Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gavin R. Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridge, United Kingdom
| | - Simone J. Capp
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Bristol, United Kingdom
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|