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Schuster BA, Okamoto Y, Takahashi T, Kurihara Y, Keating CT, Cook JL, Kosaka H, Ide M, Naruse H, Kraaijkamp C, Osu R. A cross-cultural examination of bi-directional mentalising in autistic and non-autistic adults. Mol Autism 2025; 16:29. [PMID: 40361199 PMCID: PMC12076830 DOI: 10.1186/s13229-025-00659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 03/24/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND So-called 'mismatch accounts' propose that, rather than arising from a socio-cognitive deficit present in autistic people, mentalising difficulties are the product of a mismatch in neurotype between interaction partners. Although this idea has grown in popularity over recent years, there is currently only limited empirical evidence to support mismatch theories. Moreover, the social model of disability such theories are grounded in demands a culturally situated view of social interaction, yet research on mentalising and/or autism is largely biased towards Western countries, with little knowledge on how successful mentalising is defined differently, and how tools to assess socio-cognitive ability compare, across cultures. METHODS Using a widely employed mentalising task-the animations task-, the current study investigated and compared the bi-directional mentalising performance of British and Japanese autistic and non-autistic adults and assessed observer-agent kinematic similarity as a potential dimension along which mismatches may occur between neurotypes. Participants were asked to depict various mental state- and action-based interactions by moving two triangles across a touch-screen device before viewing and interpreting stimuli generated by other participants. RESULTS In the UK sample, our results replicate a seminal prior study in showing poorer mentalising abilities in non-autistic adults for animations generated by the autistic group. Crucially, the same pattern did not emerge in the Japanese sample, where there were no mentalising differences between the two groups. LIMITATIONS Limitations of the current study include that efforts to match all samples within and across cultures in terms of IQ, gender, and age were not successful in all comparisons, but control analyses suggest this did not affect our results. Furthermore, any performance differences were found for both the mental state- and action-based conditions, mirroring prior work and raising questions about the domain-specificity of the employed task. CONCLUSIONS Our results add support for a paradigm shift in the autism literature, moving beyond deficit-based models and towards acknowledging the inherently relational nature of social interaction. We further discuss how our findings suggest limited cultural transferability of common socio-cognitive measures rather than superior mentalising abilities in Japanese autistic adults, underscoring the need for more cross-cultural research and the development of culturally sensitive scientific and diagnostic tools.
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Affiliation(s)
- Bianca A Schuster
- School of Human Sciences, Waseda University, Tokorozawa, Japan.
- Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan.
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.
| | - Y Okamoto
- Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan
- Department of Sports Science, Faculty of Health and Sports Science, Juntendo University, Tokyo, Japan
| | - T Takahashi
- School of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Y Kurihara
- School of Human Sciences, Waseda University, Tokorozawa, Japan
| | - C T Keating
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - J L Cook
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
| | - H Kosaka
- University of Fukui, Fukui, Japan
| | - M Ide
- National Rehabilitation Center for Persons With Disabilities, Tokorozawa, Japan
| | - H Naruse
- University of Fukui, Fukui, Japan
| | - C Kraaijkamp
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
| | - R Osu
- School of Human Sciences, Waseda University, Tokorozawa, Japan
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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2025; 47:1061-1080. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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Behn N, Power E, Prodger P, Togher L, Cruice M, Marshall J, Rietdijk R. Feasibility and Reliability of the Adapted Kagan Scales for Rating Conversations for People With Acquired Brain Injury: A Multiphase Iterative Mixed-Methods Design. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2025:1-16. [PMID: 39898775 DOI: 10.1044/2024_ajslp-24-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
PURPOSE Rating the quality of conversations can assess communication skills in both people with acquired brain injury and their communication partners. This study explored the clinical feasibility and reliability of two conversation rating scales: the Adapted Measure of Participation in Conversation (MPC) and the Adapted Measure of Support in Conversation (MSC). METHOD Raters were final-year speech and language therapy students (n = 14) and qualified clinicians (n = 2). Raters attended training on the Adapted MPC and MSC, watched 5 or 10 min of videotaped conversations (n = 23), and then scored them on the MPC and MSC scales. Data were collected over four phases, which varied according to the length of the training, sample length, number of samples rated, and level of clinical expertise. Feasibility data (time taken to score conversations and ease of use) were collected. Interrater reliability was assessed using intraclass correlations (ICCs: absolute agreement, single measures). RESULTS Raters took 30-45 min to score a 10-min sample, and they took 20-30 min to score a 5-min sample. Ease of use was rated highly across all phases. Overall reliability for rating 5 min of conversation (ICC = .52-.73) was better than for 10 min of conversation (ICC = .33-.68). Reliability for the MPC was moderate for both students (ICC = .69) and clinicians (ICC = .55), and for the MSC, it was moderate for both students (ICC = .73) and clinicians (ICC = .58). Reliability was better for students compared with clinicians. CONCLUSIONS Rating a 5-min conversation in under 30 min was feasible, with more reliable results for 5-min compared with 10-min conversations. Implications for assessing conversation in the future are discussed.
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Affiliation(s)
- Nicholas Behn
- Department of Language and Communication Science, City St Georges, University of London, United Kingdom
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Penny Prodger
- Department of Language and Communication Science, City St Georges, University of London, United Kingdom
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Madeline Cruice
- Department of Language and Communication Science, City St Georges, University of London, United Kingdom
| | - Jane Marshall
- Department of Language and Communication Science, City St Georges, University of London, United Kingdom
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Singh JS, Brasher S, Sarrett J, Barger B, Guerra K, Dilly LJ, Rubin IL, Stapel-Wax JL, Benevides T, Fernandez-Carriba S. Structural, Institutional, and Interpersonal Racism: Calling for Equity in Autism Research and Practice. J Racial Ethn Health Disparities 2025:10.1007/s40615-024-02280-x. [PMID: 39821775 DOI: 10.1007/s40615-024-02280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 12/20/2024] [Accepted: 12/23/2024] [Indexed: 01/19/2025]
Abstract
Disparities in autism research and practices based on race and ethnicity are evident across many outcomes and life course stages. However, most of the research has focused on outlining differences and not the underlying systemic inequities driving these disparities. In this conceptual paper, we aim to shift the focus by outlining mechanisms of structural racism within the institutions of science, healthcare, and residential segregation and educational systems in the United States (U.S.). We argue that these and other forms of institutional racism constitute structural racism that are influencing the racial and ethnic disparities we see in autism services and care. For each of these institutions, we identify institutional racism related to autism and offer an example of how it shapes interpersonal racism and adverse outcomes, including misdiagnosis, delayed diagnosis, unequal access to educational services, and differential treatment in clinical encounters. We then provide anti-racism approaches in autism research and practice for each of these institutions that addresses institutional and interpersonal racism shaping autism inequities among racial and ethnic minorities. We conclude with a call to action to clinicians, researchers, and others to prioritize and disrupt the impacts of structural, institutional, and interpersonal racism through targeted anti-racism approaches.
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Affiliation(s)
- Jennifer S Singh
- School of History and Sociology, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| | - Susan Brasher
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Jennifer Sarrett
- Emory University, Center for the Study of Human Health, Atlanta, GA, USA
| | - Brian Barger
- Georgia State University, Population Health Sciences, Atlanta, GA, USA
| | - Karen Guerra
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Laura J Dilly
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - I Leslie Rubin
- Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA, USA
- Break the Cycle of Health Disparities Inc, Atlanta, GA, USA
| | - Jennifer L Stapel-Wax
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Teal Benevides
- Augusta University, Institute of Public and Preventive Health, Augusta, GA, USA
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Wynn CJ, McClain MB, Roanhorse TT, Golson ME, Harris B, Bera J, Shahid R. Sociodemographic Differences Impact the Perceived Importance of Social Communication and Interaction Behaviors. J Autism Dev Disord 2025:10.1007/s10803-024-06711-w. [PMID: 39786534 DOI: 10.1007/s10803-024-06711-w] [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: 12/23/2024] [Indexed: 01/12/2025]
Abstract
The evaluation of social communication and interaction (SC/I) behaviors is foundational to the autism identification process. However, this type of evaluation is made difficult by the fact that SC/I is a construct in which perceptions and expectations are largely influenced by norms and attitudes of different sociodemographic groups. While there are many factors that influence differences in SC/I behaviors across sociodemographic groups, one factor that may be especially important is the perceived value of these behaviors. The purpose of this study is to investigate which sociodemographic factors influence the perceived importance of SC/I behaviors among caregivers of children and adolescents. Caregivers (n = 398) living in the United States completed the Social Communication and Interaction Perceptions Scale (SCIPS). Linear mixed-effect models were used to investigate the relationship between the perceived importance of SC/I behaviors and seven sociodemographic factors as well as determine if this relationship was moderated by SC/I behavior type (i.e., foundational vs. advanced behaviors). Several different sociodemographic factors (i.e., caregiver race/ethnicity, caregiver gender, household income, child disability status, child age, child gender) were associated with caregiver ratings of the perceived importance of SC/I behaviors. This relation was, in some instances (i.e., caregiver race/ethnicity, caregiver gender, child disability status), moderated by whether the SC/I behaviors were foundational or advanced. Our findings highlight the importance of considering the values of caregivers regarding perceived SC/I importance during the autism identification process.
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Affiliation(s)
- Camille J Wynn
- Department of Communication Sciences and Disorders, University of Houston, Houston, TX, USA.
| | | | - Tyus T Roanhorse
- Department of Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Megan E Golson
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Bryn Harris
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Jac'lyn Bera
- Department of Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Rabbiya Shahid
- Department of Psychology, Indiana University Bloomington, Bloomington, IN, USA
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McClain MB, Golson ME, Haverkamp CR, Harris B, Ficklin E, Schwartz SE, Wynn CJ. Caregiver Perceptions of Social Communication and Interaction: Development and Validation of the SCIPS. J Autism Dev Disord 2025; 55:1-8. [PMID: 36637592 DOI: 10.1007/s10803-022-05840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/14/2023]
Abstract
Social communication and interaction (SC/I) skill quality may be influenced by cultural values, norms, and expectations. Because difficulties in SC/I is a core criterion for identifying autism and is a frequent construct of interest in autism research, a measure designed to capture cross-cultural differences in the perspectives of SC/I skills is warranted. To address this need we developed and validated the Social Communication and Interaction Perceptions Scale (SCIPS), a caregiver report measure for children ages 6-18 years, that measures both frequency and perceived importance of various SC/I skills. Results from 401 diverse caregiver participants showed that for both domains (i.e., Frequency and Importance) the SCIPS has good reliability (α = 0.88-0.95) and two factors that examine basic and advanced aspects of SC/I skills. Findings support the use of the SCIPS as a measure of caregiver perspectives of SC/I skills in clinical and research contexts.
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Affiliation(s)
- Maryellen Brunson McClain
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, USA.
| | - Megan E Golson
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, USA
| | - Cassity R Haverkamp
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, USA
| | - Bryn Harris
- School of Education & Human Development, University of Colorado Denver, Denver, USA
| | - Erica Ficklin
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, USA
| | - Sarah E Schwartz
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, USA
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Chen Y, Xi Z, Saunders R, Simmons D, Totsika V, Mandy W. A systematic review and meta-analysis of the relationship between sensory processing differences and internalising/externalising problems in autism. Clin Psychol Rev 2024; 114:102516. [PMID: 39515075 DOI: 10.1016/j.cpr.2024.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/20/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024]
Abstract
There is evidence to suggest that sensory processing differences (SPDs) to external stimuli are a plausible underlying mechanism for mental health problems among autistic people. In the current systematic review, we examined the associations between, on the one hand, eleven types of SPDs and, on the other hand, internalising and externalising problems. The literature search was conducted on five databases (MEDLINE, PsycINFO, Web of Science, EMBASE, and CINAHL) between 1990 and August 2024. Studies with autistic people aged under 65 years-old that reported correlations between SPDs and internalising/externalising problems were included. Three-level and random-effects meta-analyses and narrative synthesis were conducted. In total, we included 63 articles (11,659 participants) in the current review. Overall, higher levels of all SPD subtypes were found to be associated with greater internalising/externalising problems. Hypersensitivity, visual, auditory, and tactile sensitivities were strongly associated with internalising/externalising problems, while smaller effects were observed for unusual processing of smell and taste. Sensation seeking was highly linked with externalising problems, whereas it was the least associated sensory subtype with internalising problems. Future studies could address the limitations in the extant literature (e.g., heterogeneity in the estimates of associations, a lack of externalising problem investigations and longitudinal studies) to further advance our understanding of the role of SPDs in the aetiology, development, and treatment of internalising/externalising problems in autism.
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Affiliation(s)
- Yixin Chen
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK.
| | - Zhenyang Xi
- Department of Experimental Psychology, University College London, 26 Bedford Way, London, UK
| | - Rob Saunders
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK
| | - David Simmons
- School of Psychology and Neuroscience, University of Glasgow, 62 Hillhead Street, Glasgow, UK
| | - Vasiliki Totsika
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK
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Frisch M, Canale R, L Yantz C, Barton ML. Autism or not? A case series of evaluation decision points in child and adolescent psychological assessment. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-12. [PMID: 39436766 DOI: 10.1080/21622965.2024.2418447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
Increase in the incidence of autism spectrum disorders (ASD) and increased attention to symptoms of ASD in social media have contributed to a significant rise in referrals for neuropsychological assessment of possible ASD. Many practitioners lack specific training in the assessment of ASD and may avoid addressing these concerns, despite the frequency of those referrals. This paper reviews potential contributors to the rise in referrals and several related conditions which share some overlap with features of ASD. That is followed by descriptions of four school-aged children and adolescents referred for comprehensive evaluation of suspected ASD. The authors describe decision points in the diagnostic process for those with or without proficiency in ASD-specific testing and close with a series of recommendations for the assessment of clients with complex presentations referred for suspected ASD.
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Affiliation(s)
- MaryKate Frisch
- Department of Psychological Science, University of Connecticut, Mansfield, Connecticut, USA
| | - Rebecca Canale
- Department of Psychological Science, University of Connecticut, Mansfield, Connecticut, USA
| | - Christine L Yantz
- Department of Psychological Science, University of Connecticut, Mansfield, Connecticut, USA
| | - Marianne L Barton
- Department of Psychological Science, University of Connecticut, Mansfield, Connecticut, USA
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Halliday AR, Vucic SN, Georges B, LaRoche M, Mendoza Pardo MA, Swiggard LO, McDonald K, Olofsson M, Menon SN, Francis SM, Oberman LM, White T, van der Velpen IF. Heterogeneity and convergence across seven neuroimaging modalities: a review of the autism spectrum disorder literature. Front Psychiatry 2024; 15:1474003. [PMID: 39479591 PMCID: PMC11521827 DOI: 10.3389/fpsyt.2024.1474003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 09/30/2024] [Indexed: 11/02/2024] Open
Abstract
Background A growing body of literature classifies autism spectrum disorder (ASD) as a heterogeneous, complex neurodevelopmental disorder that often is identified prior to three years of age. We aim to provide a narrative review of key structural and functional properties that differentiate the neuroimaging profile of autistic youth from their typically developing (TD) peers across different neuroimaging modalities. Methods Relevant studies were identified by searching for key terms in PubMed, with the most recent search conducted on September 1, 2023. Original research papers were included if they applied at least one of seven neuroimaging modalities (structural MRI, functional MRI, DTI, MRS, fNIRS, MEG, EEG) to compare autistic children or those with a family history of ASD to TD youth or those without ASD family history; included only participants <18 years; and were published from 2013 to 2023. Results In total, 172 papers were considered for qualitative synthesis. When comparing ASD to TD groups, structural MRI-based papers (n = 26) indicated larger subcortical gray matter volume in ASD groups. DTI-based papers (n = 14) reported higher mean and radial diffusivity in ASD participants. Functional MRI-based papers (n = 41) reported a substantial number of between-network functional connectivity findings in both directions. MRS-based papers (n = 19) demonstrated higher metabolite markers of excitatory neurotransmission and lower inhibitory markers in ASD groups. fNIRS-based papers (n = 20) reported lower oxygenated hemoglobin signals in ASD. Converging findings in MEG- (n = 20) and EEG-based (n = 32) papers indicated lower event-related potential and field amplitudes in ASD groups. Findings in the anterior cingulate cortex, insula, prefrontal cortex, amygdala, thalamus, cerebellum, corpus callosum, and default mode network appeared numerous times across modalities and provided opportunities for multimodal qualitative analysis. Conclusions Comparing across neuroimaging modalities, we found significant differences between the ASD and TD neuroimaging profile in addition to substantial heterogeneity. Inconsistent results are frequently seen within imaging modalities, comparable study populations and research designs. Still, converging patterns across imaging modalities support various existing theories on ASD.
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Affiliation(s)
- Amanda R. Halliday
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Samuel N. Vucic
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Brianna Georges
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Madison LaRoche
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - María Alejandra Mendoza Pardo
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Liam O. Swiggard
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Kaylee McDonald
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Michelle Olofsson
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sahit N. Menon
- Noninvasive Neuromodulation Unit, Experimental Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Sunday M. Francis
- Noninvasive Neuromodulation Unit, Experimental Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Lindsay M. Oberman
- Noninvasive Neuromodulation Unit, Experimental Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Tonya White
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Isabelle F. van der Velpen
- Section on Social and Cognitive Developmental Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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Young K, Harris B, Hall-Lande J, Esler A. The Intersection of Systemic, Child, and Evaluation Factors in the Prediction of Autism Special Education Eligibility; Examining the Role of Race and Ethnicity. J Autism Dev Disord 2024; 54:3274-3289. [PMID: 37480439 DOI: 10.1007/s10803-023-06059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
Though there is evidence autism identification has been inequitable for populations who are culturally and linguistically minoritized, there is limited research that explains the issue of disproportionality and factors contributing to its occurrence, especially within an educational setting. To explore contributors to racial/ethnic disparities in autism special education eligibility, the current investigation evaluated child and evaluation characteristics as they relate to the absence of autism eligibility. Data were obtained from the Autism and Developmental Disabilities Monitoring (ADDM) Network Study and included children with behavioral characteristics consistent with autism and educational evaluation records. Despite documented characteristics consistent with autism, only 72% of the sample received educational services under autism eligibility. To characterize children without autism eligibility, hierarchical logistic regression was used to evaluate factors documented in evaluation records predicting the absence of autism eligibility. Factors influencing autism eligibility included behavioral characteristics documented, evaluation components completed, intellectual ability, and clinical diagnoses present. There was no unique contribution of race/ethnicity in predicting the absence of autism eligibility when accounting for these previous predictors, but many of these predictors differed by racial/ethnic group. Disproportionality in autism may be the manifestation of inequitable evaluation experiences, including experiencing less comprehensive evaluations, and not receiving an autism specific assessment. Though race/ethnicity did not uniquely contribute to the absence of autism eligibility above and beyond those combined factors, it is important to evaluate and reduce inequities experienced within the autism identification process for populations who are culturally and linguistically minoritized.
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Affiliation(s)
- Kelsey Young
- Department of Research, Assessment, & Measurement, Curriculum Associates, North Billerica, MA, USA.
| | - Bryn Harris
- School of Education & Human Development, University of Colorado Denver, Denver, CO, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota; Twin Cities, Minneapolis, MN, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota; Twin Cities, Minneapolis, MN, USA
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Sturm A, Huang S, Bal V, Schwartzman B. Psychometric exploration of the RAADS-R with autistic adults: Implications for research and clinical practice. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2334-2345. [PMID: 38305196 DOI: 10.1177/13623613241228329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
LAY ABSTRACT Surveys used to screen for autism are being used much more by adults. Adults and clinicians want to be confident that the results from their surveys are accurate. If scores are not accurate, it is not possible to compare the scores of different groups of individuals. There are also concerns that these surveys do not accurately identify autistic individuals. This study explored the accuracy of two commonly used autism screening surveys for adults: the RAADS-R and the RAADS-14. The accuracy of these two screening tools was measured using a sample of 839 adults. Adults in the study were in one of the following categories: (1) diagnosed with autism, (2) adults who considered themselves to be autistic but had not been diagnosed, (3) adults who were unsure whether they were autistic, and (4) adults who did not consider themselves to be autistic and had not been diagnosed. The study found that the RAADS-R and the RAADS-14 are accurate. The study also found that a person's age, gender, autism diagnosis, or whether an individual considered themselves to be autistic did not impact how they understood the survey. Survey accuracy could be improved by changing the number of question responses from four to two. Importantly, individuals with a clinical diagnosis of autism and those who considered themselves to be autistic responded to survey items in a very similar way. Individuals with autism diagnoses and those who were unsure whether they were autistic were more different in their responses. Four specific survey items related to sensory experiences and social interaction identified key differences between autistic and non-autistic adults.
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Affiliation(s)
| | | | - Vanessa Bal
- Rutgers, The State University of New Jersey, USA
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12
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Martin AM, Keehn B, Paxton A, Ciccarelli MR, Keehn RM. Associations Among Race, Ethnicity, and Clinical Profiles of Young Children Evaluated for Autism in the Primary Care Setting. J Dev Behav Pediatr 2024; 45:e414-e421. [PMID: 39023852 PMCID: PMC11483192 DOI: 10.1097/dbp.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/13/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Despite long-standing racial and ethnic disparities in autism spectrum (AS) diagnosis, recent research suggests that overall, greater numbers of Black and Latine children are now diagnosed with AS as compared with non-Latine White (NLW) children in some US regions. However, gaps remain in the equitable detection of Black and Latine children with AS without significant developmental impairment. The objective of this study was to determine whether the clinical profiles of young children evaluated for AS across a statewide system of early autism diagnosis in Indiana vary by race and ethnicity. METHODS We examined racial and ethnic differences in: (1) AS symptom severity, (2) developmental functioning, (3) adaptive functioning, and (4) behavior problems in a sample of 147 children, aged 14 to 48 months (M = 2.6 years), referred for AS evaluation. RESULTS Clinical profiles of young children evaluated differed significantly by race and ethnicity, with Black and Latine children exhibiting lower developmental ( p = 0.008) and adaptive abilities ( p = 0.01) and higher AS symptoms ( p = 0.03) as compared with NLW children. CONCLUSION Potential explanations for findings include racial and ethnic differences in family and community awareness and knowledge about AS and follow-through on evaluation referral, both driven by social determinants of health (SDOH) affecting minoritized children. Bias in screening and assessment instruments and clinician surveillance, screening, and referral practices may also underlie differences in clinical profiles of children evaluated. Future research is needed to understand the SDOH that influence AS detection and diagnosis to improve equitable access to early diagnosis and intervention.
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Affiliation(s)
| | - Brandon Keehn
- Department of Speech, Language, and Hearing Sciences, Purdue University
- Department of Psychological Sciences, Purdue University
| | - Angela Paxton
- Department of Pediatrics, Indiana University School of Medicine
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13
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Bhargava H, Salomon C, Suresh S, Chang A, Kilian R, Stijn DV, Oriol A, Low D, Knebel A, Taraman S. Promises, Pitfalls, and Clinical Applications of Artificial Intelligence in Pediatrics. J Med Internet Res 2024; 26:e49022. [PMID: 38421690 PMCID: PMC10940991 DOI: 10.2196/49022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Artificial intelligence (AI) broadly describes a branch of computer science focused on developing machines capable of performing tasks typically associated with human intelligence. Those who connect AI with the world of science fiction may meet its growing rise with hesitancy or outright skepticism. However, AI is becoming increasingly pervasive in our society, from algorithms helping to sift through airline fares to substituting words in emails and SMS text messages based on user choices. Data collection is ongoing and is being leveraged by software platforms to analyze patterns and make predictions across multiple industries. Health care is gradually becoming part of this technological transformation, as advancements in computational power and storage converge with the rapid expansion of digitized medical information. Given the growing and inevitable integration of AI into health care systems, it is our viewpoint that pediatricians urgently require training and orientation to the uses, promises, and pitfalls of AI in medicine. AI is unlikely to solve the full array of complex challenges confronting pediatricians today; however, if used responsibly, it holds great potential to improve many aspects of care for providers, children, and families. Our aim in this viewpoint is to provide clinicians with a targeted introduction to the field of AI in pediatrics, including key promises, pitfalls, and clinical applications, so they can play a more active role in shaping the future impact of AI in medicine.
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Affiliation(s)
- Hansa Bhargava
- Children's Hospital of Atlanta, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
- Healio, South New Jersey, NJ, United States
| | | | - Srinivasan Suresh
- Division of Health Informatics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony Chang
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | | | | | - Albert Oriol
- Rady Children's Hospital, San Diego, CA, United States
| | | | | | - Sharief Taraman
- Cognoa, Inc, Palo Alto, CA, United States
- Children's Hospital of Orange County, Orange, CA, United States
- University of California Irvine School of Medicine, Irvine, CA, United States
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14
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So WC, Wong E, Ng W, Fuego J, Lay S, So MT, Lee YY, Chan WY, Chua LY, Lam HL, Lam WT, Li HM, Leung WT, Ng YH, Wong WT. Seeing through a robot's eyes: A cross-sectional exploratory study in developing a robotic screening technology for autism. Autism Res 2024; 17:366-380. [PMID: 38183409 DOI: 10.1002/aur.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
The present exploratory cross-sectional case-control study sought to develop a reliable and scalable screening tool for autism using a social robot. The robot HUMANE, installed with computer vision and linked with recognition technology, detected the direction of eye gaze of children. Children aged 3-8 (M = 5.52; N = 199) participated, 87 of whom had been confirmed with autism, 55 of whom were suspected to have autism, and 57 of whom were not considered to cause any concern for having autism. Before a session, a human experimenter instructed HUMANE to narrate a story to a child. HUMANE prompted the child to return his/her eye gaze to the robot if the child looked away, and praised the child when it re-established its eye gaze quickly after a prompt. The reliability of eye gaze detection was checked across all pairs of human raters and HUMANE and reached 0.90, indicating excellent interrater agreement. Using the pre-specified reference standard (Autism Spectrum Quotient), the sensitivity and specificity of the index tests (i.e., the number of robot prompts and duration of inattentiveness) reached 0.88 or above and the Diagnostic Odds Ratios were beyond 190. These results show that social robots may detect atypical eye patterns, suggesting a potential future for screening autism using social robots.
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Affiliation(s)
- Wing-Chee So
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Elsa Wong
- NEC Hong Kong Limited, Hung Hom, Hong Kong
| | - Wingo Ng
- NEC Hong Kong Limited, Hung Hom, Hong Kong
| | - John Fuego
- NEC Hong Kong Limited, Hung Hom, Hong Kong
| | - Sally Lay
- NEC Hong Kong Limited, Hung Hom, Hong Kong
| | - Ming-Ting So
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yuen-Yung Lee
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai-Yan Chan
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lok-Ying Chua
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu-Lok Lam
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing-Tung Lam
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hin-Miu Li
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing-To Leung
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yu-Hei Ng
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing-Ting Wong
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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15
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Cepanec M, Šimleša S. Item-Based Analysis of Some ADOS-2 Items with Typically Developing Participants Might help Improve Cross-Cultural Validity of ADOS-2. J Autism Dev Disord 2024; 54:109-120. [PMID: 36323993 DOI: 10.1007/s10803-022-05791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Most internationally recognized instruments for the screening and diagnosis of autism spectrum disorder have been developed in the USA, which calls into question the degree of their cultural adaptation to diverse populations. The aim of this study is to examine the characteristics of social communication in typically developing Croatian-speaking participants (N = 220) using ADOS-2-defined item-level normative values. Croatian subjects showed the expected ("typical") results in the domain of verbal communication, slightly atpical results in nonverbal communication (primarily gesture use), and more significant deviations in pragmatics (offering and asking for information), relative to the expectations of the ADOS-2. As ADOS-2 has become an important component of thorough ASD diagnostic evaluations worldwide, identifying methods for increasing the cross-cultural validity is essential.
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Affiliation(s)
- Maja Cepanec
- Child Communication Research Laboratory, Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia.
| | - Sanja Šimleša
- Child Communication Research Laboratory, Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
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16
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Coulter KL, Moreno P, Barton M, Dumont-Mathieu T, Robins DL, Fein DA. Validity of the Toddler Autism Symptom Inventory in Non-Hispanic White and Black Toddlers. J Autism Dev Disord 2024; 54:339-352. [PMID: 36316523 PMCID: PMC10148924 DOI: 10.1007/s10803-022-05756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 05/01/2023]
Abstract
Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.
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Affiliation(s)
- Kirsty L Coulter
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA.
| | - Paula Moreno
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Marianne Barton
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Thyde Dumont-Mathieu
- University of Connecticut School of Medicine, Connecticut Children's Medical Center, Farmington, CT, USA
| | | | - Deborah A Fein
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
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17
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Fountain C, Winter AS, Cheslack-Postava K, Bearman PS. Developmental Trajectories of Autism. Pediatrics 2023; 152:e2022058674. [PMID: 37615073 PMCID: PMC10551845 DOI: 10.1542/peds.2022-058674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES The goal of this study was to describe the typical, longitudinal, developmental trajectories of communication and social functioning in individuals with autism spectrum disorder from childhood through adulthood and to determine the correlates of these trajectories. METHODS Children with autism spectrum disorder who were born in California from 1992 through 2016 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations in the database were excluded, resulting in a sample of 71 285 individuals. Score sequences were constructed based on evaluative items for communication and social functioning. Typical trajectories were identified using group-based latent trajectory modeling, and logistic regression was used to determine the odds of classification into a social adolescent decline trajectory by individual-, family-, and zip code-level factors. RESULTS Six typical patterns of communication functioning and 7 typical patterns of social functioning were identified. Whereas the majority of autistic individuals exhibit improved communication functioning as they age, the majority of individuals exhibit steady social functioning. A small group of individuals (5.0%) exhibits high social functioning in childhood that declines in adolescence. Membership in this adolescent decline group is associated with maternal non-Hispanic white race and ethnicity, female sex, moderate levels of maternal education, lower zip code-level median home values and population density, and higher zip code-level inequality. CONCLUSIONS Most autistic individuals show improved communication and social functioning as they age, but not all do. Trajectory group membership is correlated with socioeconomic status. Future research should investigate what drives these correlations.
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Affiliation(s)
- Christine Fountain
- Department of Anthropology & Sociology, Fordham
University, New York, NY
| | - Alix S. Winter
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
| | | | - Peter S. Bearman
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
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18
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Smith GC, Hayslip B. Grandmother and Grandchild Reports of Psychological Difficulties Among Custodial Grandchildren: Whose View Matters and Why is It Important? CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106793. [PMID: 37220553 PMCID: PMC10201918 DOI: 10.1016/j.childyouth.2022.106793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We conducted this first ever study comparing reports of custodial grandchildren's (CG) psychological difficulties obtained jointly from 163 custodial grandmothers (CGM) and their CG between ages 6-12. Internalizing and externalizing difficulties were indicated by whether any of the corresponding scales on the Strengths and Difficulties Questionnaire (SDQ, reported by CGM) or Dominic Interactive (DI, reported by CG) reached the 90th percentile. Internalizing and externalizing difficulties were reported by informant types at rates higher than those typically observed in the general population, with externalizing difficulties being more prevalent among male CG. At the dichotomous level of (dis)agreement, nearly two-thirds of informant pairs showed concordance regarding whether or not they reported the CG at the 90th percentile on either externalizing and internalizing difficulties. When (dis)agreement was further broken into four specific categories (i.e., "neither report", "both report", "CGM only", and "CG only", CGM's use of mental health services, race, depressive and anxiety symptoms, harsh/punitive discipline, and warmth impacted such concordance as did CG's gender, age, and use of mental health services. The overall findings were remarkably similar regardless of which specific SDQ and DI scales were used in the analyses. The present study unearths new ground regarding the extent to which grandchildren's distress is similarly perceived by CG themselves versus their CGMs. Such findings are important to the extent that accurate estimates exist regarding the emotional difficulties CG face and lay the groundwork for timely and efficacious interventions designed to alleviate their distress.
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19
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Fears NE, Sherrod GM, Templin TN, Bugnariu NL, Patterson RM, Miller HL. Community-based postural control assessment in autistic individuals indicates a similar but delayed trajectory compared to neurotypical individuals. Autism Res 2023; 16:543-557. [PMID: 36627838 PMCID: PMC10023334 DOI: 10.1002/aur.2889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
Autistic individuals exhibit significant sensorimotor differences. Postural stability and control are foundational motor skills for successfully performing many activities of daily living. In neurotypical development, postural stability and control develop throughout childhood and adolescence. In autistic development, previous studies have focused primarily on individual age groups (e.g., childhood, adolescence, adulthood) or only controlled for age using age-matching. Here, we examined the age trajectories of postural stability and control in autism from childhood through adolescents using standardized clinical assessments. In study 1, we tested the postural stability of autistic (n = 27) and neurotypical (n = 41) children, adolescents, and young adults aged 7-20 years during quiet standing on a force plate in three visual conditions: eyes open (EO), eyes closed (EC), and eyes open with the head in a translucent dome (Dome). Postural sway variability decreased as age increased for both groups, but autistic participants showed greater variability than neurotypical participants across age. In study 2, we tested autistic (n = 21) and neurotypical (n = 32) children and adolescents aged 7-16 years during a dynamic postural control task with nine targets. Postural control efficiency increased as age increased for both groups, but autistic participants were less efficient compared to neurotypical participants across age. Together, these results indicate that autistic individuals have a similar age trajectory for postural stability and control compared to neurotypical individuals, but have lower postural stability and control overall.
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Affiliation(s)
- Nicholas E. Fears
- University of Michigan, 830 N. University Ave., Ann Arbor, Michigan, 48170, USA
- University of North Texas Health Science Center, School of Health Professions, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
- Louisiana State University, 50 Fieldhouse Dr. Baton Rouge, Louisiana, 70802, USA
| | - Gabriela M. Sherrod
- University of North Texas Health Science Center, School of Health Professions, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
- University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL, 35294, USA
| | - Tylan N. Templin
- University of North Texas Health Science Center, School of Health Professions, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
- Southwest Research Institute, 6220 Culebra Rd., San Antonio, TX, 78238, USA
| | - Nicoleta L. Bugnariu
- University of North Texas Health Science Center, School of Health Professions, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
- University of the Pacific, School of Health Sciences, 155 Fifth St., San Francisco, CA, 94103, USA
| | - Rita M. Patterson
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
| | - Haylie L. Miller
- University of Michigan, 830 N. University Ave., Ann Arbor, Michigan, 48170, USA
- University of North Texas Health Science Center, School of Health Professions, 3500 Camp Bowie Blvd., Fort Worth, TX, 76109, USA
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20
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Affiliation(s)
- Oluwatobi Abubakare
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
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21
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Krakowski A. Balanced Sex Ratios and the Autism Continuum. Biol Psychiatry 2022; 92:e35-e36. [PMID: 36137707 DOI: 10.1016/j.biopsych.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Aneta Krakowski
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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22
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Chellew T, Barbaro J, Freeman NC. The Early Childhood Signs of Autism in Females: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractCompared to males, females are at a much greater likelihood of receiving a later diagnosis of autism, which impacts their opportunity to receive early support. To assist with early identification, this systematic literature review aimed to ascertain whether females differ from males in the early childhood signs of autism. The small number of heterogeneous studies made it difficult to draw conclusions, although it appears that females and males under 6 years of age are more similar than different in terms of their expression of autistic behaviours. Given the discrepant sex/gender ratio in autism, these findings highlight the importance of exploring whether there are different and/or specific, not yet identified, early signs of autism in females and males.
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23
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Zheng S, Kaat A, Farmer C, Thurm A, Burrows CA, Kanne S, Georgiades S, Esler A, Lord C, Takahashi N, Nowell KP, Will E, Roberts J, Bishop SL. Bias in measurement of autism symptoms by spoken language level and non-verbal mental age in minimally verbal children with neurodevelopmental disorders. Front Psychol 2022; 13:927847. [PMID: 35967726 PMCID: PMC9372407 DOI: 10.3389/fpsyg.2022.927847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Increasing numbers of children with known genetic conditions and/or intellectual disability are referred for evaluation of autism spectrum disorder (ASD), highlighting the need to refine autism symptom measures to facilitate differential diagnoses in children with cognitive and language impairments. Previous studies have reported decreased specificity of ASD screening and diagnostic measures in children with intellectual disability. However, little is known about how cognitive and language abilities impact the measurement of specific ASD symptoms in this group. We aggregated a large sample of young children (N = 1196; aged 31-119 months) to examine measurement invariance of ASD symptoms among minimally verbal children within the context of the Autism Diagnostic Observation Schedule (ADOS) Module 1. Using confirmatory factor analysis (CFA) and moderated non-linear factor analysis (MNLFA), we examined how discrete behaviors were differentially associated with the latent symptom domains of social communication impairments (SCI) and restricted and repetitive behaviors (RRB) across spoken language levels and non-verbal mental age groupings. While the two-factor structure of SCI and RRB held consistently across language and cognitive levels, only partial invariance was observed for both ASD symptom domains of SCI and RRB. Specifically, four out of the 15 SCI items and one out of the three RRB items examined showed differential item functioning between children with "Few to No Words" and those with "Some Words"; and one SCI item and one RRB item showed differential item functioning across non-verbal mental age groups. Moreover, even after adjusting for the differential item functioning to reduce measurement bias across groups, there were still differences in ASD symptom domain scores across spoken language levels. These findings further underscore the influence of spoken language level on measurement of ASD symptoms and the importance of measuring ASD symptoms within refined spoken language levels, even among those with minimal verbal abilities.
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Affiliation(s)
- Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Aaron Kaat
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cristan Farmer
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, United States
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, United States
| | - Catherine A. Burrows
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Stephen Kanne
- Center for Autism and the Developing Brain, Weill Cornell Medical College, White Plains, NY, United States
| | - Stelios Georgiades
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Amy Esler
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Catherine Lord
- UCLA Semel Institute for Neuroscience & Human Behavior, Center for Autism Research and Treatment, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicole Takahashi
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States
| | - Kerri P. Nowell
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
| | - Elizabeth Will
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Jane Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Somer L. Bishop
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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24
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Zhu Z, Jiao D, Li X, Zhu Y, Kim C, Ajmal A, Matsumoto M, Tanaka E, Tomisaki E, Watanabe T, Sawada Y, Anme T. Measurement invariance and country difference in children's social skills development: Evidence from Japanese and Chinese samples. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 35531072 PMCID: PMC9061028 DOI: 10.1007/s12144-022-03171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
Abstract
The diversity of child social skills development is not well detected among Asian countries. Culturally validated assessments are needed for practitioners to evaluate child social skills. This study tested the measurement invariance of the Social Skill Scale (SSS) across Japanese and Chinese samples and explored country differences in child social skills development. The SSS utilizes a widely used factor structure (assertion, self-control, and cooperation subdomains) and has established Japanese and Chinese versions. We conducted investigations with an identical process and materials with different language versions, collecting data from 931 Japanese kindergarten children (Mage = 4.35, SDage = 1.07; 53.6% boys) and from 1130 Chinese kindergarten children (Mage = 4.47, SDage = 1.00; 52.3% boys). We used multiple confirmatory factor analysis to test measurement invariance of the SSS and established the validity, reliability, and scalar measurement invariance for the first-order factor structure of the SSS across the two country samples. We also examined country differences on the associations between demographics, parenting practice, and child social skills development. We found that, compared to the Chinese sample, cooperation skills significantly increased more with age among the Japanese sample. However, spanking was negatively related to self-control skills development in both countries. Our findings contribute to the demonstration of the diversity of child social skills development and have important implications for assessing and developing child social skills using culture-specific strategies.
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Affiliation(s)
- Zhu Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8577 Japan
- Faculty of Preschool and Special Education, Xuzhou Kindergarten Teachers College, Xuzhou, 221004 China
| | - Dandan Jiao
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8577 Japan
| | - Xiang Li
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8577 Japan
| | - Yantong Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8577 Japan
| | - Cunyoen Kim
- School of Education Science, Leshan Normal University, Leshan, 614000 China
| | - Ammara Ajmal
- Department of Anesthesia, Sandeman Provincial Hospital, Quetta, 87300 Pakistan
| | - Munenori Matsumoto
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8577 Japan
| | - Emiko Tanaka
- Faculty of Nursing, Musashino University, Tokyo, 202-8585 Japan
| | - Etsuko Tomisaki
- Faculty of Nursing and Medical Care, Keio University, Tokyo, 160-8582 Japan
| | - Taeko Watanabe
- Faculty of Nursing, Shukutoku University, Chiba, 260-8701 Japan
| | - Yuko Sawada
- Faculty of Health Medicine, Morinomiya University of Medical Sciences, Osaka, 559-8611 Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 305-8577 Japan
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25
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Samadi SA, Biçak CA, Noori H, Abdalla B, Abdullah A, Ahmed L. Autism Spectrum Disorder Diagnostic Criteria Changes and Impacts on the Diagnostic Scales-Utility of the 2nd and 3rd Versions of the Gilliam Autism Rating Scale (GARS). Brain Sci 2022; 12:brainsci12050537. [PMID: 35624925 PMCID: PMC9138584 DOI: 10.3390/brainsci12050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
There is joint agreement among professionals internationally on the importance of diagnosing autism spectrum disorders (ASD) in the early stages of the emergence of symptoms. Criteria changes for the diagnosis of ASD need updated versions of the scale to make the diagnosis feasible. This study aimed to evaluate the level of overlap between two different versions of the Gilliam Autism Rating Scale (GARS-2 and GARS-3), which have been updated based on changes in DSM-IV and DSM-5 on a Kurdish sample of individuals at risk of having ASD and Intellectual Disability, referred to the Bahoz center in the Kurdistan Region of Iraq. A group of 148 cases with ASD and developmental disabilities (DD) was evaluated using the 2nd and 3rd versions of the GARS scale to understand the level of cases that confirm an ASD diagnosis in both scales. Ninety-six individuals (65%) scored about the cut-off score for being diagnosed with ASD based on the GARS-2, and 137 individuals (93%) scored above the cut-off score based on the GARS-3. Moreover, keeping updated and meeting the changing demand of standardization and cultural suitability of the updating scales is a challenge. This challenge is due to the shortage of infrastructure sources and lack of established professionals in low- and middle-income countries (LMICs). Findings indicated that GARS-3, updated based on the DSM-5, tends to diagnose children with accompanying diagnoses and different levels of symptoms severity of ASD at different age levels. Further studies are needed to help professionals and policymakers in low- and middle-income countries understand the updated versions of the available scales and depend on the older version, which must be considered cautiously.
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Affiliation(s)
- Sayyed Ali Samadi
- Institute of Nursing and Health Research, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
- Correspondence: ; Tel.: +964-7502040080
| | - Cemal A. Biçak
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
| | - Hana Noori
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
| | - Barez Abdalla
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
| | - Amir Abdullah
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
| | - Lizan Ahmed
- Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (C.A.B.); (H.N.); (B.A.); (A.A.); (L.A.)
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Vanegas SB, Dueñas AD, Kunze M, Xu Y. Adapting
parent‐focused
interventions for diverse caregivers of children with intellectual and developmental disabilities: Lessons learned during global crises. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ana D. Dueñas
- College of Education and Human Services Lehigh University Bethlehem Pennsylvania USA
| | - Megan Kunze
- Department of Special Education and Clinical Sciences and Center for Brain Injury Research and Training University of Oregon Eugene Oregon USA
| | - Yue Xu
- Department of Health Sciences Education University of Illinois College of Medicine at Rockford Rockford Illinois USA
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27
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Schmidt J, Harris B, McClain MB, Benallie KJ. Evaluating psychometric properties of common autism educational identification measures through a culturally and linguistically responsive lens. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jaime Schmidt
- School of Education and Human Development University of Colorado Denver Denver Colorado USA
| | - Bryn Harris
- School of Education and Human Development University of Colorado Denver Denver Colorado USA
| | | | - Kandice J. Benallie
- Emma Eccles Jones College of Education and Human Services Utah State University Logan Utah USA
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28
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Kalb LG, Singh V, Hong JS, Holingue C, Ludwig NN, Pfeiffer D, Reetzke R, Gross AL, Landa R. Analysis of Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2). JAMA Netw Open 2022; 5:e229498. [PMID: 35471566 PMCID: PMC9044110 DOI: 10.1001/jamanetworkopen.2022.9498] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There are long-standing disparities in the prevalence of autism spectrum disorder (ASD) across race and sex. Surprisingly, few studies have examined whether these disparities arise partially out of systematic biases in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the reference standard measure of ASD. OBJECTIVE To examine differential item functioning (DIF) of ADOS-2 items across sex and race. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study of children who were evaluated for ASD between 2014 and 2020 at a specialty outpatient clinic located in the Mid-Atlantic region of the US. Data were analyzed from July 2021 to February 2022. EXPOSURES Child race (Black/African American vs White) and sex (female vs male). MAIN OUTCOMES AND MEASURES Item-level biases across ADOS-2 harmonized algorithm items, including social affect (SA; 10 items) and repetitive/restricted behaviors (RRBs; 4 items), were evaluated across 3 modules. Measurement bias was identified by examining DIF and differential test functioning (DTF), within a graded response, item response theory framework. Statistical significance was determined by a likelihood ratio χ2 test, and a series of metrics was used to examine the magnitude of DIF and DTF. RESULTS A total of 6269 children (mean [SD] age, 6.77 [3.27] years; 1619 Black/African American [25.9%], 3151 White [50.3%], and 4970 male [79.4%]), were included in this study. Overall, 16 of 140 ADOS-2 diagnostic items (11%) had a significant DIF. For race, 8 items had a significant DIF, 6 of which involved SA. No single item showed DIF consistently across all modules. Most items with DIF had greater difficulty and poorer discrimination in Black/African American children compared with White children. For sex, 5 items showed significant DIF. DIF was split across SA and RRB. However, hand mannerisms evidenced DIF across all 5 algorithms, with generally greater difficulty. The magnitude of DIF was only moderate to large for 2 items: hand mannerisms (among female children) and repetitive interests (among Black/African American children). The overall estimated effect of DIF on total DTF was not large. CONCLUSIONS AND RELEVANCE These findings suggest that the ADOS-2 does not have widespread systematic measurement bias across race or sex. However, the findings raise some concerns around underdetection that warrant further research.
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Affiliation(s)
- Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Ji Su Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Natasha N. Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danika Pfeiffer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Reetzke
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alden L. Gross
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Samadi SA, Noori H, Abdullah A, Ahmed L, Abdalla B, Biçak CA, McConkey R. The Psychometric Properties of the Gilliam Autism Rating Scale (GARS-3) with Kurdish Samples of Children with Developmental Disabilities. CHILDREN (BASEL, SWITZERLAND) 2022; 9:434. [PMID: 35327806 PMCID: PMC8947096 DOI: 10.3390/children9030434] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 01/02/2023]
Abstract
There is marked variation internationally in the prevalence of children identified as having autism spectrum disorders (ASD). In part, this may reflect a shortage of screening tools for the early identification of children with ASD in many countries. This study aimed to evaluate the Kurdish translation of the Gilliam autism rating scale-third edition (GARS-3), a scale commonly used in Western countries that evaluates six domains related to the ASD definition from the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, notably Restricted/Repetitive Behavior, deficits in Social interaction and Social Communication, as well as differences in Cognitive Style, Maladaptive Speech, and Emotional Response. GARS-3 assessments were completed through interviews with parents of 735 children, 442 (53%) of whom were diagnosed with ASD. 165 (22%) with an intellectual disability, 49 (7%) with communication disorders, and 133 (18%) typically developing children. The reliability, construct, and the predictive validity of the scale was assessed, and the scores suggestive of a child having ASD were identified. The factor structure was broadly replicated, especially on items relating to social interaction and social communication. The cutoffs for the total scores that were indicative of possible ASD had a high degree of specificity and sensitivity in distinguishing children with ASD from typically developing peers. Some children with I.D. and communication disorders may also score above the threshold, and further assessments should be sought to confirm the presence of autistic traits. Although GARS-3 could be recommended for use in Kurdistan and possibly similar cultures, further prospective research is needed to confirm a diagnosis of assessment with children who score above and below the cutoff scores identified in this study. Moreover, the development of normative data drawn from Kurdish samples of children would be advantageous, although ambitious, given the lack of diagnostic services in many low- and middle-income countries.
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Affiliation(s)
- Sayyed Ali Samadi
- Institute of Nursing and Health Research, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK;
- Northern Ireland and Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq
| | - Hana Noori
- Evaluation Unit, Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Amir Abdullah
- Evaluation Unit, Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Lizan Ahmed
- Evaluation Unit, Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Barez Abdalla
- Evaluation Unit, Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Cemal A. Biçak
- Evaluation Unit, Bahoz Centre for Children with Developmental Disabilities, Erbil 44002, The Kurdistan Region of Iraq, Iraq; (H.N.); (A.A.); (L.A.); (B.A.); (C.A.B.)
| | - Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Newtownabbey BT37 0QB, Northern Ireland, UK;
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30
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Zajic MC, Brown HM. Measuring Autistic Writing Skills: Combining Perspectives from Neurodiversity Advocates, Autism Researchers, and Writing Theories. Hum Dev 2022. [DOI: 10.1159/000524015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Autism and writing are commonly discussed independently as complex, multifaceted entities. However, studies examining their intersections are limited and often oversimplify the nuances innate to both topics. This paper focuses on the complexities involved in studying autistic individuals’ foundational writing skills (i.e., transcription and text generation skills) by drawing on theories of writing and autism grounded in perspectives from the neurodiversity movement. We frame our discussion around the complex sociocultural and cognitive factors important to writing by drawing on the Writer(s)-within-Community model. Our discussion highlights findings and trends among observational and intervention research studies as well as offers suggestions for future research guided by the ongoing reconceptualization and understanding of autistic development. In doing so, we argue that future research must look beyond written products as the only measure of writing development and beyond a diagnosis of autism as the indicator of atypical written language development.
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31
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Fombonne E, Zuckerman KE. Clinical Profiles of Black and White Children Referred for Autism Diagnosis. J Autism Dev Disord 2022; 52:1120-1130. [PMID: 33871736 DOI: 10.1007/s10803-021-05019-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 12/28/2022]
Abstract
Black children with autism are diagnosed at an older age. Whether or not late detection is paralleled by differing clinical presentation is not known. We evaluated symptom profiles of 245 Black and 488 sex- and age-matched White non-Hispanic participants (82.8% male; mean age: 4.2 years) referred for ASD diagnosis. Both groups showed similar overall levels of autistic symptoms. Black children had significantly but slightly lower scores on cognitive tests and on the Vineland communication domain than White children. Groups were comparable on internalizing and externalizing co-occurring problems. Given the largely similar clinical profiles, clinical differences in initial presentation may not be a primary reason for Black/White disparities in diagnostic and services use. Limitations of a cross-sectional referred sample are acknowledged.
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Affiliation(s)
- Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Department of Pediatrics, Oregon Health & Science University, Portland, USA.
| | - Katharine E Zuckerman
- Department of Pediatrics, Oregon Health & Science University, Portland, USA
- Oregon Health & Science University, Portland State University School of Public Health, Portland, USA
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32
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Hudock RL, Esler AN. Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children. Clin Neuropsychol 2022; 36:921-942. [DOI: 10.1080/13854046.2022.2025907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebekah L. Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Amy N. Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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33
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 373] [Impact Index Per Article: 124.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Barger B, Benevides T, Rizk S, Rice C, Heiman H, Salmon A, Sanchez-Alvarez S. Race/ethnic inequities in conjoint monitoring and screening for U.S. children 3 and under. Disabil Health J 2022; 15:101179. [PMID: 34412986 DOI: 10.1016/j.dhjo.2021.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 07/10/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Non-White children with developmental disabilities are frequently identified later than White children and therefore miss out on opportunities for early intervention (EI). Recent research indicates that conjoint monitoring and screening is more strongly associated with EI receipt than monitoring or screening alone. OBJECTIVE To determine if there are racial/ethnic inequities in the conjoint receipt of monitoring and screening. METHOD A series of survey weighted and stratified logistic regression analyses were conducted on National Surveys of Children's Health (2016-2018) data with conjoint monitoring and screening, screening alone, monitoring alone, and non-receipt as outcomes for children aged 9-23 months of age. The primary predictor was child race/ethnicity (Black, Hispanic, Other, and White). Additional co-variates included child (e.g., Age), caretaker/family (e.g., poverty level), healthcare (e.g., usual source of healthcare), state EI policies, and city metropolitan status. RESULTS Bivariate analyses indicated significant variation in conjoint monitoring and screening across racial/ethnic groups and covariates. Bivariate analyses showed that Black and Hispanic children had significantly lower odds of conjoint monitoring and screening receipt than White children. Multivariate analyses showed that this relationship was better accounted by co-variates. The health service variable, usual source of healthcare, had the strongest relationship with receipt of conjoint monitoring and screening. CONCLUSIONS Black and Hispanic children are less likely to receive conjoint monitoring and screening than White children. Analyses investigating the role of usual source of healthcare seem particularly promising for understanding the sources of inequities in monitoring and screening receipt.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, United States; Population Health Sciences, School of Public Health, Georgia State University, United States.
| | - Teal Benevides
- Department of Occupational Therapy, Augusta State University, United States
| | - Sabrin Rizk
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, United States
| | | | - Harry Heiman
- Center for Leadership in Disability, School of Public Health, Georgia State University, United States; Department of Health Management and Policy, School of Public Health, Georgia State University, United States
| | - Ashley Salmon
- Center for Leadership in Disability, School of Public Health, Georgia State University, United States
| | - Sonia Sanchez-Alvarez
- Center for Leadership in Disability, School of Public Health, Georgia State University, United States
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Golson ME, Ficklin E, Haverkamp CR, McClain MB, Harris B. Cultural differences in social communication and interaction: A gap in autism research. Autism Res 2021; 15:208-214. [PMID: 34936220 DOI: 10.1002/aur.2657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/30/2021] [Accepted: 12/09/2021] [Indexed: 11/07/2022]
Abstract
Social communication and interaction deficits are a diagnostic criteria of autism and integral to practitioner and researcher conceptualization. Culture is an influential factor in expectations for, and demonstration of, social communication and interaction skills, but there is limited research published in autism journals on this topic. This paucity of autism research examining cultural factors related to social communication and interaction may contribute to known identification disparities for racial and ethnic populations minoritized by systemic factors and research bias. We call for increased commitment from researchers to recruit racially and ethnically minoritized participants, prioritize investigating cultural expectations and perceptions of social communication and interaction, and evaluate measures related to social communication for cultural and linguistic responsivity. LAY SUMMARY: A diagnosis of autism requires the presence of deficits in social communication and interaction. Examples of these behaviors and skills include holding a back-and-forth conversation, the use of nonverbal communicative behaviors (e.g., gestures), and developing and maintaining social relationships. Culture influences the expectations for, and presentation of, these behaviors. However, research on this topic is lacking. Conducting more research related to culture and social communication could help reduce the disparities in autism identification across racially and ethnically minoritized populations.
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Affiliation(s)
- Megan E Golson
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Erica Ficklin
- Department of Psychology, Utah State University, Logan, Utah, USA
| | | | | | - Bryn Harris
- University of Colorado Denver, Denver, Colorado, USA
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36
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Rosen NE, Lord C, Volkmar FR. The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond. J Autism Dev Disord 2021; 51:4253-4270. [PMID: 33624215 PMCID: PMC8531066 DOI: 10.1007/s10803-021-04904-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/27/2022]
Abstract
In this paper we review the impact of DSM-III and its successors on the field of autism-both in terms of clinical work and research. We summarize the events leading up to the inclusion of autism as a "new" official diagnostic category in DSM-III, the subsequent revisions of the DSM, and the impact of the official recognition of autism on research. We discuss the uses of categorical vs. dimensional approaches and the continuing tensions around broad vs. narrow views of autism. We also note some areas of current controversy and directions for the future.
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Affiliation(s)
| | | | - Fred R. Volkmar
- Yale University, New Haven, USA
- Southern Connecticut State University, New Haven, USA
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37
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Hart CM, Curtin S. Trajectories of Vocabulary Development in Children with Autism Spectrum Disorder Across Multiple Measures. J Autism Dev Disord 2021; 53:1347-1362. [PMID: 34817769 DOI: 10.1007/s10803-021-05379-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
This longitudinal study examined how receptive and expressive vocabulary assessments capture vocabulary development in children with Autism Spectrum Disorder (ASD) and typically developing (TD) children. Using mixed regression modelling, we explored when children with ASD significantly different from TD children. We also examined the variability of individual trajectories of vocabulary development in children with ASD. Children with ASD showed slowed trajectories and significantly differed from TD children by 24 months on all assessments except for picture-based assessments. Children with ASD also showed high heterogeneity in trajectories, with some showing inconsistent patterns of growth, stagnation, and regression across assessments. This suggests that conclusions based on individual assessments of vocabulary can vary and assessment characteristics must be considered when monitoring vocabulary development.
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Affiliation(s)
- Chelsie M Hart
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,, Calgary, AB, T3G 4B5, Canada.
| | - Suzanne Curtin
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Child and Youth Studies, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
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38
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Ronkin E, Tully EC, Branum-Martin L, Cohen LL, Hall C, Dilly L, Tone EB. Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1282-1295. [PMID: 34657471 DOI: 10.1177/13623613211047070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT When toddlers are suspected of autism spectrum disorder (ASD), the gold-standard assessment technique is with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Toddler Module, a behavioral observation system. ASD is a neurodevelopmental condition more frequently diagnosed in toddler boys than in toddler girls. There is some evidence that the ADOS-2 assesses behaviors that are more characteristic of boys with ASD than girls. Thus, it is possible that focusing on these behaviors contributes at least in part to why more boys are diagnosed than girls. Specifically, girls may show more social skills than boys during the ADOS-2 assessment due to their socialization histories, which may lead to missed diagnoses of ASD in toddler girls. The current study examined eight social behaviors assessed by the ADOS-2 in a sample of toddlers with suspected ASD to see if they contributed differently to the total score of those items. Examination of those items suggested that those social communication behaviors work the same for boys and girls with suspected ASD, which was inconsistent with hypotheses. However, examination of particular items raises the possibility of examining creative/imaginative play as an area for future research.
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Shawahna R, Jaber M, Yahya N, Jawadeh F, Rawajbeh S. Are medical students in Palestine adequately trained to care for individuals with autism spectrum disorders? A multicenter cross-sectional study of their familiarity, knowledge, confidence, and willingness to learn. BMC MEDICAL EDUCATION 2021; 21:424. [PMID: 34376162 PMCID: PMC8356397 DOI: 10.1186/s12909-021-02865-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical students are the future workforce of physicians in primary, secondary, tertiary, and highly specialized care centers. The present study was undertaken to assess familiarity, knowledge, confidence, of medical students with regard to autism spectrum disorders (ASDs). METHODS This multicenter study was conducted in a cross-sectional design among medical students in the 3 main universities in Palestine. In addition to the sociodemographic and academic details, the questionnaire measured familiarity (8-items), knowledge (12-items), confidence and willingness to learn (5-items) with regard to ASDs. RESULTS The questionnaire was completed by309 medical students (response rate = 77.3 %). The median familiarity, knowledge, and confidence scores were 50 % (42.5 %, 57.5 %), 50 % (41.7 %, 66.7 %), and 60.0 % (54.0 %, 68.0 %), respectively. There was a positive moderate correlation between familiarity and knowledge scores (Spearman's rho = 0.29, p-value < 0.001) and familiarity and confidence scores (Spearman's rho = 0.34, p-value < 0.001). Medical students who have received a course on autism were 3.08-fold (95 % C.I. of 1.78-5.31) more likely to score ≥ 50 % on the familiarity items compared to those who did not receive a course. The medical students who were in their clinical academic stage, who received a course on ASDs, and those who interacted with individuals with ASDs were 2.36-fold (95 % C.I. of 1.34-4.18), 2.66-fold (95 % C.I. of 1.52-4.65), and 2.59-fold (95 % C.I. of 1.44-4.63) more likely to score ≥ 50 % on the knowledge items. Medical students who reported high satisfaction with their social life were 2.84-fold (95 % C.I. of 1.15-7.00) more likely to score ≥ 50 % on the confidence items. CONCLUSIONS The present study identified considerable awareness and knowledge gaps among medical students with regard to ASDs. Medical students in this study reported low confidence in their ability to provide healthcare services to individuals with ASDs. Appropriately designed educational interventions might improve familiarity, knowledge, and confidence of medical students. More studies are still needed to investigate if such interventions can improve healthcare services for individuals with ASDs.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, New Campus, Building: 19, Office: 1340, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Nourhan Yahya
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Firdaous Jawadeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Shahd Rawajbeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Stevanovic D, Costanzo F, Fucà E, Valeri G, Vicari S, Robins DL, Samms-Vaughan M, Ozek Erkuran H, Yaylaci F, Deshpande SN, Deshmukh V, Arora NK, Albores-Gallo L, García-López C, Gatica-Bahamonde G, Gabunia M, Zirakashvili M, Machado FP, Radan M, Samadi SA, Toh TH, Gayle W, Brennan L, Zorcec T, Auza A, de Jonge M, Shoqirat N, Marini A, Knez R. Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries. Autism Res 2021; 14:2544-2554. [PMID: 34346193 DOI: 10.1002/aur.2586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022]
Abstract
The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.
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Affiliation(s)
- Dejan Stevanovic
- Department of Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Handan Ozek Erkuran
- Child and Adolescent Psychiatry Unit, Dr Behcet Uz Children's Research and Training Hospital, Izmir, Turkey
| | - Ferhat Yaylaci
- Child Psychiatry Unit, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Smita N Deshpande
- Department of Psychiatry, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences; Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lilia Albores-Gallo
- Research Division, Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Secretaría de Salud, Mexico City, Mexico
| | | | | | | | | | | | - Miruna Radan
- National Institute for Maternal and Child Health, Bucharest, Romania
| | - Sayyed Ali Samadi
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Teck-Hock Toh
- Clinical Research Centre & Department of Pediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Windham Gayle
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California, USA
| | | | - Tatjana Zorcec
- Developmental Department, University Children's Hospital, Skopje, Macedonia
| | - Alejandra Auza
- Language and Cognition Laboratory, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maretha de Jonge
- Faculty of Social Science, Education and Child Studies, Clinical Neuroscience and Developmental Disorders, Leiden University, Leiden, The Netherlands
| | | | | | - Rajna Knez
- Department of Women's and Children's Health, Skaraborgs Hospital, Skövde, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Bordes Edgar V, Meneses V, Shaw D, Romero RA, Salinas CM, Kissel A. Clinical utility of the ECLECTIC framework in providing culturally-informed autism spectrum disorder evaluations: a pediatric case-based approach. Clin Neuropsychol 2021; 36:1148-1171. [PMID: 34126862 DOI: 10.1080/13854046.2021.1936187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Social cognition does not exist within a vacuum. One's culture and surrounding social environment influence 1) development of social skills and behaviors, and 2) society's expectations regarding "normal" behavior versus behaviors consistent with the diagnosis of Autism Spectrum Disorder (ASD). Use of a comprehensive cultural framework such as Fujii's ECLECTIC model undergirds valid ASD testing by enhancing clinician awareness of potential biases during clinical decision-making and by supporting culturally relevant recommendations. Method: Four diverse pediatric patients presenting for concerns of ASD are described. Neuropsychological test data and salient cultural considerations are presented within the ECLECTIC framework. Results: The cases illustrate relevant cultural factors critical to the ASD assessment for youth with wide diversity (Southeast Asian, Deaf, Black, Hispanic/Latinx, and Chinese cultures) and varied contextual factors (adoption, underlying Down syndrome). The ECLETIC model better allows integration of salient factors such as cognition, family dynamics, behaviors, educational services, and language dominance. Conclusions: Unrecognized ethnocentric biases may shadow the complexities and nuances involved in ASD assessment across cultures. Such errors are minimized using a comprehensive cultural framework to guide equitable neuropsychological services. The ECLECTIC model's emphasis on cultural and contextual factors results in more accurate findings and more individualized planning for the patient. Recommendations for clinical application are provided.
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Affiliation(s)
- Veronica Bordes Edgar
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Children's Medical Center, Dallas, TX, USA
| | - Veronica Meneses
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Pediatric Developmental Disabilities, Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Daphna Shaw
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Children's Medical Center, Dallas, TX, USA
| | - Regilda Anne Romero
- Department of Psychiatry, University of Florida, Gainesville, FL, USA.,Center for Autism and Neurodevelopment, University of Florida Health, Jacksonville, FL, USA
| | - Christine M Salinas
- Neuropsychology Concierge®, Indialantic, FL, USA.,Niños Health, Indialantic, FL, USA
| | - Abigail Kissel
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Children's Medical Center, Dallas, TX, USA
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Kumm AJ, Viljoen M, de Vries PJ. The Digital Divide in Technologies for Autism: Feasibility Considerations for Low- and Middle-Income Countries. J Autism Dev Disord 2021; 52:2300-2313. [PMID: 34121159 PMCID: PMC8200284 DOI: 10.1007/s10803-021-05084-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
Digital technologies have the potential to empower individuals with autism and their families. The COVID-19 pandemic emphasized and accelerated the drive towards technology for information, communication, training, clinical care and research, also in the autism community. However, 95% of individuals with autism live in low- and middle-income countries (LMIC) where access to electricity, internet and the ever-increasing range of digital devices may be highly limited. The World Bank coined the term ‘the digital divide’ to describe the disparities in access to digital technologies between high-income and LMIC contexts. Here we evaluated the feasibility of six emerging technologies for autism spectrum disorders, and reflected on key considerations for implementation in LMIC contexts to ensure that we do not inadvertently widen the pre-existing digital divide.
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Affiliation(s)
- Aubrey J Kumm
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa
| | - Marisa Viljoen
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.
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Finkelman MD, Wei T, Lowe SR. Computer-Based Testing to Shorten the Social Communication Questionnaire (SCQ): a Proof- of-Principle Study of the Lifetime and Current Forms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Samadi SA, McConkey R, Abdollahi-Boghrabadi G, Pourseid-Mohammad M. Developmental Signs of Autism Spectrum Disorder in Iranian Pre-Schoolers. J Pediatr Nurs 2021; 58:e69-e73. [PMID: 33536153 DOI: 10.1016/j.pedn.2021.01.006] [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] [Received: 10/22/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Early identification and intervention is recommended for developmental disabilities such as autism spectrum disorders (ASD). Various screening tools are available, but most were developed in affluent English speaking countries. DESIGN AND METHODS In order to identify possible early signs of ASD within Iranian society, parents of 623 children in an age range from 3 to 7 years of age at risk of ASD, were interviewed about the signs that alerted their concerns. Also two screening instruments were developed and tested with the parents using items derived from the Gilliam Autism Rating Scale (GARS2). One focused on autistic behaviors and the second on developmental indicators. RESULTS Using both tools, 93% of the children who were identified as likely to have ASD based on a full GARS assessment were identified using the two screening tools. PRACTICE IMPLICATIONS These assessments might be used in initial screening for ASD by early year's personnel or public health professionals with Iranian parents of toddlers who have concerns about their child's development.
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Affiliation(s)
| | - Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Iran
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45
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Martinot M, Giacobi C, De Stefano C, Rezzoug D, Baubet T, Klein A. [Age at diagnosis of Autism Spectrum Disorder depending on ethno-cultural background or migratory status: A systematic literature review]. L'ENCEPHALE 2021; 47:157-170. [PMID: 33051084 PMCID: PMC7547827 DOI: 10.1016/j.encep.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review. METHOD Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles. RESULTS Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion. CONCLUSION Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.
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Affiliation(s)
- M Martinot
- GHU Paris psychiatrie neurosciences, centre médical Marmottan, 17, rue d'Armaillé, 75017 Paris, France.
| | - C Giacobi
- Hôpital Avicenne, AP-HP, Bobigny, France
| | | | - D Rezzoug
- CESP Inserm U1178, université Paris 13 EA 4403, hôpital Avicenne, AP-HP, Bobigny, France; Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France
| | - T Baubet
- CESP Inserm U1178, université Paris 13 EA 4403, hôpital Avicenne, AP-HP, Bobigny, France; Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France
| | - A Klein
- Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France; Université Paris 13, hôpital Avicenne, AP-HP, Bobigny, 129, rue de Stalingrad, 93009 Bobigny, France
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Are Developmental Monitoring and Screening Better Together for Early Autism Identification Across Race and Ethnic Groups? J Autism Dev Disord 2021; 52:203-218. [PMID: 33666797 DOI: 10.1007/s10803-021-04943-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
National Surveys of Children's Health (NSCH, 2016-2018) data were analyzed to determine if conjoint monitoring and screening showed stronger associations with children under 5 identified with ASD compared to monitoring alone, screening alone or no monitoring or screening; and investigate relationships between monitoring and screening across racial/ethnic subgroups. 86 of 332 children with ASD received their diagnosis in a timeframe suggesting potential monitoring and screening for identification purposes. Analyses showed that conjoint monitoring and screening and monitoring alone, but not screening alone, was associated with early identified ASD cases across race groups. Caution is warranted as interpreting NSCH monitoring and screening items solely for identification purposes is inaccurate in many cases. More research on monitoring with screening is needed.
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Como DH, Stein Duker LI, Polido JC, Cermak SA. Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E135. [PMID: 33375475 PMCID: PMC7795681 DOI: 10.3390/ijerph18010135] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.
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Affiliation(s)
- Dominique H. Como
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - José C. Polido
- Children’s Hospital Los Angeles and Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA;
| | - Sharon A. Cermak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
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de Leeuw A, Happé F, Hoekstra RA. A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe. Autism Res 2020; 13:1029-1050. [PMID: 32083402 PMCID: PMC7614360 DOI: 10.1002/aur.2276] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022]
Abstract
Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.
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Affiliation(s)
- Anne de Leeuw
- Amsterdam University Medical Centre, location VUmc, Amsterdam, The Netherlands
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Rosa A Hoekstra
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Nichols HM, Dababnah S, Troen B, Vezzoli J, Mahajan R, Mazefsky CA. Racial Disparities in a Sample of Inpatient Youth with ASD. Autism Res 2020; 13:532-538. [PMID: 31930779 DOI: 10.1002/aur.2262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/09/2022]
Abstract
Although more than one in 10 youth with Autism Spectrum Disorder (ASD) is admitted to a psychiatric facility before they reach adulthood, the inpatient population is underrepresented in research. Furthermore, Black youth are more likely to be psychiatrically hospitalized, compared to their White counterparts. Yet, prior research has been inconsistent in potential racial differences in ASD symptoms and severity. This study examined differences in the symptom presentation of psychiatrically hospitalized Black and White youth with ASD. Researchers collected data as part of a larger study of youth admitted to one of six US specialized inpatient psychiatric units between 2013 and 2017. We used bivariate and multivariate models to analyze the data. The study included 654 youth diagnosed with ASD, with an average age of 13 years. While bivariate analyses found that Black youth had lower written language and daily living skills and more impaired social affect and inappropriate speech, multivariate regression models suggested that overall ability level and age may be driving these differences. Specifically, the only variables that significantly predicted adaptive functioning (written language, daily living) and behavioral profiles (social affect, inappropriate speech) were verbal ability, IQ, and age. Race was not a significant predictor in any of the models. Cultural diversity and competency are vital to the identification and treatment of ASD clinical care. Thus, understanding the role race may play in early detection and accurate diagnosis is important to improving ASD identification, diagnosis, and treatment. Autism Res 2020, 13: 532-538. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examined differences in autism symptoms between Black and White youth in psychiatric hospitals. We found that while it initially appeared that Black and White youth differed in written language and daily living skills, these racial differences were not significant once we accounted for differences in IQ, age, and verbal ability. Our findings suggest that providers should pay greater attention to other potential reasons for racial disparities in autism services.
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Affiliation(s)
- Helen M Nichols
- School of Social Work, University of Maryland, Baltimore, Maryland
| | - Sarah Dababnah
- School of Social Work, University of Maryland, Baltimore, Maryland
| | | | - Jessica Vezzoli
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rajneesh Mahajan
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Sheppard Pratt Health System, Baltimore, Maryland
| | - Carla A Mazefsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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50
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Franz L, Dawson G. Implementing early intervention for autism spectrum disorder: a global perspective. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:44. [PMID: 31535090 PMCID: PMC6750262 DOI: 10.21037/pm.2019.07.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Lauren Franz
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Global Health.Institute, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
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