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Wang YC, Tai YM, Wu YY, Chiu YN, Tsai WC, Gau SSF. A follow-up study of peer relationships in autistic and non-autistic youths: Mediating effects from autistic, emotional and behavioral symptoms. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104768. [PMID: 38870673 DOI: 10.1016/j.ridd.2024.104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 04/10/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Little is known about how clinical features prospectively influence peer relationships in autistic populations. AIMS This study investigated the clinical symptoms mediating the link between autism spectrum disorder (ASD) diagnosis and peer relationships at follow-up, i.e. the second time evaluation of this study. METHODS The sample consisted of 366 autistic youths and 134 non-autistic comparisons. The autistic traits and emotional/behavioral problems were measured at baseline by Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL). The interactions and problems with peers were assessed by the Social Adjustment Inventory for Children and Adolescents (SAICA) at follow-up. RESULTS Each subscore of SRS and CBCL showed significant mediation effects. Multiple mediation analyses showed atypical social communication, social awareness problems, and delinquent behaviors mediated the link from ASD to less active peer interactions after controlling for sex, age, and IQ. Moreover, atypical social communication, social-emotional problems, and attention difficulties predicted problems with peers. After considering these mediation effects, the diagnosis of ASD still demonstrated a significantly direct effect on peer relationships at follow-up. CONCLUSIONS AND IMPLICATIONS Our findings support that social-related autistic features, attention problems, and delinquent behaviors mediated a link between ASD and peer relationships. These mediators are potential measures for improving interactions and decreasing difficulties with peers in the autistic population.
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Affiliation(s)
- Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan
| | - Yueh-Ming Tai
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taiwan
| | - Yu-Yu Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taiwan
| | - Yen-Nan Chiu
- Department of Psychiatry, National Taiwan University Hospital, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan.
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2
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Song W, McLean KJ, Gifford J, Kissner H, Sipe R. Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06401-7. [PMID: 38771506 DOI: 10.1007/s10803-024-06401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. OBJECTIVE The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. PARTICIPANTS AND SETTING Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. METHODS Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. RESULTS Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. CONCLUSION These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.
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Affiliation(s)
- Wei Song
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Kiley J McLean
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Jordan Gifford
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Hailey Kissner
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Rosalind Sipe
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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3
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Li W, Song C, Hu L, Wu L, Zhu Z. Influence of parental education on the intelligence quotient profiles and socially adaptive behavior of school-age children with autism spectrum disorder in eastern China. J Zhejiang Univ Sci B 2024:1-11. [PMID: 38423538 DOI: 10.1631/jzus.b2300354] [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: 05/22/2023] [Accepted: 09/24/2023] [Indexed: 03/02/2024]
Abstract
Intelligence quotient (IQ) and adaptive behavior are the influencing factors of autism spectrum disorder (ASD) in children entering mainstream schools. This study explored the association between parental education level, IQ, and adaptive behavior in ASD groups. A total of 257 school-age ASD children were enrolled in our study from January 2017 to June 2021. Their parents completed a standard demographic form, including age at autism diagnosis, gender, school placement, and parents' educational background. The Chinese version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) was completed by a certified assessor for each enrolled child. Parents were interviewed on adaptive behavior using the Chinese version of the Adaptive Behavior Assessment System, Second Edition (ABAS-II). The average IQ of school-age ASD children was 76.88 (standard deviation (SD)=22.62) and boys had higher IQ levels than girls. The IQ was positively correlated with age. The General Adaptive Composite (GAC) score was 82.47 (SD=15.86) and adaptive behavior did not increase with age. ASD children who attended mainstream schools had better adaptive behavior profiles than other children. The mother's education level showed a significant correlation with the IQ and adaptive behavior of autistic children, while the father's education level did not. Consequently, better training and support for parents may help autistic children enter mainstream schools, with adaptive training being the most urgently required skill for parents.
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Affiliation(s)
- Wenhao Li
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310053, China
| | - Chao Song
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310053, China
| | - Lifei Hu
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310053, China
| | - Lingling Wu
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310053, China
| | - Zhiwei Zhu
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310053, China.
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Chun J, Kuo HJ, Curtiss SL, Lee GK, Lee H, Awadu J. The interplay of supports and barriers during the transition to adulthood for youth on the autism spectrum. Disabil Rehabil 2023; 45:2879-2889. [PMID: 35996958 DOI: 10.1080/09638288.2022.2112097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Transition to adulthood is a complex process that involves important life domains such as education, work, independent living, community, health, and social relationships. Autistic youth face the transition with greater challenges than their peers, and there continues to have significant gaps in the services as they approach young adulthood. The study was conducted to understand the complex interplay between supports and barriers to participation in the transition process. METHOD Data was collected through six focus groups with 24 participants (7 parents, 11 practitioners, 6 autistic youth), digitally audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS Four themes were reported: Inadequacy of Services, Ambivalence about Formal Services and Support, Understanding Good Partnership, and Evolving Parental Involvement. While parents and practitioners see the fragmented services and lack of comprehensive support as the most prominent challenge, autistic youth feel ambivalent about the type of services they need. Practitioners address the importance of establishing an appropriate level of engagement with parents in the transition process. Autistic youth expect their parents to set a boundary that affirms their independence. CONCLUSIONS Our study highlights the need to elicit input across different stakeholders to make transition services centralized, easily accessible, and individualized.Implications for RehabilitationIt is important to have a systematic road map, early preparation of families and autistic youth about the array of adult transition services, and a centralized hub of information to be disseminated.Disability service agencies should develop and implement plans for enhancing outreach and services to transition youth on the autism spectrum and their families.Practitioners need to identify locally available resources and channels for outreach and make available service more visible by producing transition-related materials with examples of current legislative information, problem solving, and best practices.Practitioners should consider how autistic youth identify their needs and wants may be different than how service providers and parents conceptualize them.It is critical to capitalize appropriate levels of caregivers/family support and engagement by provision of education about policies and guidelines for communication and collaboration.
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Affiliation(s)
- Jina Chun
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Hung Jen Kuo
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
| | - Sarah L Curtiss
- College of Education and Human Development, University of Delaware, Newark, DE, USA
| | - Gloria K Lee
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
| | - Heekyung Lee
- Graduate and Professional Studies in Education, California State University-Sacramento, Sacramento, CA, USA
| | - Jorem Awadu
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
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5
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Lucas R, Cage E, James AI. Supporting Effective Transitions From University to Post-graduation for Autistic Students. Front Psychol 2022; 12:768429. [PMID: 35197881 PMCID: PMC8858974 DOI: 10.3389/fpsyg.2021.768429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The number of autistic students graduating is increasing; however, little is known regarding their transition out of university. Understanding this transition is particularly pertinent with regard to the employment of autistic graduates. It is vital that we understand autistic people's experiences of the transition and identify what support would be beneficial during this time. METHOD Thirty-four autistic graduates from the United Kingdom took part in a mixed-methods study exploring their transition experience. Both quantitative and qualitative questions were used to obtain in-depth information concerning participants' experiences. Participants completed questions regarding their experiences and emotions in relation to the transition, the support they received for the transition, and their career and post-graduation plans. RESULTS Participants reported high levels of fear and low preparedness for the transition. They did not feel well supported in preparing for the transition or for their future career. In the 6 months pre-graduation, 59% of participants had accessed emotion-related transition support and 70% accessed career-related support. Post-graduation, one-third accessed emotion-related or career-related support. Perspectives on this accessed support were mixed, as were transition experiences. Additional support desired included preparation for life changes, career planning, employment accessibility, and autism-specific support. Advice for future students centered on forward planning. CONCLUSION These results highlight the importance of supporting autistic students with the transition out of university. Service provision should be tailored to autistic students' needs and support early planning for the transition.
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Affiliation(s)
- Rebecca Lucas
- School of Psychology, University of Roehampton, London, United Kingdom
| | - Eilidh Cage
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Alana I. James
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Shea LL, Cooper D, Wilson AB. Preventing and improving interactions between autistic individuals and the criminal justice system: A roadmap for research. Autism Res 2021; 14:2053-2060. [PMID: 34402601 DOI: 10.1002/aur.2594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
Researchers have identified that autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. The prevalence of autism spectrum disorder (ASD) is increasing and generating a comprehensive approach to addressing criminal justice system involvement among autistic individuals is a timely and urgent need. Revisions to an established framework generated for use among individuals with mental health diagnoses, the sequential Intercept Model (SIM), were produced by an international consortium of interdisciplinary stakeholders presenting a new opportunity to identify gaps in ASD research and generate preventive solutions across the criminal justice system. The revised SIM maps each criminal justice system component, or Intercept, and includes paths for the experiences of autistic individuals as victims or witnesses to crimes as well as offenders to catalyze new and interdisciplinary research, policy, and practice efforts. As the field of ASD research continues to grow, the revised SIM is a promising pathway to avoiding siloed research approaches, including diverse autistic voices, and contributing to international dialogue about criminal justice reform at a critical juncture. LAY SUMMARY: Autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. A revised version of the SIM generated by an international consortium provides a cohesive framework to ensure research focused on this topic extends across the criminal justice system. Preventing and improving interactions between autistic individuals and the criminal justice system is an urgent research, policy, and practice need.
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Affiliation(s)
- Lindsay Lawer Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dylan Cooper
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Amy Blank Wilson
- School of Social Work, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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Houtrow A, Elias ER, Davis BE. Promoting Healthy Sexuality for Children and Adolescents With Disabilities. Pediatrics 2021; 148:peds.2021-052043. [PMID: 34183359 DOI: 10.1542/peds.2021-052043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This clinical report updates a 2006 report from the American Academy of Pediatrics titled "Sexuality of Children and Adolescents With Developmental Disabilities." The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.
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Affiliation(s)
- Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Ellen Roy Elias
- School of Medicine, University of Colorado and Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
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Schott W, Nonnemacher S, Shea L. Service Use and Unmet Needs Among Adults with Autism Awaiting Home- and Community-Based Medicaid Services. J Autism Dev Disord 2021; 51:1188-1200. [PMID: 32671666 DOI: 10.1007/s10803-020-04593-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Autistic adults in need of long-term services and supports spend months on waiting lists before receiving such services through Medicaid. Data from a state-wide survey of adults and their caregivers on a waiting list for autism waivers suggest that the majority have unmet needs for functional skills services (63.6%), employment or vocation services (62.1%), and mental and behavioral health services (52.8%). Almost a third require case management services (28.3%). Predictors of greater service need are African American race and the number of physical and behavioral health diagnoses. Predictors of greater service receipt were employment status, housing type, and school enrollment; there was lower service receipt for African American race, Hispanic ethnicity, over age 21 years, and college completion.
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Affiliation(s)
- Whitney Schott
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Stacy Nonnemacher
- Bureau of Supports for Autism and Special Populations, Pennsylvania Department of Human Services, 801 Market St., Philadelphia, PA, 19107, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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Lee GK, Curtiss SL, Kuo HJ, Chun J, Lee H, Nimako DD. The Role of Acceptance in the Transition to Adulthood: A Multi-Informant Comparison of Practitioners, Families, and Youth with Autism. J Autism Dev Disord 2021; 52:1444-1457. [PMID: 33942187 DOI: 10.1007/s10803-021-05037-1] [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] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
This study investigated the role of acceptance during the transition process among autistic young adults, parents, and practitioners. Six focus groups were run and thematic analysis was used to identify four themes: Youth on the autism spectrum discussed transition as a time where Self-Advocacy and Self-Acceptance were salient. Both youth and parents discussed the Lack of Understanding and Acceptance they experience. Particularly, youth highlighted the lack of understanding of sensory needs and parents underscored the lack of understanding by medical professionals. In contrast, practitioners highlighted the presence of Community Openness. Both practitioners and parents discussed Finding Personal Support through Acceptance. Self-acceptance and acceptance of autism are imperative for autistic young adults and families to achieve well-being.
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Affiliation(s)
- Gloria K Lee
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA.
| | - Sarah L Curtiss
- College of Education and Human Development, University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Hung Jen Kuo
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA
| | - Jina Chun
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Madison, WI, 53706, USA
| | - Heekyung Lee
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI, 48824, USA
| | - Danielle D Nimako
- Department or Counselor Education, Emporia State University, 1601 State Street, Emporia, KS, 66801, USA
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Chen Y, Wang J, Guo Y, Zhu Z, Bai X, Li X. Reliability and validity of a novel caregiver-assessed skills system based on the ALSO conception in children with autism spectrum disorders. Transl Pediatr 2021; 10:366-377. [PMID: 33708523 PMCID: PMC7944178 DOI: 10.21037/tp-20-319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In responding to the potential challenges in the transition from childhood to adulthood for individuals with autism spectrum disorders (ASD) in China, a novel conception of "ALSO" was proposed to bridge the transitional needs and early intervention. To facilitate the application of ALSO in early intervention, ALSOLIFE skills assessment system (ALSOLIFE Assessment) was developed to enable caregivers to evaluate their children's skills guided by the ALSO conception. Given that the critical shortage of qualified professionals in China, many caregivers of children with ASD must function as home therapists. To address the practical needs of Chinese families of children with ASD, ALSOLIFE Assessment is designed as a free, online, technology-assisted, self-operated and behavioral intervention approaches supported system. The assessment report then further served as the basis for caregivers to deliver the tailored educational intervention to their children. Although ALSOLIFE Assessment provides caregivers a home-based intervention program, it is still unclear whether its evaluation is reliable and accurate. Therefore, we conduct this study to investigate the reliability and validity of the ALSOLIFE Assessment. METHODS A total of 1,050 children with ASD (1 to 10 years old) were recruited from 31 provinces of mainland China. Their caregivers participated simultaneously as ALSOLIFE Assessment evaluators. The testing results of Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and Psychoeducational Profile-3 (PEP-3) were also collected for a portion of the child participants (VB-MAPP, N=34; PEP-3, N=31) to check criterion-related validity. RESULTS The reliability and validity of the ALSOLIFE Assessment satisfied psychometric requirements after the reduction from 511 to 464 items. Exploratory factor analysis (EFA) of ALSOLIFE Assessment scoring data yielded six factors, and confirmatory factor analysis (CFA) verified the best fitting construct model is a bifactorial model with one general factor and six group factors. Compared to the VB-MAPP and PEP-3, the ALSOLIFE Assessment exhibited good criterion-related validity across three levels: total scores, 6 skill domains, and 22 skill subdomains. The reliability tests indicated its strong internal consistency, test-retest reliability, and inter-rater reliability. CONCLUSIONS The reliability and validity of the revised ALSOLIFE Assessment (464-items) satisfied psychometric requirements. It is essential to develop validated and comprehensive evaluation tools, embedded on the needs of Chinese families of children with ASD.
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Affiliation(s)
- Yuanxin Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jingyi Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yanqin Guo
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Zhuohong Zhu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoyu Bai
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xinying Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
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Embedded research approaches to address the needs of the increasing, aging autistic population. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100517. [PMID: 33436313 DOI: 10.1016/j.hjdsi.2020.100517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 08/30/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022]
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12
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Psychiatr Clin North Am 2020; 43:673-686. [PMID: 33127001 DOI: 10.1016/j.psc.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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13
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Lewis AS, van Schalkwyk GI. Systematic Review: Distribution of Age and Intervention Modalities in Therapeutic Clinical Trials for Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:2208-2216. [PMID: 30815774 DOI: 10.1007/s10803-019-03942-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of ASD remains relatively stable across the lifespan, necessitating a quantitative understanding of how intervention clinical research is applied across age groups. Here we report a systematic review of treatment studies between 2013 and 2017, enrolling 11,213 subjects with ASD in 218 studies. Individuals under 18 years old constituted the majority of studies (84%) and subjects (92%). Subjects under 18 years old were more likely to be enrolled in behavioral studies (OR (CI) = 1.34 (1.17-1.54)), and less likely to be enrolled in pharmacological (OR = 0.60 (0.52-0.69)) studies than subjects ≥ 18 years old. Identified disparities in both intervention modalities and outcome measures should serve to guide future research priorities.
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Affiliation(s)
- Alan S Lewis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 465 21st Ave. S., MRBIII Room 6140B, Nashville, TN, 37240, USA.
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Gerrit Ian van Schalkwyk
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Keller R, Chieregato S, Bari S, Castaldo R, Rutto F, Chiocchetti A, Dianzani U. Autism in Adulthood: Clinical and Demographic Characteristics of a Cohort of Five Hundred Persons with Autism Analyzed by a Novel Multistep Network Model. Brain Sci 2020; 10:brainsci10070416. [PMID: 32630229 PMCID: PMC7407178 DOI: 10.3390/brainsci10070416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/27/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and relational skills, associated with repetitive verbal and motor behaviors, restricted patterns of interest, need for a predictable and stable environment, and hypo- or hypersensitivity to sensory inputs. Due to the challenging diagnosis and the paucity of specific interventions, persons with autism (PWA) reaching the adult age often display a severe functional regression. In this scenario, the Regional Center for Autism in Adulthood in Turin seeks to develop a personalized rehabilitation and enablement program for PWA who received a diagnosis of autism in childhood/adolescence or for individuals with suspected adulthood ASD. This program is based on a Multistep Network Model involving PWA, family members, social workers, teachers, and clinicians. Our initial analysis of 500 PWA shows that delayed autism diagnosis and a lack of specific interventions at a young age are largely responsible for the creation of a “lost generation” of adults with ASD, now in dire need of effective psychosocial interventions. As PWA often present with psychopathological co-occurrences or challenging behaviors associated with lack of adequate communication and relational skills, interventions for such individuals should be mainly aimed to improve their self-reliance and social attitude. In particular, preparing PWA for employment, whenever possible, should be regarded as an essential part of the intervention program given the social value of work. Overall, our findings indicate that the development of public centers specialized in assisting and treating PWA can improve the accuracy of ASD diagnosis in adulthood and foster specific habilitative interventions aimed to improve the quality of life of both PWA and their families.
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Affiliation(s)
- Roberto Keller
- Adult Autism Center, Mental Health Department, Health Unit ASL Città di Torino, 10138 Turin, Italy; (R.K.); (S.C.); (S.B.); (R.C.)
| | - Silvia Chieregato
- Adult Autism Center, Mental Health Department, Health Unit ASL Città di Torino, 10138 Turin, Italy; (R.K.); (S.C.); (S.B.); (R.C.)
| | - Stefania Bari
- Adult Autism Center, Mental Health Department, Health Unit ASL Città di Torino, 10138 Turin, Italy; (R.K.); (S.C.); (S.B.); (R.C.)
| | - Romina Castaldo
- Adult Autism Center, Mental Health Department, Health Unit ASL Città di Torino, 10138 Turin, Italy; (R.K.); (S.C.); (S.B.); (R.C.)
| | - Filippo Rutto
- Department of Psychology, University of Turin, 10100 Turin, Italy;
| | - Annalisa Chiocchetti
- Department of Health Sciences, Universita’ del Piemonte Orientale, 28100 Novara, Italy;
| | - Umberto Dianzani
- Department of Health Sciences, Universita’ del Piemonte Orientale, 28100 Novara, Italy;
- Correspondence:
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15
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am 2020; 29:345-358. [PMID: 32169266 DOI: 10.1016/j.chc.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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16
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Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol 2020; 19:434-451. [PMID: 32142628 DOI: 10.1016/s1474-4422(20)30034-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Abstract
Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.
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17
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Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [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: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
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Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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An International Clinical Study of Ability and Disability in Autism Spectrum Disorder Using the WHO-ICF Framework. J Autism Dev Disord 2019; 48:2148-2163. [PMID: 29423605 PMCID: PMC5948258 DOI: 10.1007/s10803-018-3482-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This is the fourth international preparatory study designed to develop International Classification of Functioning, Disability and Health (ICF, and Children and Youth version, ICF-CY) Core Sets for Autism Spectrum Disorder (ASD). Examine functioning of individuals diagnosed with ASD as documented by the ICF-CY in a variety of clinical settings. A cross-sectional study was conducted, involving 11 units from 10 countries. Clinical investigators assessed functioning of 122 individuals with ASD using the ICF-CY checklist. In total, 139 ICF-CY categories were identified: 64 activities and participation, 40 body functions and 35 environmental factors. The study results reinforce the heterogeneity of ASD, as evidenced by the many functional and contextual domains impacting on ASD from a clinical perspective.
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19
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Abstract
Youth with ASD are more likely to experience bullying than their typically developing peers. This risk has not been studied in youth with ASD transitioning to college. We examined the occurrence of bullying in 35 high functioning youth with ASD who were preparing to attend college. We also examined youth anxiety and ASD symptoms. Fifty-one percent of the sample reported being recent victims of bullying; 31% of parents reported their child was a victim of bullying. Parent report of bullying correlated significantly with ratings of youth social anxiety symptoms. These findings suggest that bullying is an issue of concern for higher functioning, older adolescents with ASD, and that their own reports may be particularly important in identifying its occurrence.
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20
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Bölte S, Mahdi S, de Vries PJ, Granlund M, Robison JE, Shulman C, Swedo S, Tonge B, Wong V, Zwaigenbaum L, Segerer W, Selb M. The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:449-467. [PMID: 29378422 PMCID: PMC6376609 DOI: 10.1177/1362361318755522] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder is associated with diverse social, educational, and
occupational challenges. To date, no standardized, internationally accepted
tools exist to assess autism spectrum disorder–related functioning. World Health
Organization’s International Classification of Functioning, Disability and
Health can serve as foundation for developing such tools. This study aimed to
identify a comprehensive, a common brief, and three age-appropriate brief autism
spectrum disorder Core Sets. Four international preparatory studies yielded in
total 164 second-level International Classification of Functioning, Disability
and Health candidate categories. Based on this evidence, 20 international autism
spectrum disorder experts applied an established iterative decision-making
consensus process to select from the candidate categories the most relevant ones
to constitute the autism spectrum disorder Core Sets. The consensus process
generated 111 second-level International Classification of Functioning,
Disability and Health categories in the Comprehensive Core Set for autism
spectrum disorder—one body structure, 20 body functions, 59 activities and
participation categories, and 31 environmental factors. The Common Brief Core
Set comprised 60 categories, while the age-appropriate core sets included 73
categories in the preschool version (0- to 5-year-old children), 81 in the
school-age version (6- to 16-year-old children and adolescents), and 79 in the
older adolescent and adult version (⩾17-year-old individuals). The autism
spectrum disorder Core Sets mark a milestone toward the standardized assessment
of autism spectrum disorder–related functioning in educational, administrative,
clinical, and research settings.
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Affiliation(s)
- Sven Bölte
- 1 Karolinska Institutet, Sweden.,2 Stockholm County Council, Sweden
| | - Soheil Mahdi
- 1 Karolinska Institutet, Sweden.,2 Stockholm County Council, Sweden
| | | | | | | | | | | | | | | | | | | | - Melissa Selb
- 11 Swiss Paraplegic Research, Switzerland.,12 ICF Research Branch, Switzerland
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