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Panganiban J, Kasari C. Educators apply new teaching strategies despite initial attributions of autistic students' controllability of their behaviors. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:379-385. [PMID: 37213585 PMCID: PMC10197991 DOI: 10.1080/20473869.2023.2204560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
Autistic children are less likely to be jointly engaged with a play partner than nonautistic children, negatively impacting social communication development. Promoting joint engagement during play can be an important target for educators of autistic students, but educator perceptions of autistic students may affect their interactions with students. This secondary data analysis investigated educator perceptions of the behaviors of their autistic students, their relationship on educator behavior, and their relationship on the implementation of an intervention promoting joint engagement. Participants included 66 autistic preschool students, and twelve educators from six preschools. Schools were randomized to educator training or a waitlist. Before training, educators rated their students' controllability over autism related behaviors. To observe educator behavior, they were filmed playing for ten minutes with students, before and after receiving training. Ratings of controllability were positively correlated with cognitive scores, and negatively correlated with ADOS (Autism Diagnostic Observation Schedule) comparison scores. Furthermore, educator ratings of controllability predicted joint engagement strategies used by educators during play. Educators tended to use strategies promoting joint engagement for students perceived as more able to control their autism spectrum disorder behavior. Among educators that received JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) training, ratings of controllability did not predict changes in strategy scores after training. Educators were able to learn and implement new joint engagement strategies despite their initial perceptions.
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Affiliation(s)
- Jonathan Panganiban
- Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA, USA
- Correspondence to: Jonathan Panganiban, Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA 90024, USA.
| | - Connie Kasari
- Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA, USA
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2
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Soleiman P, Moradi H, Mehralizadeh B, Ameri H, Arriaga RI, Pouretemad HR, Baghbanzadeh N, Vahid LK. Fully robotic social environment for teaching and practicing affective interaction: Case of teaching emotion recognition skills to children with autism spectrum disorder, a pilot study. Front Robot AI 2023; 10:1088582. [PMID: 37207048 PMCID: PMC10190599 DOI: 10.3389/frobt.2023.1088582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/03/2023] [Indexed: 05/21/2023] Open
Abstract
21st century brought along a considerable decrease in social interactions, due to the newly emerged lifestyle around the world, which became more noticeable recently of the COVID-19 pandemic. On the other hand, children with autism spectrum disorder have further complications regarding their social interactions with other humans. In this paper, a fully Robotic Social Environment (RSE), designed to simulate the needed social environment for children, especially those with autism is described. An RSE can be used to simulate many social situations, such as affective interpersonal interactions, in which observational learning can take place. In order to investigate the effectiveness of the proposed RSE, it has been tested on a group of children with autism, who had difficulties in emotion recognition, which in turn, can influence social interaction. An A-B-A single case study was designed to show how RSE can help children with autism recognize four basic facial expressions, i.e., happiness, sadness, anger, and fear, through observing the social interactions of two robots speaking about these facial expressions. The results showed that the emotion recognition skills of the participating children were improved. Furthermore, the results showed that the children could maintain and generalize their emotion recognition skills after the intervention period. In conclusion, the study shows that the proposed RSE, along with other rehabilitation methods, can be effective in improving the emotion recognition skills of children with autism and preparing them to enter human social environments.
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Affiliation(s)
| | - Hadi Moradi
- School of ECE, University of Tehran, Tehran, Iran
- Intelligent Systems Research Institute, Sungkyunkwan University, Suwon, Republic of Korea
- *Correspondence: Hadi Moradi,
| | | | - Hamed Ameri
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Rosa I. Arriaga
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | | | | | - Leila Kashani Vahid
- Department of Psychology, Islamic Azad University Science and Research Branch, Tehran, Iran
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3
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Panganiban JL, Shire SY, Williams J, Kasari C. Supporting peer engagement for low-income preschool students with autism spectrum disorder during academic instruction: A pilot randomized trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2175-2187. [PMID: 35420044 PMCID: PMC9596950 DOI: 10.1177/13623613221085339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Schools are the portal through which many children with autism spectrum disorder access early intervention. Collaborating with teachers can be an effective way to implement evidence-based practices. In this study, teachers learned to embed strategies from the Joint Attention, Symbolic Play, Engagement, and Regulation intervention into the standard preschool curriculum. Twelve schools with special education preschool classrooms for students with moderate to severe disabilities from under-resourced neighborhoods were randomized to augment their curriculum with Joint Attention, Symbolic Play, Engagement, and Regulation strategies or continue the standard curriculum. Teachers’ strategy implementation, children’s time on task, and social communication were examined before and after completing the intervention phase. Teachers in the Joint Attention, Symbolic Play, Engagement, and Regulation group implemented more Joint Attention, Symbolic Play, Engagement, and Regulation strategies than the control group after the intervention phase. Children in both groups increased time on task during teacher-led small group instruction. Children in the Joint Attention, Symbolic Play, Engagement, and Regulation group were more likely to be engaged with peers during small group instruction at the end of the intervention phase. Children from both groups improved in standardized measures of joint attention, requesting, expressive language, and receptive language. Training teachers to embed Joint Attention, Symbolic Play, Engagement, and Regulation strategies into small group instruction can help facilitate peer engagement, providing children more opportunities for peer socialization.
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Nuske HJ, Buck J, Ramesh B, Becker-Haimes EM, Zentgraf K, Mandell DS. Making Progress Monitoring Easier and More Motivating: Developing a Client Data Collection App Incorporating User-Centered Design and Behavioral Economics Insights. SOCIAL SCIENCES (BASEL, SWITZERLAND) 2022; 11:106. [PMID: 35496358 PMCID: PMC9053102 DOI: 10.3390/socsci11030106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data collection is an important component of evidence-based behavioral interventions for children with autism, but many one-to-one aides (i.e., behavioral support staff) do not systemically collect quantitative data that are necessary for best-practice client progress monitoring. Data collection of clients' behaviors often involves labor-intensive pen-and-paper practices. In addition, the solitary nature of one-to-one work limits opportunities for timely supervisor feedback, potentially reducing motivation to collect data. We incorporated principles from behavioral economics and user-centered design to develop a phone-based application, Footsteps, to address these challenges. We interviewed nine one-to-one aides working with children with autism and seven supervisors to ask for their app development ideas. We then developed the Footsteps app prototype and tested the prototype with 10 one-to-one aides and supervisors through three testing cycles. At each cycle, one-to-one aides rated app usability. Participants provided 76 discrete suggestions for improvement, including 29 new app features (e.g., behavior timer), 20 feature modifications (e.g., numeric type-in option for behavior frequency), four flow modifications (e.g., deleting a redundant form), and 23 out-of-scope suggestions. Of the participants that tested the app, 90% rated usability as good or excellent. Results support continuing to develop Footsteps and testing its impact in a clinical trial.
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Affiliation(s)
- Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - Jacqueline Buck
- Sandra Rosenbaum School of Social Work, University of Wisconsin – Madison, WI, USA
| | - Brinda Ramesh
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - Emily M. Becker-Haimes
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Kelly Zentgraf
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - David S. Mandell
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
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5
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Proactive versus Reactive: Strategies in the Implementation of School-based Services for Students with ASD. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:575-586. [PMID: 34997368 DOI: 10.1007/s10488-021-01184-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
Autism spectrum disorder (ASD) is increasingly prevalent, intervention costs are high, and long-term outcomes are poor. Proactive implementation of evidence-based practices (EBPs; Steinbrenner et al., Evidence-Based Practices for Children, Youth, and Young Adults with Autism, 2020) through an assessment or planning process can lead to more effective services (Rubin et al., Admin Policy Mental Health Mental Health Serv Res 43(6), 1023-1028, 2016). The objective of this study is (a) to identify factors associated with the use of proactive versus reactive strategies for school-based services for students with ASD and (b) to examine school personnel perceptions of the use of proactive versus reactive strategies. Data were from a larger project in which 6 semi-structured focus groups were conducted to understand school personnel perceptions of how school districts implement new programs for ASD. Transcripts were coded using an iterative coding and review process. In the present study, primary themes were identified and classified as proactive or reactive. Participants reported both proactive and reactive allocation of district resources for intervention implementation. Reactive implementation was associated with litigation or due process, escalated student behavior, and non-public school placement, whereas proactive implementation was associated with ASD-specific programming, grants, personnel experience with EBPs, and prospective needs assessment. Participants perceived the reactive strategies as disadvantageous, and yet these strategies were sometimes still employed. Understanding the role of proactive and reactive strategies and the factors that influence their use could enable more effective planning for EBP use to improve both cost savings and student outcomes. This study is an important first step to explore resource allocation for school-based services for students with ASD.
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Carter M, Casey S, O’Keeffe GW, Gibson L, Murray DM. Mid-gestation cytokine profiles in mothers of children affected by autism spectrum disorder: a case-control study. Sci Rep 2021; 11:22315. [PMID: 34785716 PMCID: PMC8595633 DOI: 10.1038/s41598-021-01662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
Autism Spectrum disorder is one of the commonest and most important neurodevelopmental conditions affecting children today. With an increasing prevalence and an unclear aetiology, it is imperative we find early markers of autism, which may facilitate early identification and intervention. Alterations of gestational cytokine profiles have been reported in mothers of autistic children. Increasing evidence suggests that the intrauterine environment is an important determinant of autism risk. This study aims to examine the mid-gestational serum cytokine profiles of the mothers of autistic children from a well-characterised birth cohort. A nested sub-cohort within a large mother-child birth cohort were identified based on a confirmed multi-disciplinary diagnosis of autism before the age 10 years and neuro-typical matched controls in a 2:1 ratio. IFN-γ, IL-1β, IL-4, IL-6, IL-8, IL-17A, GMCSF and TNFα were measured in archived maternal 20-week serum using MesoScale Diagnostics multiplex technology and validation of our IL-17A measurements was performed using an ultrasensitive assay. From a cohort of 2137 children, 25 had confirmed autism before 10 years and stored maternal serum from mid-gestation. We examined the sera of these 25 cases and 50 matched controls. The sex ratio was 4:1 males to females in each group, and the mean age at diagnosis was 5.09 years (SD 2.13). We found that concentrations of IL-4 were significantly altered between groups. The other analytes did not differ significantly using either multiplex or ultra-sensitive assays. In our well-characterised prospective cohort of autistic children, we confirmed mid-gestational alterations in maternal IL-4 concentrations in autism affected pregnancies versus matched controls. These findings add to promising evidence from animal models and retrospective screening programmes and adds to the knowledge in this field.
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Affiliation(s)
- Michael Carter
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland. .,National Children's Research Centre, Crumlin, Dublin 12, Ireland. .,Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland.
| | - Sophie Casey
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Anatomy and Neuroscience, University College Cork (UCC), Cork, Ireland
| | - Gerard W. O’Keeffe
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Anatomy and Neuroscience, University College Cork (UCC), Cork, Ireland
| | - Louise Gibson
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland
| | - Deirdre M. Murray
- grid.7872.a0000000123318773The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork (UCC), Cork, Ireland
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7
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Davis R, Fletcher-Watson S, Digard BG. Autistic People's Access to Bilingualism and Additional Language Learning: Identifying the Barriers and Facilitators for Equal Opportunities. Front Psychol 2021; 12:741182. [PMID: 34630254 PMCID: PMC8492951 DOI: 10.3389/fpsyg.2021.741182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
Bilingualism is a valuable tool that enriches and facilitates cultural, social and lived experiences for autistic and non-autistic people alike. Research consistently finds no negative effects of bilingualism and highlights the potential for positive effects across cognitive and socio-cultural domains for autistic and non-autistic children. Yet parents of autistic children remain concerned that bilingualism will cause delays in both cognitive and language development and are still frequently advised by practitioners to raise their child monolingually. Evidently, findings from research are not reflected in practice or subsequent advice, and it is essential to identify ways to ensure equal access to additional language learning. We briefly summarise the existing literature on bilingualism and autism, considering perspectives from the bilingual autistic community, and experimental research. We identify the most pertinent barriers to participation for autistic bilingual children in terms of familial, clinical and educational perspectives. We propose novel solutions to promote additional language learning and suggest changes to practice that will contribute to an evidence base for families and practitioners. This commentary makes innovative recommendations at both the individual and societal level to ensure that autistic bilingual people have equal rights and opportunities to language learning and are optimally supported in accessing them.
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Affiliation(s)
- Rachael Davis
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
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8
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Suhrheinrich J, Melgarejo M, Root B, Aarons GA, Brookman-Frazee L. Implementation of school-based services for students with autism: Barriers and facilitators across urban and rural districts and phases of implementation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2291-2304. [PMID: 34132123 DOI: 10.1177/13623613211016729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The law requires that schools use evidence-based practices to educate students with autism spectrum disorder. However, these practices are often not used, or are not used correctly in school programs. Understanding barriers and facilitators of use of evidence-based practices in schools will help improve the implementation process. This study uses focus groups to characterize how school-based providers representing urban or rural school districts perceive barriers and facilitators for implementing new practices for students with autism spectrum disorder. Guiding questions include the following: (1) Are contextual factors perceived as barriers or facilitators and how do these vary by district location? and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases? Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some personnel-related themes and organizational factors were unique to rural or urban districts. For example, themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in identifying implementation strategies that may improve the use of evidence-based practices in schools.
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Affiliation(s)
- Jessica Suhrheinrich
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
| | - Melina Melgarejo
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
| | - Brittney Root
- San Diego State University, USA.,Child and Adolescent Services Research Center, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, USA.,University of California, San Diego, USA
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9
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Halder S, Bruyere SM. Self-reported impediments at home, school, and community: autistic adults' first-person accounts of their life trajectories and derived pathways. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:900-912. [PMID: 37113660 PMCID: PMC10127941 DOI: 10.1080/20473869.2021.1917111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 06/19/2023]
Abstract
Objectives: Despite suggestions of strengths and abilities of autistic people, it has been an underexplored area in autism research, the primary focus of which has been on examining differences and atypicalities as deficits rather than strengths. Understanding the self-reported impediments via first-person accounts of autistic adults for facilitating the strengths is an important prerequisite for an in-depth comprehension of the unique diversities and potentialities of autistic people, and roadmap development. Methods: The study is based on qualitative phenomenological inductive thematic analysis through in-depth interviews with 10 verbally- and cognitively-able autistic adults, following purposive and snowball sampling. Results: The impediments at home, school, and communities are presented through the five inductively extracted themes. Additionally, the study proposes future pathways for fostering an effective environment to nurture the innate potentialities of autistic people via a strength-focused lens. Conclusion: The study endorses the paradox of strength and atypicalities and advocates a shift from a deficit-focused approach to a strength-focused approach of support, and promotes the neurodiverse model of acceptance and embrace.
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Affiliation(s)
- Santoshi Halder
- Fulbright Academic and Professional Excellence Fellow, YTI, ILR, Cornell University, Ithaca, NY, USA
- Department of Education, University of Calcutta, Kolkata, India
| | - Susanne Marie Bruyere
- K. Lisa Yang and Hock E. Tan Institute on Employment and Disability, Ithaca, NY, USA
- Disability Studies, Cornell University, Ithaca, NY, USA
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10
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Seeking Team Collaboration, Dialogue and Support: The Perceptions of Multidisciplinary Staff-Members Working in ASD Preschools. J Autism Dev Disord 2019; 49:4634-4645. [PMID: 31440870 DOI: 10.1007/s10803-019-04175-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Autism spectrum disorder (ASD) impacts various developmental domains, requiring interventions by professionals from multiple disciplines. In Israel, ASD community preschools' multidisciplinary teams aim to provide each child with an integrative intervention program. The current study focused on the working experience of 21 professionals from multidisciplinary teams in ASD-preschools, with special emphasis on their perceptions of the intra-staff dialogue in their teams. Interviews were transcribed verbatim and analyzed through grounded theory. Arising themes covered: challenges characterizing the delivery of intervention to children with ASD in a community setting; challenges met by professionals when attempting to navigate multidisciplinary teamwork; and factors that facilitate multidisciplinary work. Practices that support multidisciplinary team cohesion at the team, the organizational, and the policy-making levels are discussed.
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Stahmer AC, Vejnoska S, Iadarola S, Straiton D, Segovia FR, Luelmo P, Morgan EH, Lee HS, Javed A, Bronstein B, Hochheimer S, Cho E, Aranbarri A, Mandell D, Hassrick EM, Smith T, Kasari C. Caregiver Voices: Cross-Cultural Input on Improving Access to Autism Services. J Racial Ethn Health Disparities 2019; 6:752-773. [PMID: 30859514 PMCID: PMC6936957 DOI: 10.1007/s40615-019-00575-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/17/2019] [Accepted: 02/12/2019] [Indexed: 01/16/2023]
Abstract
Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education; increasing culturally responsive care; improving provider-family partnerships; and addressing practical challenges to service access.
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Affiliation(s)
- Aubyn C Stahmer
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA.
| | - Sarah Vejnoska
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
| | - Suzannah Iadarola
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Diondra Straiton
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
- Department of Psychology, Michigan State University, 316 Physics, Rd., East Lansing, MI, 48824, USA
| | - Francisco Reinosa Segovia
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
| | - Paul Luelmo
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
- Department of Special Education, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Elizabeth H Morgan
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
| | - Hyon Soo Lee
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
| | - Asim Javed
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Briana Bronstein
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
| | - Samantha Hochheimer
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - EunMi Cho
- College of Education, California State University, Sacramento, 6000 J St., Sacramento, CA, 95819, USA
| | - Aritz Aranbarri
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
- Mental Health Department, Sant Juan de Deu Barcelona Children's Hospital, Itaka Building 1st floor, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - David Mandell
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
| | - Elizabeth McGhee Hassrick
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street | Suite 560, Philadelphia, PA, 19104, USA
| | - Tristram Smith
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Connie Kasari
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
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12
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Singh JS, Bunyak G. Autism Disparities: A Systematic Review and Meta-Ethnography of Qualitative Research. QUALITATIVE HEALTH RESEARCH 2019; 29:796-808. [PMID: 30474491 DOI: 10.1177/1049732318808245] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Racial, ethnic, and socioeconomic disparities associated with autism spectrum disorder (ASD) are evident across many service domains including access to early assessment, diagnosis, and therapeutic interventions. To better understand the complex social and structural factors contributing to these disparities, this article offers a systematic review of peer-reviewed qualitative research conducted from 2010 to 2016 in the United States that investigates autism disparities experienced by marginalized communities. Based on these criteria, we identified 24 qualitative research studies and conducted an analysis using meta-ethnography and an intersectional interpretive lens. We identified three interdependent themes contributing to autism disparities, including familial, cultural, and structural barriers. Omissions in the literature were also evident, including a lack of research on underserved adults with ASD and the gendered inequities of caregiving. We discuss the implications of our findings and offer new questions that take an intersectional approach using qualitative research to investigate autism disparities.
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Affiliation(s)
| | - Garrett Bunyak
- 1 Georgia Institute of Technology, Atlanta, Georgia, USA
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13
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Iadarola S, Pérez-Ramos J, Smith T, Dozier A. Understanding stress in parents of children with autism spectrum disorder: A focus on under-represented families. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 65:20-30. [PMID: 30873280 PMCID: PMC6411305 DOI: 10.1080/20473869.2017.1347228] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Parents of children with autism spectrum disorder (ASD) report high levels of stress that can interfere with important child and family treatments. Limited past research considers how the caregiving experience and social determinants of health may contribute to treatment engagement and outcomes, particularly in under-represented families, who already experience service and health disparities. We aimed to assess the experiences of caring for an individual with ASD, with specific emphasis on perceptions of stress. METHODS Three key informant interviews were conducted with parents (n=1) and providers (n=2) of children with ASD to refine interview guide questions. Once questions were refined, four focus groups (n=17) and one key informant interview were conducted with parents of children with ASD who were (a) non-white, (b) Spanish speakers, (c) of limited financial resources, and/or (d) living in rural counties. All participants lived in Western New York, with the majority residing in Rochester. Content analysis by two independent coders was used to identify and refine themes. RESULTS Themes included: (a) caregiving for an individual with ASD can cause interference with family functioning, (b) misperceptions of ASD contribute to caregiver stress, (c) culture contributes to stressors for parents, and (d) service navigation difficulties are a significant source of stress. Suggestions for interventions to address parents stress included: modular and integrative treatments for multiple content areas, addressing cultural barriers to treatment engagement, and education on ASD to the community. CONCLUSIONS Parent-focused interventions for caregivers of children with ASD should specifically explore and address service and health disparities for parents, especially those predicated on race, ethnicity, rurality, and language of origin. Interventions should also be individualized to parent characteristics and experiences. In future research on parent training, the unique contributions of caregiver stress and other characteristics (e.g., race-related stress, geographic location) should be included as potential modifiers of treatment.
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Affiliation(s)
- Suzannah Iadarola
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY14642, USA
- Correspondence to: Suzannah Iadarola, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave Box 671, Rochester, NY 14642, USA.
| | - José Pérez-Ramos
- Clinical Translational Science Institute, University of Rochester Medical Center, Rochester, NY14642, USA
| | - Tristram Smith
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY14642, USA
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY14642, USA
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Smith T, Iadarola S, Mandell DS, Harwood R, Kasari C. Community-Partnered Research With Urban School Districts That Serve Children With Autism Spectrum Disorder. Acad Pediatr 2017; 17:614-619. [PMID: 28454928 DOI: 10.1016/j.acap.2017.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/11/2017] [Accepted: 04/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To illustrate the process of community-partnered participatory research to develop and evaluate interventions for children with autism in urban school districts. METHODS We formed partnerships of school personnel, parents, and researchers to guide the project. We then conducted focus groups, key informant interviews, and town halls to explore how public schools currently serve students with autism. We used findings from these activities to adapt interventions for public schools. We then tested interventions in randomized clinical trials (RCTs). RESULTS Community input indicated a particular need for interventions to improve children's social interaction and instructional supports to promote their success throughout the day. On the basis of this input, we adapted 2 interventions: Remaking Recess for improving peer engagement during social times; and Schedules, Tools, and Activities for Transition (STAT) for facilitating successful transitions between activities throughout the daily routine. Results of the RCT of Remaking Recess are not yet available. The RCT of STAT involved 150 children and 56 teachers. Teachers reported high buy-in and increased their proficiency at implementing STAT; children with ASD reduced their disruptive behavior and made progress toward teacher-nominated goals. However, teachers' implementation remained inconsistent, and children did not reliably improve in academic engagement or independence. CONCLUSIONS The findings suggest that although community-partnered participatory research has limitations, it can assist in selecting interventions to address community priorities and produce some favorable outcomes for children with autism in public schools. An important next step is to evaluate the sustainability of the interventions introduced in this project.
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Affiliation(s)
- Tristram Smith
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
| | - Suzannah Iadarola
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - David S Mandell
- Center for Mental Health Policy and Services Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Robin Harwood
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Md
| | - Connie Kasari
- Graduate School of Education and Information Sciences, University of California, Los Angeles, Calif
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15
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Iadarola S, Shih W, Dean M, Blanch E, Harwood R, Hetherington S, Mandell D, Kasari C, Smith T. Implementing a Manualized, Classroom Transition Intervention for Students With ASD in Underresourced Schools. Behav Modif 2017; 42:126-147. [PMID: 28675941 DOI: 10.1177/0145445517711437] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with autism spectrum disorder (ASD) in public education settings experience difficulties with transitions during classroom routines, which can result in challenging behavior. Single-subject research supports techniques for transitions, but school-based approaches often require resources and training unavailable in low-resource districts, limiting implementation. We developed and evaluated the Schedules, Tools, and Activities for Transitions (STAT) program, a short-term, manualized intervention of behavioral supports to support daily routine transitions for students with ASD (K-5) in underresourced districts. We utilized a multisite, cluster-randomized, group comparison design (immediate treatment versus waitlist) with matched pairs ( n = 150 students, 57 educators). Data indicated (a) no group differences for academic engagement or classroom independence, and (b) an advantage for STAT in reducing challenging behavior and increasing teacher fidelity. Results show preliminary support for an intervention that is feasible and perceived as sustainable in real-world settings.
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Affiliation(s)
| | - Wendy Shih
- 2 University of California, Los Angeles, CA, USA
| | - Michelle Dean
- 3 California State University Channel Islands, Camarillo, CA, USA
| | - Erica Blanch
- 4 University of Pennsylvania, Philadelphia, PA, USA
| | - Robin Harwood
- 5 Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
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16
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Kaufmann WE, Kidd SA, Andrews HF, Budimirovic DB, Esler A, Haas-Givler B, Stackhouse T, Riley C, Peacock G, Sherman SL, Brown WT, Berry-Kravis E. Autism Spectrum Disorder in Fragile X Syndrome: Cooccurring Conditions and Current Treatment. Pediatrics 2017; 139:S194-S206. [PMID: 28814540 PMCID: PMC5619699 DOI: 10.1542/peds.2016-1159f] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Individuals with fragile X syndrome (FXS) are frequently codiagnosed with autism spectrum disorder (ASD). Most of our current knowledge about ASD in FXS comes from family surveys and small studies. The objective of this study was to examine the impact of the ASD diagnosis in a large clinic-based FXS population to better inform the care of people with FXS. METHODS The study employed a data set populated by data from individuals with FXS seen at specialty clinics across the country. The data were collected by clinicians at the patient visit and by parent report for nonclinical and behavioral outcomes from September 7, 2012 through August 31, 2014. Data analyses were performed by using χ2 tests for association, t tests, and multiple logistic regression to examine the association between clinical and other factors with ASD status. RESULTS Half of the males and nearly 20% of females met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for current ASD. Relative to the FXS-only group, the FXS with ASD (FXS+ASD) group had a higher prevalence of seizures (20.7% vs 7.6%, P < .001), persistence of sleep problems later in childhood, increased behavior problems, especially aggressive/disruptive behavior, and higher use of α-agonists and antipsychotics. Behavioral services, including applied behavior analysis, appeared to be underused in children with FXS+ASD (only 26% and 16% in prekindergarten and school-age periods, respectively) relative to other populations with idiopathic ASD. CONCLUSIONS These findings confirm among individuals with FXS an association of an ASD diagnosis with important cooccurring conditions and identify gaps between expected and observed treatments among individuals with FXS+ASD.
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Affiliation(s)
- Walter E. Kaufmann
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Greenwood Genetic Center, Greenwood, South Carolina;,Address correspondence to Walter E. Kaufmann, MD, Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Cir, Greenwood, SC 29646. E-mail:
| | - Sharon A. Kidd
- National Fragile X Foundation, Washington, District of Columbia
| | - Howard F. Andrews
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | | | - Amy Esler
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Georgina Peacock
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie L. Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - W. Ted Brown
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York; and
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Biochemistry, Rush University Medical Center, Chicago, Illinois
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17
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Locke J, Wolk CB, Harker C, Olsen A, Shingledecker T, Barg F, Mandell D, Beidas R. Pebbles, rocks, and boulders: The implementation of a school-based social engagement intervention for children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:985-994. [PMID: 28954537 DOI: 10.1177/1362361316664474] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Few evidence-based practices, defined as the use of empirically supported research and clinical expertise for children with autism, have been successfully implemented and sustained in schools. This study examined the perspectives of school personnel ( n = 39) on implementing a social engagement intervention for children with autism. Semi-structured interviews, informed by the Domitrovich et al. (2008) framework, were conducted. Participants were asked about (1) school factors that affect the general implementation of evidence-based practices, (2) their specific experiences implementing the social engagement intervention, and (3) barriers to and facilitators of implementing the social engagement intervention. Data were analyzed using an integrated approach. General (e.g. implementation process, leadership, support, and staff) and intervention-specific (e.g. staff, barriers, and facilitators) implementation themes were identified. These findings suggest that a variety of factors should be considered when implementing evidence-based practices in schools and that implementing social engagement interventions for children with autism may require additional specific support for implementation.
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Edwards A, Brebner C, Mccormack PF, Macdougall C. "More than blowing bubbles": What parents want from therapists working with children with autism spectrum disorder. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:493-505. [PMID: 27063689 DOI: 10.3109/17549507.2015.1112835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Providing therapy to children with autism spectrum disorder (ASD) often requires therapists to work closely with both the child with ASD and their family. Although there is evidence outlining best practice for therapists when working with families of children with disabilities, few studies have examined the parental perspective. This study investigated the qualities parents seek in therapists who work with their children with ASD. METHOD Semi-structured interviews were conducted with 14 parents of children with ASD. Thematic analysis was undertaken to analyse the data, with emergence of two core themes; Partnership and Effective Therapy. RESULT The parents of children with ASD interviewed for this study valued both working in partnership with therapists and therapists delivering effective therapy. Parents ultimately wanted therapists to produce positive outcomes for their children and were willing to sacrifice other desired qualities, as long as the therapy program was effective. CONCLUSION While parents of children with ASD identified a range of qualities that they want in therapists, a therapist being able to produce positive outcomes for their child was considered most important. The implications of these findings are discussed both in terms of clinical implications for therapists and directions for future research.
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Affiliation(s)
- Amelia Edwards
- a Speech Pathology , Flinders University of South Australia , Adelaide , Australia and
| | - Chris Brebner
- a Speech Pathology , Flinders University of South Australia , Adelaide , Australia and
| | - Paul F Mccormack
- a Speech Pathology , Flinders University of South Australia , Adelaide , Australia and
| | - Colin Macdougall
- b Discipline of Public Health , Flinders University of South Australia , Adelaide , Australia
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Sarrett JC, Rommelfanger KS. Commentary: Attention to Eyes Is Present but in Decline in 2-6-Month-Old Infants Later Diagnosed with Autism. Front Public Health 2015; 3:272. [PMID: 26697420 PMCID: PMC4672052 DOI: 10.3389/fpubh.2015.00272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/23/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jennifer C Sarrett
- Center for the Study of Human Health, Emory University Atlanta , Atlanta, GA , USA
| | - Karen S Rommelfanger
- Center for Ethics Neuroethics Program, Emory University Atlanta , Atlanta, GA , USA ; Department of Neurology, Emory University Atlanta , Atlanta, GA , USA ; Department of Psychiatry and Behavioral Sciences, Emory University Atlanta , Atlanta, GA , USA
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