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Mire SS, Truong DM, Sakyi GJ, Ayala-Brittain ML, Boykin JD, Stewart CM, Daniels F, Duran B, Gardner S, Barth AM, Richardson G, McKee SL. A Systematic Review of Recruiting and Retaining Sociodemographically Diverse Families in Neurodevelopmental Research Studies. J Autism Dev Disord 2024; 54:2307-2321. [PMID: 37022579 DOI: 10.1007/s10803-023-05968-x] [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] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
Underrepresentation of socioeconomically, culturally, and/or linguistically diverse (SCLD) children with neurodevelopmental disorders (NDD) and their families has become a focal point for researchers. This systematic review aimed to identify researchers' strategies for recruiting and retaining SCLD families of children with NDD, published between 1993 and 2018. One hundred twenty-six articles were included, and study samples were categorized as "High SCLD" and "Low SCLD". Chi-square tests of independence were used to determine associations between sample composition (i.e., High/Low SCLD sample) and study characteristics reported. Significant associations were found between sample composition and studies that explicitly stated intention to recruit SCLD families, χ2(1) = 12.70, p < .001, Phi = 0.38 (moderate); and for studies that reported the following participant characteristics: language, χ2(1) = 29.58, p < .001, Phi = 0.48 (moderate-to-large); and race/ethnicity + SES + language, χ2(1) = 19.26, p <. 001, Phi = 0.39 (moderate). However, associations were not found between recruitment and retention approaches and whether studies included High SCLD or Low SCLD samples. Further study of NDD researchers' recruitment and retention approaches that successfully include SCLD families is needed.
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Affiliation(s)
- Sarah S Mire
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA.
- School of Education, Department of Educational Psychology, Baylor University, One Bear Place #97304, Waco, TX, 76798-7304, USA.
| | - Dieu M Truong
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgina J Sakyi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Mycah L Ayala-Brittain
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Jelisa D Boykin
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Christian M Stewart
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Fre'Dasia Daniels
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Brenda Duran
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Scarlett Gardner
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Alexandra M Barth
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgette Richardson
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Shannon L McKee
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
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Nutor C, Dunlop A, Sadler O, Brennan PA. Prenatal Cannabis Use and Offspring Autism-Related Behaviors: Examining Maternal Stress as a Moderator in a Black American Cohort. J Autism Dev Disord 2024; 54:2355-2367. [PMID: 37097527 PMCID: PMC10127191 DOI: 10.1007/s10803-023-05982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Prenatal cannabis use and maternal stress have been proposed as risk factors for autism spectrum disorder (ASD). Black mothers and mothers of lower socioeconomic status (SES) may be especially likely to experience high levels of stress. This study examined the impact of prenatal cannabis use and maternal stress (i.e., prenatal distress, racial discrimination, and lower SES) on child ASD-related behaviors in a sample of 172 Black mother-child pairs. We found that prenatal stress was significantly associated with ASD-related behaviors. Prenatal cannabis use did not predict ASD-related behaviors and did not interact with maternal stress to predict ASD-related behaviors. These findings replicate previous work on prenatal stress-ASD associations and add to the limited literature on prenatal cannabis-ASD associations in Black samples.
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Affiliation(s)
- C Nutor
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA.
| | - A Dunlop
- Department of Gynecology and Obstetrics, Emory University, 1365 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - O Sadler
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| | - P A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
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Chen Y, Duku E, Szatmari P, Salt M, Smith I, Richard A, Zwaigenbaum L, Vaillancourt T, Zaidman‐Zait A, Bennett T, Elsabbagh M, Kerns C, Georgiades S. Trajectories of adaptive functioning from early childhood to adolescence in autism: Identifying turning points and key correlates of chronogeneity. JCPP ADVANCES 2024; 4:e12212. [PMID: 38827978 PMCID: PMC11143958 DOI: 10.1002/jcv2.12212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/29/2023] [Indexed: 06/05/2024] Open
Abstract
Background Previous research has demonstrated heterogeneous adaptive outcomes across the autism spectrum; however, the current literature remains limited in elucidating turning points and associated factors for longitudinal variability (chronogeneity). To address these empirical gaps, we aimed to provide a finer-grained characterization of trajectories of adaptive functioning from early childhood to adolescence in autism. Methods Our sample (N = 406) was drawn from an inception cohort of children diagnosed Autistic at ages 2-5. Adaptive functioning was assessed with Vineland Adaptive Behavior Scales (VABS, 2nd Edition) across 6 visits from the time of diagnosis by age 18. Parallel-process latent growth curve modeling were used to estimate domain-level VABS trajectories, followed by latent class growth analysis to identify trajectory subgroups. Child characteristics at diagnosis, family demographics, and participation outcomes at adolescence were compared across subgroups. Results Piecewise latent growth models best described VABS trajectories with two turning points identified at around ages 5-6 and 9-10, respectively reflecting transitions into school age and early adolescence. We parsed four VABS trajectory subgroups that vary by level of functioning and change rate for certain domains and periods. Around 16% of the sample exhibited overall adequate functioning (standard score >85) with notable early growth and social adaptation during adolescence. About 21% showed low adaptive functioning (standard score ≤70), with decreasing slopes by age 6 followed by improvements in communication and daily-living skills by age 10. The other two subgroups (63% in total) were characterized by adaptive functioning between low and adequate levels, with relatively stable trajectories entering school age. These subgroups differed most in their cognitive ability at diagnosis, household income, and social participation in adolescence. Conclusions We identified key individual and family characteristics and time windows associated with distinct adaptive functioning trajectories, which have important implications for providing timely and tailored supports to Autistic people across developmental stages.
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Affiliation(s)
| | | | - Peter Szatmari
- Centre for Addiction and Mental HealthThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Mackenzie Salt
- McMaster UniversityHamiltonONCanada
- Autism Alliance of CanadaTorontoONCanada
| | - Isabel Smith
- Dalhousie UniversityHalifaxNSCanada
- Autism Research CentreIWK Health CentreHalifaxNSCanada
| | - Annie Richard
- Autism Research CentreIWK Health CentreHalifaxNSCanada
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Yan X, Li Y, Li Q, Li Q, Xu G, Lu J, Yang W. Prevalence of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2021 to 2022. J Autism Dev Disord 2024:10.1007/s10803-024-06390-7. [PMID: 38778000 DOI: 10.1007/s10803-024-06390-7] [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: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The prevalence of autism spectrum disorder (ASD) among children and adolescents seem to be high in countries around the world, and it's worth understanding the latest prevalence and trends of ASD in children and adolescents. The purpose of this study was to examine the latest prevalence and decade trend of ASD among individuals aged 3-17 years in the United States. METHODS A total of 13,198 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2021-2022). Weighted prevalence for each of the selected developmental disabilities were calculated. RESULTS This cross-sectional study estimated the weighted prevalence of autism spectrum disorder were 3.05, 3.79, and 3.42% among individuals aged 3-17 years in the US in 2021, 2022, and the 2-year overall, respectively. We also observed a decade-long upward trend even after adjusting for demographic characteristics (P for trend < .05). CONCLUSION The results of this study showed that the prevalence of ASD among children and adolescents aged 3-17 years in the United States remained high and has increased over the past decade. The further investigation is necessary to evaluate potential modifiable risk factors and causes of ASD.
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Affiliation(s)
- Xiaofang Yan
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yanmei Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qishan Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qian Li
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Guifeng Xu
- Department of Pediatrics, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangdong Province, Guangzhou Medical University, Guangzhou, 510623, China.
| | - Wenhan Yang
- Department of Child and Adolescent Health, School of Public Health, Guangdong Province, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
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Wieckowski AT, Robins DL. Community testing practices prompt the rethinking of gold standard autism assessment. Paediatr Perinat Epidemiol 2024. [PMID: 38772728 DOI: 10.1111/ppe.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 05/23/2024]
Affiliation(s)
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Dahl E, Moody EJ, Barger B, Rosenberg S, DiGuiseppi C, Fallin MD, Lee LC, Wiggins L. Differential Performance of Social Communication Questionnaire Items in African American/Black vs. White Children. J Autism Dev Disord 2024; 54:1820-1833. [PMID: 36897518 PMCID: PMC10913152 DOI: 10.1007/s10803-023-05931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
Screening for autism spectrum disorder (ASD) is an essential early step in the identification process and inaccurate screening may lead to significant delays in the onset of treatment. Past research has highlighted discrepancies in the performance of ASD screening tools such as the Social Communication Questionnaire (SCQ) among certain racial and ethnic groups. The current study explored the functioning of the SCQ among African American/Black and White respondents based on item level performance on the measure. Differential Item Functioning (DIF) analyses showed that 16 (41%) items of the SCQ functioned differently for African American/Black respondents when compared to White respondents. Implications, such as the potential for delayed diagnosis and treatment, and the influence on downstream outcomes, are discussed.
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Affiliation(s)
- Ethan Dahl
- Department of Education, Health, & Behavior Studies, College of Education & Human Development, University of North Dakota, 231 Centennial Dr Stop 7189, Grand Forks, ND, 58202-7189, USA.
| | - Eric J Moody
- Wyoming Institute for Disabilities, University of Wyoming, Laramie, WY, USA
| | - Brian Barger
- Center for Leadership in Disabilities, Georgia State University, Atlanta, Georgia
| | - Steven Rosenberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Patten KK, Murthi K, Onwumere DD, Skaletski EC, Little LM, Tomchek SD. Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan. Am J Occup Ther 2024; 78:7803397010. [PMID: 38758762 DOI: 10.5014/ajot.2024.078301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. OBJECTIVE These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. METHOD These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. RESULTS A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.
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Affiliation(s)
- Kristie K Patten
- Kristie K. Patten, PhD, OT/L, FAOTA, is Counselor to the President and Professor, Department of Occupational Therapy, New York University, New York, NY
| | - Kavitha Murthi
- Kavitha Murthi, MSc(OT), FHEA(UK), OTR, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Dora D Onwumere
- Dora D. Onwumere, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Emily C Skaletski
- Emily C. Skaletski, MOT, OTR/L, is PhD Candidate, Department of Kinesiology, University of Wisconsin-Madison
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, FAOTA, is Associate Dean of Research, College of Health Sciences, and Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, School of Medicine, University of Louisville, Louisville, KY
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Xu Q, Li H, Zhu D. Socioeconomic status, personality, and major mental disorders: a bidirectional Mendelian randomization study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:49. [PMID: 38678036 PMCID: PMC11055884 DOI: 10.1038/s41537-024-00471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
Previous research has suggested a correlation between socioeconomic status (SES) and mental diseases, while personality traits may be associated with SES and the risk of mental disorders. However, the causal nature of these associations remains largely uncertain. Our Mendelian randomization (MR) study aims to explore the bidirectional causality between SES and mental disorders, as well as to evaluate the potential mediating role of personality in these associations. Using bidirectional MR approach, we assessed the causality between SES indicators and mental disorders. We then used a two-step MR method to further investigate whether and to what extent personality mediates the causal associations in Caucasians. The forward MR analyses identified that years of education, household income, age at first birth and the Townsend deprivation index had a causal association with at least one mental disorder. The reverse MR analyses identified causal effects of genetically predicted schizophrenia, bipolar disorder, and attention deficit/hyperactivity disorder on five SES indicators. Importantly, mediation analysis showed that neuroticism partly mediated the causality of household income and years of education on major depressive disorder, respectively. In brief, our study confirmed the bidirectional relationship between SES and mental disorders. We also revealed the role of neuroticism in mediating the association between SES and major depressive disorder, highlighting the importance of considering both socioeconomic and personality factors in mental health research and interventions.
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Affiliation(s)
- Qiang Xu
- Department of Radiology, Tianjin Key Lab of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
| | - Haonan Li
- Department of Radiology, Tianjin Key Lab of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Zhu
- Department of Radiology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China.
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Mao Y, Lin X, Wu Y, Lu J, Shen J, Zhong S, Jin X, Ma J. Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study. Mol Autism 2024; 15:17. [PMID: 38600595 PMCID: PMC11007945 DOI: 10.1186/s13229-024-00596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that can significantly impact an individual's ability to socially integrate and adapt. It's crucial to identify key factors associated with ASD. Recent studies link both birth asphyxia (BA) and febrile seizures (FS) separately to higher ASD prevalence. However, investigations into the interplay of BA and FS and its relationship with ASD are yet to be conducted. The present study mainly focuses on exploring the interactive effect between BA and FS in the context of ASD. METHODS Utilizing a multi-stage stratified cluster sampling, we initially recruited 84,934 Shanghai children aged 3-12 years old from June 2014 to June 2015, ultimately including 74,251 post-exclusion criteria. A logistic regression model was conducted to estimate the interaction effect after controlling for pertinent covariates. The attributable proportion (AP), the relative excess risk due to interaction (RERI), the synergy index (SI), and multiplicative-scale interaction were computed to determine the interaction effect. RESULTS Among a total of 74,251 children, 192 (0.26%) were diagnosed with ASD. The adjusted odds ratio for ASD in children with BA alone was 3.82 (95% confidence interval [CI] 2.42-6.02), for FS alone 3.06 (95%CI 1.48-6.31), and for comorbid BA and FS 21.18 (95%CI 9.10-49.30), versus children without BA or FS. The additive interaction between BA and FS showed statistical significance (P < 0.001), whereas the multiplicative interaction was statistically insignificant (P > 0.05). LIMITATIONS This study can only demonstrate the relationship between the interaction of BA and FS with ASD but cannot prove causation. Animal brain experimentation is necessary to unravel its neural mechanisms. A larger sample size, ongoing monitoring, and detailed FS classification are needed for confirming BA-FS interaction in ASD. CONCLUSION In this extensive cross-sectional study, both BA and FS were significantly linked to ASD. The coexistence of these factors was associated with an additive increase in ASD prevalence, surpassing the cumulative risk of each individual factor.
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Affiliation(s)
- Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xindi Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yuhan Wu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayi Lu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xingming Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Nielsen TC, Nassar N, Boulton KA, Guastella AJ, Lain SJ. Estimating the Prevalence of Autism Spectrum Disorder in New South Wales, Australia: A Data Linkage Study of Three Routinely Collected Datasets. J Autism Dev Disord 2024; 54:1558-1566. [PMID: 36652127 PMCID: PMC10981615 DOI: 10.1007/s10803-022-05887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
Routinely collected data help estimate the prevalence of autism spectrum disorder (ASD) in jurisdictions without active autism surveillance. We created a population-based cohort of 1,211,834 children born in 2002-2015 in New South Wales, Australia using data linkage. Children with ASD were identified in three datasets - disability services, hospital admissions, and ambulatory mental health data. The prevalence of ASD in the cohort was 1.3% by age 12 and prevalence at age 6 increased an average of 4.1% per year (95% Confidence Interval, 3.3%, 4.8%). Most children with ASD were identified in disability services data (87%), although data linkage identified 1,711 additional cases that were more likely female, older at first contact, and living in major cities and less disadvantaged areas.
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Affiliation(s)
- Timothy C Nielsen
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Natasha Nassar
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kelsie A Boulton
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Adam J Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Samantha J Lain
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
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Onovbiona H, Quetsch L, Del Rosario EA. Exploring Factors of Diagnostic Timing Among Black Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06283-9. [PMID: 38509323 DOI: 10.1007/s10803-024-06283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/22/2024]
Abstract
The goal of the present study was to compare profiles among Black families of autistic youth who were identified Early (≤ 2 years of age), Mid (age 3 or 4), and Delayed (≥ 5 years of age) to better identify the characteristics that contribute to early ASD identification and delayed ASD identification. Black caregivers with autistic youth (N = 101) were divided into Early (N = 34), Mid (N = 39), and Delayed (N = 28) groups and compared on (a) the age at which signs of autism signs were first noticed, (b) wait times, (c) previous misdiagnoses rates, and (d) racial barriers experienced during the diagnostic process. The results revealed differences between the diagnostic profiles. Specifically, (a) Delayed families noticed the first signs of autism significantly later, (b) Early families had significantly smaller wait times between age of noticing signs of autism and age of receiving the diagnosis, (c) the odds of receiving a later or delayed autism diagnosis was nearly three times higher for caregivers who reported receiving a misdiagnosis, and (d) there were no significant differences in racial barriers experienced between Early, Mid, and Delayed families. Challenges in receiving a timely diagnosis remain for some Black autistic youth. To improve early identification for Black autistic youth who are at risk for receiving delayed diagnostic care, further research should examine factors and practices that improve autism knowledge among professionals and caregivers, enhance assessment practices, and integrate culturally responsive practices into assessment and screening procedures.
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Affiliation(s)
- Harlee Onovbiona
- Department of Psychological Science, University of Arkansas, 306 Memorial Hall, Fayetteville, AR, 72701, USA.
| | - Lauren Quetsch
- Department of Psychological Science, University of Arkansas, 306 Memorial Hall, Fayetteville, AR, 72701, USA
| | - Emily-Anne Del Rosario
- Department of Psychological Science, University of Arkansas, 306 Memorial Hall, Fayetteville, AR, 72701, USA
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12
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Rockhold MN, Gimbel BA, Richardson AA, Kautz-Turnbull C, Speybroeck EL, de Water E, Myers J, Hargrove E, May M, Abdi SS, Petrenko CLM. Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention. Front Public Health 2024; 12:1355802. [PMID: 38544727 PMCID: PMC10965703 DOI: 10.3389/fpubh.2024.1355802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.
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Affiliation(s)
| | - Blake A. Gimbel
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | | | - Emily L. Speybroeck
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Julianne Myers
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Emily Hargrove
- International Adult Leadership Collaborative of FASD Changemakers
| | - Maggie May
- International Adult Leadership Collaborative of FASD Changemakers
| | - Samia S. Abdi
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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13
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Perkovich E, Laakman A, Mire S, Yoshida H. Conducting head-mounted eye-tracking research with young children with autism and children with increased likelihood of later autism diagnosis. J Neurodev Disord 2024; 16:7. [PMID: 38438975 PMCID: PMC10910727 DOI: 10.1186/s11689-024-09524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Over the past years, researchers have been using head-mounted eye-tracking systems to study young children's gaze behaviors in everyday activities through which children learn about the world. This method has great potential to further our understanding of how millisecond-level gaze behaviors create multisensory experiences and fluctuate around social environments. While this line of work can yield insight into early perceptual experiences and potential learning mechanisms, the majority of the work is exclusively conducted with typically-developing children. Sensory sensitivities, social-communication difficulties, and challenging behaviors (e.g., disruption, elopement) are common among children with developmental disorders, and they may represent potential methodological challenges for collecting high-quality data. RESULTS In this paper, we describe our research practices of using head-mounted eye trackers with 41 autistic children and 17 children with increased likelihood of later autism diagnosis without auditory or visual impairments, including those who are minimally or nonspeaking and/or have intellectual disabilities. The success rate in gathering data among children with autism was 92.68%. 3 of 41 children failed to complete the play-session, resulting in an 86.36% success rate among 1-4-year-olds and a 100.00% success rate among 5-8-year-olds. 1 of 17 children with increased likelihood of later autism diagnosis failed to complete the play-session, resulting in a success rate of 94.11%. There were numerous "challenging" behaviors relevant to the method. The most common challenging behaviors included taking the eye-tracking device off, elopement, and becoming distressed. Overall, among children with autism, 88.8% of 1-4-year-olds and 29.4% of 5-8-year-olds exhibited at least one challenging behavior. CONCLUSIONS Research capitalizing on this methodology has the potential to reveal early, socially-mediated gaze behaviors that are relevant for autism screening, diagnosis, and intervention purposes. We hope that our efforts in documenting our study methodology will help researchers and clinicians effectively study early naturally-occuring gaze behaviors of children during non-experimental contexts across the spectrum and other developmental disabilities using head-mounted eye-tracking. Ultimately, such applications may increase the generalizability of results, better reflect the diversity of individual characteristics, and offer new ways in which this method can contribute to the field.
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Affiliation(s)
| | - A Laakman
- University of Houston, Houston, TX, USA
| | - S Mire
- Baylor University, Waco, TX, USA
| | - H Yoshida
- University of Houston, Houston, TX, USA
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14
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Singh JKA, Ling WH, Sivanesom RS, Huay CCS, Lan ACS. Age at autism spectrum disorder diagnosis and its association with child and family characteristics in a tertiary care hospital in Malaysia. Autism Res 2024; 17:637-649. [PMID: 38400514 DOI: 10.1002/aur.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Despite the absence of a cure, early diagnosis and intensive early intervention can improve the outcomes. However, little is known about the median age at ASD diagnosis in Malaysia or the child/family characteristics associated with early diagnosis. Therefore, this study aimed to determine the median age at ASD diagnosis among Malaysian children presenting to the country's largest public tertiary neurodevelopmental center and to investigate the possible demographic, child, and family characteristics associated with an early age at diagnosis. Data were collected between February 2017 and February 2019 from a database maintained by the child development unit of the country's largest publicly funded tertiary hospital, containing data from an ethnically diverse population. Among Malaysian children attending the clinic, the median age at ASD diagnosis was 48 months. Early autism diagnosis (<36 months of age) was associated with increased severity of social communication and interaction impairments, coexisting intellectual impairment, children from high socioeconomic status families, and children who receive joint care from their families and a maid or babysitter. The study findings highlight the socioeconomic inequalities in the country, a lack of parental awareness of early ASD signs, and the presence of cultural influences on the age at diagnosis of ASD.
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Affiliation(s)
| | - Wong Hoi Ling
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | | | - Cindy Chan Su Huay
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Audrey Chong Shuk Lan
- Clinical Research Centre, Sabah Woman & Children's Hospital, Kota Kinabalu, Sabah, Malaysia
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15
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Bhargava H, Salomon C, Suresh S, Chang A, Kilian R, Stijn DV, Oriol A, Low D, Knebel A, Taraman S. Promises, Pitfalls, and Clinical Applications of Artificial Intelligence in Pediatrics. J Med Internet Res 2024; 26:e49022. [PMID: 38421690 PMCID: PMC10940991 DOI: 10.2196/49022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Artificial intelligence (AI) broadly describes a branch of computer science focused on developing machines capable of performing tasks typically associated with human intelligence. Those who connect AI with the world of science fiction may meet its growing rise with hesitancy or outright skepticism. However, AI is becoming increasingly pervasive in our society, from algorithms helping to sift through airline fares to substituting words in emails and SMS text messages based on user choices. Data collection is ongoing and is being leveraged by software platforms to analyze patterns and make predictions across multiple industries. Health care is gradually becoming part of this technological transformation, as advancements in computational power and storage converge with the rapid expansion of digitized medical information. Given the growing and inevitable integration of AI into health care systems, it is our viewpoint that pediatricians urgently require training and orientation to the uses, promises, and pitfalls of AI in medicine. AI is unlikely to solve the full array of complex challenges confronting pediatricians today; however, if used responsibly, it holds great potential to improve many aspects of care for providers, children, and families. Our aim in this viewpoint is to provide clinicians with a targeted introduction to the field of AI in pediatrics, including key promises, pitfalls, and clinical applications, so they can play a more active role in shaping the future impact of AI in medicine.
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Affiliation(s)
- Hansa Bhargava
- Children's Hospital of Atlanta, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
- Healio, South New Jersey, NJ, United States
| | | | - Srinivasan Suresh
- Division of Health Informatics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony Chang
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | | | | | - Albert Oriol
- Rady Children's Hospital, San Diego, CA, United States
| | | | | | - Sharief Taraman
- Cognoa, Inc, Palo Alto, CA, United States
- Children's Hospital of Orange County, Orange, CA, United States
- University of California Irvine School of Medicine, Irvine, CA, United States
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16
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Kim H, Karakaya MF, Skinner M, Baker D. A Systematic Literature Review of Racial Disproportionality in Autism in the U.S. J Autism Dev Disord 2024:10.1007/s10803-024-06247-z. [PMID: 38416385 DOI: 10.1007/s10803-024-06247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
In recent years, the Autism and Developmental Disabilities Monitoring Network has observed a shift in racial disparities in autism. To delineate the historical shift of racial disproportionality in US autism prevalence, our literature review examines three key topics: publication trends concerning racial disproportionality in autism, discernible national and state-level patterns, and underlying factors contributing to the disproportionality. Using the PRISMA framework, we synthesized 24 empirical studies on racial disproportionality in autism and its change over time. These studies explored national patterns and spatiotemporal variations to provide a comprehensive understanding of racial disparities in autism. Studies indicated similar national patterns for Black and Asian racial groups; both groups had had mixed results around the turn of the millennium. By 2007, the Asian group was overrepresented again. Hispanic and Native American groups have consistently been underrepresented. However, significant spatiotemporal variations were found, suggesting that these disparities might reflect inherent inequalities within the current identification and classification system. The patterns of racial disproportionality in autism seem to be influenced by numerous factors. These include varying state definitions of autism, disparities in resource distribution, differences in symptom recognition across cultures, service preferences, cultural mismatches between professionals and families, and prevailing biases and stigmas, as revealed by the reviewed studies. These findings prompt a closer look into the causes and implications of these disparities, offering the underlying issues within the current diagnostic system and highlighting the need for further research to ensure equal educational opportunities regardless of disabilities and race/ethnicity.
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Affiliation(s)
- Hyejung Kim
- Binghamton University, Binghamton, NY, 13902, USA.
| | | | | | - Diana Baker
- Hobart and William Smith Colleges, Geneva, NY, USA
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17
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Little LM, Avery A, Tomchek S, Baker A, Wallisch A, Dean E. Race and Ethnicity Reporting in Occupational Therapy Research Among Autistic Youth. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231225199. [PMID: 38281154 DOI: 10.1177/15394492231225199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Historically marginalized racial and ethnic groups are underrepresented in autism research broadly; however, patterns of inclusion in occupational therapy research are unknown.In this secondary data analysis, we examined race and ethnicity reporting across articles included in a systematic review of evidence related to occupational therapy practice with autistic individuals <18 years (2013-2021).Two team members reached >90% interrater coding agreement in race and ethnicity reporting across articles in ADLs/IADLs, education/work, play, sleep, and social participation in clinics, homes/communities, and schools.Intervention outcomes of ADL/IADLs (66.7%) and play (66.7%) had low rates of reporting, while social participation in schools (100%) and education/work (100%) had higher rates of reporting. Sample diversity was greatest among research in schools and most limited in clinic-based settings.Systemic racism that limits individuals' participation in occupational therapy research perpetuates racial and ethnic health inequities among autistic children and adolescents.
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Affiliation(s)
| | | | - Scott Tomchek
- University of Louisville School of Medicine, KY, USA
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18
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Grosvenor LP, Cohen RJ, Gordon NP, Massolo ML, Cerros HJ, Yoshida CK, Ames JL, Croen LA. Barriers to Healthcare for Latinx Autistic Children and Adolescents. J Autism Dev Disord 2024:10.1007/s10803-023-06229-7. [PMID: 38231382 DOI: 10.1007/s10803-023-06229-7] [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: 12/20/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To understand the ways in which autistic Latinx children experience disparities in diagnosis, healthcare, and receipt of specialty services. METHODS 417 individuals who identified as Latinx caregivers of autistic children who were members of the same integrated healthcare system in Northern California were surveyed. Responses were analyzed using the child's insurance coverage (Government or Commercial) and caregiver's primary language (Spanish or English). RESULTS Compared to the commercially-insured, government-insured participants accessed several services at a higher rate and were less likely to cite the high cost of co-pays as a barrier. CONCLUSION There were no significant differences in service access by language status, but Spanish speakers were more likely to cite health literacy as a barrier to receiving care.
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Affiliation(s)
- Luke P Grosvenor
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ryan J Cohen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Columbia Medical School, New York, NY, USA
| | - Nancy P Gordon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Maria L Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Hilda J Cerros
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cathleen K Yoshida
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
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19
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Coulter KL, Moreno P, Barton M, Dumont-Mathieu T, Robins DL, Fein DA. Validity of the Toddler Autism Symptom Inventory in Non-Hispanic White and Black Toddlers. J Autism Dev Disord 2024; 54:339-352. [PMID: 36316523 PMCID: PMC10148924 DOI: 10.1007/s10803-022-05756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 05/01/2023]
Abstract
Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.
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Affiliation(s)
- Kirsty L Coulter
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA.
| | - Paula Moreno
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Marianne Barton
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Thyde Dumont-Mathieu
- University of Connecticut School of Medicine, Connecticut Children's Medical Center, Farmington, CT, USA
| | | | - Deborah A Fein
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
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20
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O'Donnell MT, Schmidt RB, Butler FM. The impact of primary care access on autism spectrum disorder awareness in an underserved population. Front Public Health 2023; 11:1250259. [PMID: 38186716 PMCID: PMC10766762 DOI: 10.3389/fpubh.2023.1250259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024] Open
Abstract
American Academy of Pediatrics (AAP) recommendations for Autism Spectrum Disorder (ASD) screening do not specifically address safety-net clinics, which provide multidisciplinary healthcare services to underserved patients. This project explored the potential for ASD screening in safety-net clinics by assessing parental perceived knowledge of ASD at JayDoc Free Clinic, a student-run safety-net clinic in Wyandotte County, Kansas. May through December 2022, patients who reported to be the parent of a minor received a demographic survey and a Likert-style questionnaire assessing perceived knowledge of ASD, including understanding the importance of ASD screening and ASD signs and symptoms. Responses were categorized into positive, negative, and unsure. Demographic variables included the minor's primary care provider (PCP) status. Results were analyzed using bivariate analysis, with chi-square tests for significance (p-value ≤ 0.05). Of the 52 participants who completed at least one Likert response, 55.8% reported their child had a PCP. Responses were somewhat balanced with 44.2% positive for understanding the importance of ASD screening and 53.8% positive for understanding ASD signs and symptoms. For understanding the signs and symptoms of ASD, an unsure response (32.7% of responses) was statistically associated with a lack of PCP (p = 0.017). The balance of positive with negative and unsure responses could reflect lack of ASD knowledge and may relate to healthcare inaccessibility. This is consistent with the significant association between lack of PCP and unsure responses for understanding ASD signs and symptoms. ASD screening and education in safety-net clinics like JayDoc could be valuable, particularly for children without a PCP.
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Affiliation(s)
- Mackenzie T O'Donnell
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Randall B Schmidt
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Faith M Butler
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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21
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Zuckerman KE, Rivas Vazquez LA, Morales Santos Y, Fuchu P, Broder-Fingert S, Dolata JK, Bedrick S, Fernandez J, Fombonne E, Sanders BW. Provider perspectives on equity in use of mobile health autism screening tools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613231215399. [PMID: 38078430 DOI: 10.1177/13623613231215399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
LAY ABSTRACT Families may find information about autism online, and health care and education providers may use online tools to screen for autism. However, we do not know if online autism screening tools are easily used by families and providers. We interviewed primary care and educational providers, asking them to review results from online tools that screen for autism. Providers had concerns about how usable and accessible these tools are for diverse families and suggested changes to make tools easier to use.
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22
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Wong TJ, Yu T. Association Between Socioeconomic Status and Prevalence of Hypersensitivity Diseases and Autism: A Nationwide Study of Children. Matern Child Health J 2023; 27:2194-2202. [PMID: 37823989 DOI: 10.1007/s10995-023-03789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Prior research suggests that children with a low socioeconomic status (SES) background are at an increased risk for special healthcare needs. Conversely, for hypersensitivity-related diseases, many studies reported a lower risk among children with lower SES according to the hygiene hypothesis. We aimed to evaluate the association between SES and several hypersensitivity diseases and autism in a representative American sample. METHODS We used data from the 2016, 2017 and 2018 US National Survey of Children's Health. A total of 102,341 children aged 0-17 years were included. The dependent variables were doctor-diagnosed allergies, arthritis, asthma, diabetes, and autism. The main SES indicators were family poverty levels, highest education of the reported adults and difficulty in family income. Our analysis used logistic regression that accounted for the survey sampling design. RESULTS The sample had a mean age of 9.4 ± 5.3 years. The weighted prevalence for allergies was 24.4%, 0.3% for arthritis, 11.9% for asthma, 0.5% for diabetes and 2.6% for autism. Children with adults reporting higher educational levels had greater odds of allergies (adjusted odds ratio and 95% CI: 1.48, 1.23-1.78) than those with lower educational levels. But for all other diseases, most findings suggested that a higher odds of disease was associated with lower SES instead of higher SES. CONCLUSIONS A low SES background remains an important risk factor for hypersensitivity diseases in children. Most of our results suggested that children with low SES were associated with a higher risk of hypersensitivity diseases and autism.
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Affiliation(s)
- Tzu-Jung Wong
- Department of Healthcare Information and Management, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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23
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Baires NA, Cañón LF, García-Zambrano S, Guerrero-Wickham P, Castro-Hostetler M. A Contextual Behavioral Framework for Enhancing Cultural Responsiveness in Behavioral Service Delivery for Latino Families. Behav Anal Pract 2023; 16:938-962. [PMID: 38076756 PMCID: PMC10700274 DOI: 10.1007/s40617-023-00788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/22/2024] Open
Abstract
In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors' personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.
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Affiliation(s)
- Natalia A. Baires
- School of Psychological and Behavioral Sciences, Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
| | - Luisa F. Cañón
- Institute for Effective Behavioral Interventions/ACT to Thrive, Encino, CA USA
| | - Sebastián García-Zambrano
- School of Psychological and Behavioral Sciences, Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
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Andreu-Bernabeu Á, González-Peñas J, Arango C, Díaz-Caneja CM. Socioeconomic status and severe mental disorders: a bidirectional multivariable Mendelian randomisation study. BMJ MENTAL HEALTH 2023; 26:e300821. [PMID: 38007229 PMCID: PMC10680010 DOI: 10.1136/bmjment-2023-300821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Despite the evidence supporting the relationship between socioeconomic status (SES) and severe mental disorders (SMD), the directionality of the associations between income or education and mental disorders is still poorly understood. OBJECTIVE To investigate the potential bidirectional causal relationships between genetic liability to the two main components of SES (income and educational attainment (EA)) on three SMD: schizophrenia, bipolar disorder (BD) and depression. METHODS We performed a bidirectional, two-sample univariable Mendelian randomisation (UVMR) and multivariable Mendelian randomisation (MVMR) study using SES phenotypes (income, n=397 751 and EA, n=766 345) and SMD (schizophrenia, n=127 906; BD, n=51 710 and depression, n=500 119) genome-wide association studies summary-statistics to dissect the potential direct associations of income and EA with SMD. FINDINGS UVMR showed that genetic liability to higher income was associated with decreased risk of schizophrenia and depression, with a smaller reverse effect of schizophrenia and depression on income. Effects were comparable after adjusting for EA in the MVMR. UMVR showed bidirectional negative associations between genetic liability to EA and depression and positive associations between genetic liability to EA and BD, with no significant effects on schizophrenia. After accounting for income, MVMR showed a bidirectional positive direction between genetic liability to EA and BD and schizophrenia but not with depression. CONCLUSIONS Our results suggest a heterogeneous link pattern between SES and SMD. We found a negative bidirectional association between genetic liability to income and the risk of schizophrenia and depression. On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and BD, which only becomes apparent after adjusting for income in the case of schizophrenia. CLINICAL IMPLICATIONS These findings shed light on the directional mechanisms between social determinants and mental disorders and suggest that income and EA should be studied separately in relation to mental illness.
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Affiliation(s)
- Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier González-Peñas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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25
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Stephenson KG, Fenning RM, Macklin EA, Lu F, Norris M, Steinberg-Epstein R, Butter EM. Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy. J Autism Dev Disord 2023; 53:3787-3798. [PMID: 35879640 DOI: 10.1007/s10803-022-05681-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3-13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Rachel M Fenning
- Department of Psychological Science and Claremont Autism Center, Claremont McKenna College, Claremont, CA, USA
- Department of Child and Adolescent Studies and Center for Autism, California State University, Fullerton, CA, USA
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Eric A Macklin
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Frances Lu
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Megan Norris
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Robin Steinberg-Epstein
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Eric M Butter
- Child Development Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Davis A, Gourdine R. Intersectionality and Social Security Age-18 Redetermination: Reducing the Stress and Trauma of Transition for Black Transition-Age Youth with Disabilities. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2023; 40:513-523. [PMID: 38031577 PMCID: PMC10686266 DOI: 10.1007/s10560-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/01/2023]
Abstract
Greater attention is being paid to the transition to adulthood for youth with disabilities. We are also at a period of reckoning with the vestiges of slavery, Jim Crow, and a lack of constitutional protections for Black-identifying persons. The contemporary impact of inequitable access to opportunities, services, and supports that would improve the quality of life of racialized Black individuals has added consequences for Black youth with disabilities. A sub-population of youth with disabilities receives monthly support in the form of Supplemental Security Income (SSI), with a disproportionate number of Black-identifying youth qualifying for SSI. Such youth are impacted by the intersectionality of racism, disability, and poverty. The outcome of an SSI age-18 redetermination can be precarious and occurs in the backdrop of these intersectional forces, impacting the life course of racialized Black youth and their families on a scale that is concerning. The authors describe the time frames of pre age-18 redetermination, age-18 redetermination and post age-18 redetermination in the contexts of intersectionality and transition, and articulate what type of services and supports can reduce the experience of chronic stress in the lives of racialized Black youth facing an SSI age-18 redetermination, and thereby improve the outcomes of these youth as they transition to adulthood.
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Affiliation(s)
- Amber Davis
- Johns Hopkins University, 716 North Broadway, Baltimore, MD 21205, USA
| | - Ruby Gourdine
- Professor Emeritus, Howard University, 601 Howard Place NW, Washington, DC 20059, USA
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Young K, Harris B, Hall-Lande J, Esler A. The Intersection of Systemic, Child, and Evaluation Factors in the Prediction of Autism Special Education Eligibility; Examining the Role of Race and Ethnicity. J Autism Dev Disord 2023:10.1007/s10803-023-06059-7. [PMID: 37480439 DOI: 10.1007/s10803-023-06059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
Though there is evidence autism identification has been inequitable for populations who are culturally and linguistically minoritized, there is limited research that explains the issue of disproportionality and factors contributing to its occurrence, especially within an educational setting. To explore contributors to racial/ethnic disparities in autism special education eligibility, the current investigation evaluated child and evaluation characteristics as they relate to the absence of autism eligibility. Data were obtained from the Autism and Developmental Disabilities Monitoring (ADDM) Network Study and included children with behavioral characteristics consistent with autism and educational evaluation records. Despite documented characteristics consistent with autism, only 72% of the sample received educational services under autism eligibility. To characterize children without autism eligibility, hierarchical logistic regression was used to evaluate factors documented in evaluation records predicting the absence of autism eligibility. Factors influencing autism eligibility included behavioral characteristics documented, evaluation components completed, intellectual ability, and clinical diagnoses present. There was no unique contribution of race/ethnicity in predicting the absence of autism eligibility when accounting for these previous predictors, but many of these predictors differed by racial/ethnic group. Disproportionality in autism may be the manifestation of inequitable evaluation experiences, including experiencing less comprehensive evaluations, and not receiving an autism specific assessment. Though race/ethnicity did not uniquely contribute to the absence of autism eligibility above and beyond those combined factors, it is important to evaluate and reduce inequities experienced within the autism identification process for populations who are culturally and linguistically minoritized.
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Affiliation(s)
- Kelsey Young
- Department of Research, Assessment, & Measurement, Curriculum Associates, North Billerica, MA, USA.
| | - Bryn Harris
- School of Education & Human Development, University of Colorado Denver, Denver, CO, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota; Twin Cities, Minneapolis, MN, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota; Twin Cities, Minneapolis, MN, USA
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Patrick ME, Hughes MM, Ali A, Shaw KA, Maenner MJ. Social vulnerability and prevalence of Autism Spectrum Disorder, Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). Ann Epidemiol 2023; 83:47-53.e1. [PMID: 37094622 PMCID: PMC10910514 DOI: 10.1016/j.annepidem.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The Metropolitan Atlanta Developmental Disabilities Surveillance Program tracks autism spectrum disorder (ASD) in selected counties within Georgia as part of the Autism and Developmental Disabilities Monitoring (ADDM) Network. ADDM Network analyses have historically found a higher prevalence of ASD in areas of higher socioeconomic status. METHODS We linked 2018 data from Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to two Metropolitan Atlanta Developmental Disabilities Surveillance Program counties by census tract, grouped census tracts into tertiles representing low, medium, and high social vulnerability, and calculated ASD prevalence for each tertile, overall and by each of four SVI themes. RESULTS We found that overall prevalence was higher in areas of low compared to high vulnerability for the socioeconomic status and transportation themes, and in areas of medium compared to high vulnerability for all themes. This pattern was consistent among males but varied for females and by race or ethnicity. CONCLUSIONS Linking ASD prevalence to SVI metrics can improve the understanding of inequities among children with ASD in racial and ethnic minority groups or those living in low-resource settings. These methods can be applied to other ADDM Network surveillance sites and public health surveillance programs.
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Affiliation(s)
- Mary E Patrick
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA.
| | - Michelle M Hughes
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Akilah Ali
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Kelly A Shaw
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
| | - Matthew J Maenner
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
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29
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Maroney MR, Levitt HM, Horne SG. Exploring the Efficacy of an Online Intervention in Processing Experiences of Heterosexism Among Autistic-LGBQ + Individuals. J Autism Dev Disord 2023:10.1007/s10803-023-06027-1. [PMID: 37344732 DOI: 10.1007/s10803-023-06027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
This experimental study explored the use of online expressive writing interventions to cope with distress from heterosexist events among a sample of autistic-LBGQ + individuals. This study included an open writing condition and an emotion focused therapy guided writing condition. Over 89% of the participants indicated that the writing exercises were helpful in processing the event, with significant decreases for measures of depressive and trauma/stressor symptoms. A thematic analysis identified specific aspects of each condition that were helpful for participants in coping with heterosexist distress, such as the development of insight through the emotion-focused exercises. This low-demand exercise is promising as a solo exercise or as a therapy homework assignment, especially given the accessibility of this online intervention for autistic-LGBQ + people.
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Affiliation(s)
- Meredith R Maroney
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - Heidi M Levitt
- Department of Psychology, University of Massachusetts, Boston, USA
| | - Sharon G Horne
- Department of Counseling and School Psychology, University of Massachusetts, Boston, USA
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30
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Levinson J, Hickey E, Fuchu P, Chu A, Barnett M, Stadnick NA, Feinberg E, Broder-Fingert S. Recommendations for post-implementation adaptations to optimize family navigation in pediatric primary care: a qualitative study with parents and navigators. BMC PRIMARY CARE 2023; 24:123. [PMID: 37328810 PMCID: PMC10273746 DOI: 10.1186/s12875-023-02072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Family Navigation (FN) is an evidence-based care management intervention designed to reduce disparities in access to care by providing families with individually tailored support and care coordination. Early data suggest FN is effective, but effectiveness is significantly influenced by both contextual (e.g. setting) and individual (e.g., ethnicity) variables. To better understand how FN could be tailored to address this variability in effectiveness, we set forth to explore proposed adaptations to FN by both navigators and families who received FN. METHODS This study was a nested qualitative study set within a larger randomized clinical trial of FN to improve access to autism diagnostic services in urban pediatric primary care practices in Massachusetts, Pennsylvania, and Connecticut serving low-income, racial and ethnic minority families. Following FN implementation, key informant interviews were conducted based on the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with a purposeful sample of parents of children who received FN (n = 21) and navigators (n = 7). Interviews were transcribed verbatim and were coded using framework-guided rapid analysis to categorize proposed adaptations to FN. RESULTS Parents and navigators proposed 38 adaptations in four domains: 1) content of the intervention (n = 18), 2) context of the intervention (n = 10), 3) training and evaluation (n = 6), and 4) implementation and scale-up (n = 4). The most frequently endorsed adaptation recommendations focused on content (e.g., lengthening FN, providing parents with additional education on autism and parenting children with autism) and implementation (e.g., increasing access to navigation). Although probes targeted critical feedback, parents and navigators were overwhelmingly positive about FN. CONCLUSIONS This study builds upon prior FN effectiveness and implementation research by providing concrete areas for adaptation and refinement of the intervention. Recommendations by parents and navigators have the potential to inform improvement of existing navigation programs and development of new programs in similarly underserved populations. These findings are critical as adaptation (cultural and otherwise) is an important principle in the field of health equity. Ultimately, adaptations will need to be tested to determine clinical and implementation effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, registration number NCT02359084, February 9, 2015.
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Affiliation(s)
| | | | - Plyce Fuchu
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA.
| | | | - Miya Barnett
- University of California, Santa Barbara, Santa Barbara, USA
| | | | - Emily Feinberg
- Boston Medical Center, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Sarabeth Broder-Fingert
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA
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Abdullahi I, Sadka N, Gilbert M, Barbaro J. Who Is Attending? The Role of Child Ethnicity and Maternal Demographics in Research Engagement and Early Identification of Autism. Brain Sci 2023; 13:903. [PMID: 37371381 DOI: 10.3390/brainsci13060903] [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: 05/07/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Inequitable access to early autism developmental surveillance is evident globally. However, there is limited research examining autism diagnosis, ethnicity, and community profiles when engaging in research for the early identification of autism. We aimed to understand the relationships between child ethnicity, maternal demographics, and autism diagnosis, comparing retrospective data from the 2016 census for eight local government areas (LGAs) in Victoria, Australia. Maternal and child health (MCH) nurses monitored 13,511 children under 42 months for the early signs of autism using the Social Attention Communication Surveillance-Revised (SACS-R) and SACS-R Preschool (SACS-PR) tools during well-child checks. Of these, 340 children with a "high likelihood" of autism attended developmental assessments. Participants' maternal ethnicity ('European maternal ethnicity', EME; 'non-European maternal ethnicity,' N-EME; 'mixed maternal ethnicity,' MME'), socioeconomic factors, and autism prevalence were compared to their LGA community. Results indicated that study participants were representative of their LGA communities, though bi- and multilingualism was higher in our cohort. Differences in current maternal employment, maternal education, annual family income, and autism prevalence were found between the N-EME, EME, and MME groups. Our study found that research engagement was driven by maternal education, maternal employment, and annual family income, and further research is required to understand these relationships.
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Affiliation(s)
- Ifrah Abdullahi
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD 4068, Australia
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32
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Bradshaw J, Eberth JM, Zgodic A, Federico A, Flory K, McLain AC. County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States. J Autism Dev Disord 2023:10.1007/s10803-023-05920-z. [PMID: 37142898 PMCID: PMC11019892 DOI: 10.1007/s10803-023-05920-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 05/06/2023]
Abstract
Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children's Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed "hot spots" in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.
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Affiliation(s)
- Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Anja Zgodic
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Alexis Federico
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alexander C McLain
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA.
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Zhang W, Watson LR, Johnson KR. Racial Disparities in Hospitalization Due to Ambulatory Care Sensitive Conditions Among U.S. Children with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-05995-8. [PMID: 37142910 DOI: 10.1007/s10803-023-05995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE This study was to investigate the factors associated with preventable hospitalization due to ambulatory care sensitive conditions (ACSCs) in children with autism. METHODS Using secondary data from the U.S. Nationwide Inpatient Sample (NIS), multivariable regression analyses were conducted to determine the potential effect of race and income level on the likelihood of inpatient stays for ACSCs among autistic children. Pediatric ACSCs included three acute conditions (dehydration, gastroenteritis, and urinary infection) and three chronic conditions (asthma, constipation, and diabetes short-term complications). RESULTS In this analysis, there were 21,733 hospitalizations among children with autism; about 10% were hospitalized due to pediatric ACSCs. Overall, the odds of ACSCs hospitalization were greater among Hispanic and Black autistic children versus White autistic children. Both Hispanic and Black autistic children from the lowest income level had the highest odds to be hospitalized for chronic ACSCs. CONCLUSION Inequities of access to health care among racial/ethnic minorities were most notable for autistic children with chronic ACSC conditions.
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Affiliation(s)
- Wanqing Zhang
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Linda R Watson
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Khalilah R Johnson
- Division of Occupational Science and Occupational Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ames JL, Burjak M, Avalos LA, Braun JM, Bulka CM, Croen LA, Dunlop AL, Ferrara A, Fry RC, Hedderson MM, Karagas MR, Liang D, Lin PID, Lyall K, Moore B, Morello-Frosch R, O’Connor TG, Oh J, Padula AM, Woodruff TJ, Zhu Y, Hamra GB. Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Childhood Autism-related Outcomes. Epidemiology 2023; 34:450-459. [PMID: 36630444 PMCID: PMC10074577 DOI: 10.1097/ede.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes. METHODS We included 10 cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) program (n = 1,429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex. RESULTS Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adjusted β [95% confidence interval (CI)] = 1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adjusted β [95% highest posterior density interval] = 0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences. CONCLUSIONS Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | | | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, RI USA
| | | | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | | | | | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Pi-I D. Lin
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Brianna Moore
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Jiwon Oh
- Department of Public Health Sciences, University of California, Davis, Davis CA, USA
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
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Strathearn L, Momany A, Kovács E, Guiler W, Ladd-Acosta C. The Intersection of Genome, Epigenome and Social Experience in Autism Spectrum Disorder: Exploring Modifiable Pathways for Intervention. Neurobiol Learn Mem 2023; 202:107761. [PMID: 37121464 DOI: 10.1016/j.nlm.2023.107761] [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: 04/12/2022] [Revised: 02/22/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
The number of children diagnosed with autism spectrum disorder (ASD) has increased substantially over the past two decades. Current research suggests that both genetic and environmental risk factors are involved in the etiology of ASD. The goal of this paper is to examine how one specific environmental factor, early social experience, may be correlated with DNA methylation (DNAm) changes in genes associated with ASD. We present an innovative model which proposes that polygenic risk and changes in DNAm due to social experience may both contribute to the symptoms of ASD. Previous research on genetic and environmental factors implicated in the etiology of ASD will be reviewed, with an emphasis on the oxytocin receptor gene, which may be epigenetically altered by early social experience, and which plays a crucial role in social and cognitive development. Identifying an environmental risk factor for ASD (e.g., social experience) that could be modified via early intervention and which results in epigenetic (DNAm) changes, could transform our understanding of this condition, facilitate earlier identification of ASD, and guide early intervention efforts.
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Affiliation(s)
- Lane Strathearn
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, USA; Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, 51 Newton Road 2-471 Bowen Science Building, Iowa City, Iowa 52241, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, Iowa 52242, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, 100 Hawkins Drive, Iowa City, Iowa 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center (Hawk-IDDRC), University of Iowa, 100 Hawkins Drive, Iowa City, Iowa 52242, USA.
| | - Allison Momany
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center (Hawk-IDDRC), University of Iowa, 100 Hawkins Drive, Iowa City, Iowa 52242, USA.
| | - Emese Kovács
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, 51 Newton Road 2-471 Bowen Science Building, Iowa City, Iowa 52241, USA.
| | - William Guiler
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, Iowa 52242, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology and the Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Wallace-Watkin C, Sigafoos J, Woods L, Waddington H. Parent reported barriers and facilitators to support services for autistic children in Aotearoa New Zealand. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231168240. [PMID: 37129303 PMCID: PMC10576898 DOI: 10.1177/13623613231168240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
LAY ABSTRACT Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents' access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents' rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research.
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Affiliation(s)
| | | | - Lisa Woods
- Victoria University of Wellington, New Zealand
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37
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Liljenwall H, Lean RE, Smyser TA, Smyser CD, Rogers CE. Parental ADHD and ASD symptoms and contributions of psychosocial risk to childhood ADHD and ASD symptoms in children born very preterm. J Perinatol 2023; 43:458-464. [PMID: 35840709 PMCID: PMC9840718 DOI: 10.1038/s41372-022-01463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/02/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Examine maternal and paternal ADHD and ASD symptoms in relation to very preterm (VPT) and full-term (FT) children's ADHD and ASD symptoms. STUDY DESIGN In this longitudinal study, maternal- and teacher-report of child ADHD and ASD symptoms were obtained for 119 children (VPT = 79, FT = 40) at age 5-years using the Conner's Rating Scale-Revised (CRS-R) and Social Responsiveness Scale-2 (SRS-2). A biological parent completed self- and observer-report CRS-R and SRS-2, and measures of mood/affect, stress, and social support to assess psychosocial distress. Data were analyzed using mixed-effect models adjusted for covariates. RESULTS Child ADHD symptoms were associated with VPT birth, maternal distress, and maternal ADHD symptoms (p ≤ 0.02), and paternal ADHD symptoms (p < 0.001). Regarding ASD, VPT birth and parental ASD symptoms were associated with child ASD symptoms (p ≤ 0.009). Parental symptoms and birth group had no interaction. CONCLUSIONS VPT birth and parental psychopathology represent independent risks for ADHD and ASD.
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Affiliation(s)
- Helen Liljenwall
- Medical Education, Washington University School of Medicine, St Louis, MO, USA
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
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Casseus M, Kim WJ, Horton DB. Prevalence and treatment of mental, behavioral, and developmental disorders in children with co-occurring autism spectrum disorder and attention-deficit/hyperactivity disorder: A population-based study. Autism Res 2023; 16:855-867. [PMID: 36644987 PMCID: PMC10160807 DOI: 10.1002/aur.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
There is a lack of nationally representative studies examining the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This study examines comorbid mental, behavioral, and developmental disorders (MBDDs) and associated treatment modalities for children with co-occurring ASD and ADHD. Cross-sectional analyses were conducted using data from the pooled 2016-2018 National Survey of Children's Health (sample n = 102,341). Nationally representative prevalences were estimated for sociodemographic variables, comorbidities, psychotropic medication, and behavioral treatment. We assessed multivariable associations between co-occurring ASD + ADHD and MBDDs, use of psychotropic medication, and receipt of behavioral treatment after adjustment for sociodemographic confounders. Compared to children with ASD without co-occurring ADHD, children with ASD + ADHD had higher prevalence of most MBDDs, including anxiety (AOR 4.03 [95% CI 2.77, 4.87]), depression (AOR 3.08 [95% CI 1.77, 5.36]), behavior or conduct problems (AOR 4.06 [95% CI 2.72, 6.06]), and other mental health conditions. Similarly, compared to children with ADHD without ASD, children with ASD + ADHD had higher odds of anxiety (AOR 3.49 [95% CI 2.65, 4.61]), depression (AOR 1.67 [95% CI 1.21, 2.29]), behavior or conduct problems (AOR 2.31 [95% CI 1.68, 3.17]), and other mental health conditions. Children with ASD + ADHD were significantly more likely to take psychotropic medication than children with ASD without ADHD. Among children with ASD + ADHD, males had higher odds of receiving behavioral treatment, whereas older children and adolescents were more likely to take psychotropic medication. A multidisciplinary approach is necessary to support the complex needs of these children.
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Affiliation(s)
- Myriam Casseus
- Division of Population Health, Quality, and Implementation Sciences, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Wun Jung Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Daniel B. Horton
- Division of Population Health, Quality, and Implementation Sciences, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Rutgers School of Public Health, Piscataway, New Jersey
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Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Ladd-Acosta CM, McArthur D, Pas ET, Salinas A, Vehorn A, Williams S, Esler A, Grzybowski A, Hall-Lande J, Nguyen RH, Pierce K, Zahorodny W, Hudson A, Hallas L, Mancilla KC, Patrick M, Shenouda J, Sidwell K, DiRienzo M, Gutierrez J, Spivey MH, Lopez M, Pettygrove S, Schwenk YD, Washington A, Shaw KA. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2023; 72:1-14. [PMID: 36952288 PMCID: PMC10042614 DOI: 10.15585/mmwr.ss7202a1] [Citation(s) in RCA: 332] [Impact Index Per Article: 332.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Problem/Condition Autism spectrum disorder (ASD). Period Covered 2020. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. Results For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). Interpretation For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. Public Health Action The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.
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Loubersac J, Michelon C, Ferrando L, Picot MC, Baghdadli A. Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987-2017). Eur Child Adolesc Psychiatry 2023; 32:375-393. [PMID: 33909143 DOI: 10.1007/s00787-021-01792-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
Autism Spectrum Disorder (ASD) is an early onset neurodevelopmental disorder in which the first signs generally emerge at approximately 12 months of age but its diagnosis is feasible only from the age of 18 months. According to the literature, the average age of diagnosis ranges from 2.7 to 7.2 years, which raises the question of factors associated with early diagnosis as a condition for early intervention. In this systematic review, we aim to identify clinical, social, and environmental factors associated with the age at which the diagnosis of ASD is confirmed in children. A literature search was performed in the Pubmed, Web of Sciences, PsycInfo, and Cochrane databases. Among the 530 publications identified, 50 were selected according to the inclusion criteria. This review focuses on studies conducted in 21 countries using data collected over a period from 1987 to 2017. These studies were published before December 31st, 2019. The results suggest that the diagnosis of ASD occurs earlier if there is a delay in social communication or the presence of intellectual disability. There is a low level of evidence concerning associations between the age at diagnosis and sex, race, parental education, or socioeconomic status and accessibility to health care. Further studies using large and well-characterized data sets are needed to simultaneously explore clinical and socio-environmental factors involved in early diagnosis.
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Affiliation(s)
- Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Laetitia Ferrando
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Marie-Christine Picot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Department of Medical Information, University Hospital, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
- Faculté de Médecine, Université de Montpellier, Montpellier, France.
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Bakombo S, Ewalefo P, Konkle ATM. The Influence of Social Media on the Perception of Autism Spectrum Disorders: Content Analysis of Public Discourse on YouTube Videos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3246. [PMID: 36833941 PMCID: PMC9961260 DOI: 10.3390/ijerph20043246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Little is known about how social media shapes the public's perception of autism spectrum disorder (ASD). We used a media content analysis approach to analyze the public's perception of ASD. METHODS We conducted a YouTube search in 2019 using keywords related to ASD. The first 10 videos displayed after each search that met the eligibility criteria were selected for analysis. The final sample size of videos analyzed was 50. The top 10 comments from each respective video were selected for commentary analysis. A total of 500 comments were used for this study. Videos and comments were categorized based on sentiment, evident themes, and subthemes. In 2022, using the same key words, we conducted a subsequent YouTube search using the same criteria, except that the videos had to be 10 min or less, whereby nine videos were selected out of 70 for commentary analysis, and a total of 180 comments were used. RESULTS The dominant themes were "providing educational information on ASD characteristics" with the main subtheme being "no specific age or sex focus". The most common category of comments was "anecdote". The overwhelming sentiments of both the videos and comments were "mixed". Individuals with ASD were stigmatized as not being able to understand emotion. Furthermore, ASD was also stigmatized as being a monolithic condition only manifesting itself in the most severe form when autism varies in severity. INTERPRETATION YouTube is a powerful tool that allows people and organizations to raise awareness about ASD by providing a more dynamic view on autism and fostering an environment for public empathy and support.
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Affiliation(s)
- Schwab Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Paulette Ewalefo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Anne T. M. Konkle
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Mind Research Institute, University of Ottawa Brain, Ottawa, ON K1Y 4E9, Canada
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Shenouda J, Barrett E, Davidow AL, Sidwell K, Lescott C, Halperin W, Silenzio VMB, Zahorodny W. Prevalence and Disparities in the Detection of Autism Without Intellectual Disability. Pediatrics 2023; 151:e2022056594. [PMID: 36700335 DOI: 10.1542/peds.2022-056594] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Intellectual ability predicts functional outcomes for children with autism spectrum disorder (ASD). It is essential to classify ASD children with and without intellectual disability (ID) to aid etiological research, provide services, and inform evidence-based educational and health planning. METHODS Using a cross-sectional study design, data from 2000 to 2016 active ASD surveillance among 8-year-olds residing in the New York-New Jersey Metropolitan Area were analyzed to determine ASD prevalence with and without ID. Multivariable Poisson regression models were used to identify trends for ASD with ID (ASD-I) and without ID (ASD-N). RESULTS Overall, 4661 8-year-olds were identified with ASD. Those that were ASI-I were 1505 (32.3%) and 2764 (59.3%) were ASD-N. Males were 3794 (81.4%), 946 (20.3%) were non-Hispanic Black (Black), 1230 (26.4%) were Hispanic, and 2114 (45.4%) were non-Hispanic white (white). We observed 2-fold and 5-fold increases in the prevalence of ASD-I and ASD-N, respectively, from 2000-2016. Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas. A greater proportion of children with ASD-I resided in vulnerable areas compared with children with ASD-N. Males had higher prevalence compared with females regardless of ID status; however, male-to-female ratios were slightly lower among ASD-I compared with ASD-N cases. CONCLUSIONS One-in-3 children with ASD had ID. Disparities in the identification of ASD without ID were observed among Black and Hispanic children as well as among children residing in underserved areas.
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Affiliation(s)
- Josephine Shenouda
- Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Emily Barrett
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Amy L Davidow
- New York University School of Global Public Health, New York, New York
| | - Kate Sidwell
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Cara Lescott
- Rutgers New Jersey Medical School, Newark, New Jersey
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Waisman TC, Williams ZJ, Cage E, Santhanam SP, Magiati I, Dwyer P, Stockwell KM, Kofner B, Brown H, Davidson D, Herrell J, Shore SM, Caudel D, Gurbuz E, Gillespie-Lynch K. Learning from the experts: Evaluating a participatory autism and universal design training for university educators. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:356-370. [PMID: 35652315 DOI: 10.1177/13623613221097207] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autistic university students have many strengths. They also go through difficulties that professors may not understand. Professors may not understand what college life is like for autistic students. They might judge autistic students. A team of autistic and non-autistic researchers made a training to help professors understand autistic students better. This training also gave professors ideas to help them teach all of their students. Ninety-eight professors did an online survey before the autism training. They shared how they felt about autism and teaching. Before our training, professors who knew more about autism appreciated autism more. Professors who thought people should be equal and women also appreciated autism more. Then, 89 of the professors did our training and another survey after the training. This helped us see what they learned from the training. They did one more survey a month later. This helped us see what they remembered. Our training helped professors understand and value autism. It also helped them understand how they can teach all students better. The professors remembered a lot of what we taught them. This study shows that a training that autistic people helped make can help professors understand their autistic students better.
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Liu BM, Paskov K, Kent J, McNealis M, Sutaria S, Dods O, Harjadi C, Stockham N, Ostrovsky A, Wall DP. Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US. JAMA Netw Open 2023; 6:e2251182. [PMID: 36689227 PMCID: PMC9871799 DOI: 10.1001/jamanetworkopen.2022.51182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023] Open
Abstract
Importance While research has identified racial and ethnic disparities in access to autism services, the size, extent, and specific locations of these access gaps have not yet been characterized on a national scale. Mapping comprehensive national listings of autism health care services together with the prevalence of autistic children of various races and ethnicities and evaluating geographic regions defined by localized commuting patterns may help to identify areas within the US where families who belong to minoritized racial and ethnic groups have disproportionally lower access to services. Objective To evaluate differences in access to autism health care services among autistic children of various races and ethnicities within precisely defined geographic regions encompassing all serviceable areas within the US. Design, Setting, and Participants This population-based cross-sectional study was conducted from October 5, 2021, to June 3, 2022, and involved 530 965 autistic children in kindergarten through grade 12. Core-based statistical areas (CBSAs; defined as areas containing a city and its surrounding commuter region), the Civil Rights Data Collection (CRDC) data set, and 51 071 autism resources (collected from October 1, 2015, to December 18, 2022) geographically distributed into 912 CBSAs were combined and analyzed to understand variation in access to autism health care services among autistic children of different races and ethnicities. Six racial and ethnic categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White) assigned by the US Department of Education were included in the analysis. Main Outcomes and Measures A regularized least-squares regression analysis was used to measure differences in nationwide resource allocation between racial and ethnic groups. The number of autism resources allocated per autistic child was estimated based on the child's racial and ethnic group. To evaluate how the CBSA population size may have altered the results, the least-squares regression analysis was run on CBSAs divided into metropolitan (>50 000 inhabitants) and micropolitan (10 000-50 000 inhabitants) groups. A Mann-Whitney U test was used to compare the model estimated ratio of autism resources to autistic children among specific racial and ethnic groups comprising the proportions of autistic children in each CBSA. Results Among 530 965 autistic children aged 5 to 18 years, 83.9% were male and 16.1% were female; 0.7% of children were American Indian or Alaska Native, 5.9% were Asian, 14.3% were Black or African American, 22.9% were Hispanic or Latino, 0.2% were Native Hawaiian or other Pacific Islander, 51.7% were White, and 4.2% were of 2 or more races and/or ethnicities. At a national scale, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .01) and Hispanic autistic children (β = 0.02; 95% CI, 0-0.06; P = .02) had significant disparities in access to autism resources in comparison with White autistic children. When evaluating the proportion of autistic children in each racial and ethnic group, areas in which Black autistic children (>50% of the population: β = 0.05; <50% of the population: β = 0.07; P = .002) or Hispanic autistic children (>50% of the population: β = 0.04; <50% of the population: β = 0.07; P < .001) comprised greater than 50% of the total population of autistic children had significantly fewer resources than areas in which Black or Hispanic autistic children comprised less than 50% of the total population. Comparing metropolitan vs micropolitan CBSAs revealed that in micropolitan CBSAs, Black autistic children (β = 0; 95% CI, 0-0; P < .001) and Hispanic autistic children (β = 0; 95% CI, 0-0.02; P < .001) had the greatest disparities in access to autism resources compared with White autistic children. In metropolitan CBSAs, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .005) and Hispanic autistic children (β = 0.01; 95% CI, 0-0.06; P = .02) had the greatest disparities compared with White autistic children. Conclusions and Relevance In this study, autistic children from several minoritized racial and ethnic groups, including Black and Hispanic autistic children, had access to significantly fewer autism resources than White autistic children in the US. This study pinpointed the specific geographic regions with the greatest disparities, where increases in the number and types of treatment options are warranted. These findings suggest that a prioritized response strategy to address these racial and ethnic disparities is needed.
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Affiliation(s)
- Bennett M. Liu
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Kelley Paskov
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Jack Kent
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Maya McNealis
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Soren Sutaria
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Olivia Dods
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Christopher Harjadi
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Nate Stockham
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | | | - Dennis P. Wall
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
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Romo ML, Jordan P, McVeigh KH, Chan PY, Stingone JA, Lim S, Askew GL. Early intervention and special education in New York City: Patterns of service use and disparities affecting children of colour. Child Care Health Dev 2023; 49:119-129. [PMID: 35733292 DOI: 10.1111/cch.13024] [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: 01/09/2021] [Revised: 02/20/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Compliance with the requirements of the Individuals with Disabilities Education Act (IDEA) in the United States is monitored through review of cross-sectional reports from three discrete, age-defined programmes (early intervention [EI], early childhood special education [ECSE)] and school-age special education [SE]) to promote the timely, efficient and effective delivery of appropriate services to all eligible children. Analysis of longitudinal data is required to discern how children use services across programmes to provide the necessary context for IDEA oversight and to identify areas for programme or policy interventions to reduce barriers to service use and promote equity. METHODS We applied sequence analysis to a data linkage across five public record systems among 15 626 New York City children born in 1998 who had records from birth through third grade. RESULTS Five predominant patterns of service use were identified: (1) multiple therapies across EI/ECSE/SE (13%), (2) EI without transition to Department of Education schools or services (24%), (3) EI and intermittent ECSE/SE (16%), (4) older entry into EI and both speech and occupational therapy throughout ECSE/SE (9%) and (5) limited EI use and mostly speech therapy in ECSE/SE (38%). Each pattern had distinct demographics (e.g., pattern 2 was disproportionately White and from low poverty neighbourhoods; pattern 4 was disproportionately male and Black; pattern 5 was disproportionately Latino) and academic outcomes (e.g., pattern 1 had largest proportion in a SE school and not tested in third grade; pattern 3 had third grade tests scores that were similar to overall citywide mean scores). CONCLUSIONS The differences in demographic profiles across the five patterns of service use illustrate the systemic inequities in the delivery of these important services. Delayed entry and limited use of EI services among children of colour underscore the need for equity goals to increase early referral and optimize service use.
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Affiliation(s)
- Matthew L Romo
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Phoebe Jordan
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katharine H McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Pui Ying Chan
- Division of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Sungwoo Lim
- Division of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - George L Askew
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Oredipe T, Kofner B, Riccio A, Cage E, Vincent J, Kapp SK, Dwyer P, Gillespie-Lynch K. Does learning you are autistic at a younger age lead to better adult outcomes? A participatory exploration of the perspectives of autistic university students. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:200-212. [PMID: 35404160 DOI: 10.1177/13623613221086700] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
LAY ABSTRACT People learn they are autistic at different ages. We wanted to know if telling kids they are autistic earlier helps them feel better about their lives when they grow up. We are a team of autistic and non-autistic students and professors. Seventy-eight autistic university students did our online survey. They shared how they found out they were autistic and how they felt about being autistic. They also shared how they feel about their lives now. Around the same number of students learned they were autistic from doctors and parents. Students who learned they were autistic when they were younger felt happier about their lives than people who learned they were autistic when they were older. Students who learned they were autistic when they were older felt happier about being autistic when they first found out than people who did not have to wait as long. Our study shows that it is probably best to tell people they are autistic as soon as possible. The students who did our study did not think it was a good idea to wait until children are adults to tell them they are autistic. They said that parents should tell their children they are autistic in ways that help them understand and feel good about who they are.
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Affiliation(s)
- Tomisin Oredipe
- College of Staten Island, The City University of New York, USA
| | - Bella Kofner
- College of Staten Island, The City University of New York, USA
| | - Ariana Riccio
- The Graduate Center, The City University of New York, USA
| | | | | | | | | | - Kristen Gillespie-Lynch
- College of Staten Island, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
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Hull L, Heuvelman H, Golding J, Mandy W, Rai D. Gendered play behaviours in autistic and non-autistic children: A population-based cohort study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221139373. [PMID: 36537789 DOI: 10.1177/13623613221139373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
LAY ABSTRACT Non-autistic children tend to show gendered patterns of play behaviours - boys are more likely to play with 'masculine' toys, and girls are more likely to play with 'feminine' toys. However, little is known about whether autistic children follow these patterns as well. We looked at the masculinity and femininity of autistic and non-autistic children's play behaviours at multiple time points. Parents reported their children's play behaviours at ages 30, 42 and 57 months, and children reported their own play behaviours at 8 years old. We found no difference between autistic and non-autistic girls, who both showed more feminine play behaviours as they got older. Autistic boys' play behaviours were reported as less masculine than non-autistic boys at 42 and 57 months, and at 8 years old. We also found that non-autistic boys' play tended to become more masculine as they got older, but this was not the case for autistic boys. Our findings suggest that differences in autistic and non-autistic boys' play behaviours may develop at around 42 months old.
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Affiliation(s)
- Laura Hull
- University of Bristol, UK.,University College London, UK
| | | | | | | | - Dheeraj Rai
- University of Bristol, UK.,Avon and Wiltshire Mental Health Partnership NHS Trust, UK.,University Hospitals Bristol NHS Foundation Trust, UK
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48
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Wieckowski AT, Zuckerman KE, Broder-Fingert S, Robins DL. Addressing current barriers to autism diagnoses through a tiered diagnostic approach involving pediatric primary care providers. Autism Res 2022; 15:2216-2222. [PMID: 36254366 DOI: 10.1002/aur.2832] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022]
Abstract
Formal autism diagnosis from a specialist trained in autism assessment is customary prior to a child accessing early, intensive autism-specific services. However, long wait lists for diagnostic evaluations and limited specialty workforce have created substantial delays. Additionally, lengthy multidisciplinary evaluations are costly to insurers, inconvenient to families, and disproportionally impact under-resourced families. Diagnostic delays can impede access to intervention services. These barriers, combined with evidence regarding the importance of receiving early, autism-specific treatment, demand new approaches enabling access to autism specific services before comprehensive evaluation. Pediatric primary care providers (PCPs) are often the only health care professionals with whom a family interacts during early childhood and can play a crucial role in helping children with autism symptoms access services. Many strategies for autism diagnosis in primary care are being developed and tested; however, they have yet to be broadly adopted by PCPs, primarily due to critical implementation barriers in primary care settings. There is also not enough evidence on the accuracy of PCPs' diagnostic impressions without extensive specialty support, resulting in PCP hesitancy in diagnosing ASD, as well as family and service provider hesitancy in accepting a PCP autism diagnosis. In this commentary, we explore the acute need for shortening waitlists for autism evaluations through a tiered diagnostic approach, in which PCPs can rule in or rule out autism in children, for whom diagnosis is clear, and refer more complex cases for specialist evaluations, and explore implementation challenges to this approach.
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Affiliation(s)
| | | | - Sarabeth Broder-Fingert
- Department of Pediatrics and Eunice Kennedy Shriver Center, UMASS Chan Medical School, Worcester, Massachusetts, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Hampton M, McNamara S. The impact of educational rewards on the diagnosis of autism spectrum disorder. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101188. [PMID: 36272247 DOI: 10.1016/j.ehb.2022.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/19/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and communication. The prevalence of ASD has risen dramatically in recent years, but the underlying factors leading to this rise are not clear. In this paper, we test whether changes in state-level educational policy that impact school-level resources are associated with the rise in ASD diagnostic prevalence. Early identification of ASD can improve an array of outcomes for children, and school systems play an important role with identification of the condition. It is plausible that children attending schools with better resources from state governments are more likely to receive an ASD diagnosis and presumably appropriate services. We focus on one educational policy in particular, state-level rewards, which consist of a monetary transfer from state governments to school districts. To test the impact of educational rewards on ASD diagnosis, we rely on policy variation across states and time and estimate both two-way fixed effects (TWFE) models alongside recently advanced methods in the difference-in-differences (DiD) literature. Under a baseline TWFE specification we estimate that rewards policies are associated with a 18.46% increase in ASD diagnosis. Further, using DiD methods that account for bias in settings of differential policy timing, we find that the magnitude of the effect increases to 24.8%. We believe these findings to be suggestive evidence that educational rewards policies improved the likelihood of detection and diagnosis of ASD.
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Affiliation(s)
- Matt Hampton
- Department of Accounting, Finance, and Economics, Austin Peay State University, College of Business, Clarksville, TN 37040, USA.
| | - Scott McNamara
- Department of Kinesiology, University of New Hampshire, College of Health and Human Services, Durham, NH 03824.
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50
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Sobieski M, Sobieska A, Sekułowicz M, Bujnowska-Fedak MM. Tools for early screening of autism spectrum disorders in primary health care – a scoping review. BMC PRIMARY CARE 2022; 23:46. [PMID: 35291950 PMCID: PMC8925080 DOI: 10.1186/s12875-022-01645-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that manifests itself in early childhood. Early diagnosis of these disorders allows for the initiation of early therapy, which is crucial for the child's further functioning in society.
Objectives
This review aims to gather and present the existing ASD screening tools that can be used in primary care and adapted to different countries conditions linguistically and culturally.
Eligibility criteria
We searched for English-language publications on ASD screening tools for children aged 0–3 years suitable for use in primary care (i.e. free, requiring no additional training or qualifications).
Sources of evidence
Four databases were explored to find English studies on ASD screening tools intended for the rapid assessment of children aged 0–3.
Charting methods
The information sought (specific features of the questionnaires relevant to primary health care workers, psychometric and diagnostic values of a given cultural adaptation of screening tools, and the linguistic and cultural changes made) were extracted and collected to create profiles of these tools.
Results
We found 81 studies which met inclusion criteria and underwent full data extraction. Three additional data sources were included. These allowed to create 75 profiles of adaptations for 26 different screening tools and collect data on their psychometric values and characteristic features.
Conclusions
The results of our study indicate the availability of several diagnostic tools for early ASD screening in primary care setting concordant culturally and linguistically with a given population. They could be an effective method of accelerating the diagnostic process and starting personalized therapy faster. However, most tools have significant limitations – some are only available for research purposes, while others do not have scientific evidence to prove their effectiveness.
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