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Morrier MJ, Schwartz AJ, Rice CE, Platner A, Ousley OY, Kassem S, Krishnan AV, Lord C, Smith CJ, Oberleitner R. Validation of an Enhanced Telehealth Platform for Toddlers at Increased Likelihood for a Diagnosis of Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023:10.1007/s10803-023-06116-1. [PMID: 37740876 DOI: 10.1007/s10803-023-06116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
Use of telehealth assessments for toddlers at increased likelihood of autism spectrum disorder (ASD) began prior to the global COVID-19 pandemic; however, the value of telehealth assessments as an alternative to in-person assessment (IPA) became clearer during the pandemic. The Naturalistic Observation Diagnosis Assessment (NODA™), previously demonstrated as a valid and reliable tool to evaluate asynchronous behaviors for early diagnosis, was enhanced to add synchronous collection of behaviors to assist clinicians in making a differential diagnosis of ASD. This study was conducted to validate the information gathered through NODA-Enhanced (NODA-E™) as compared to a gold standard IPA. Forty-nine toddlers aged 16.0-32.1 months of age, recruited through community pediatric offices and a tertiary ASD clinic, participated in both NODA-E and IPA assessments. There was high agreement between the two assessment protocols for overall diagnosis (46 of 49 cases; 93.6%; κ = .878), specific diagnostic criteria for social communication and social interaction (SCI; range 95.9-98%; κ = .918-.959), and for two of four criteria specified for restricted and repetitive behaviors (RRB; range 87.8-98%; κ = .755 and .959). There was lower agreement for two subcategories of RRBs (range 65.3-67.3%; κ = .306 and .347). NODA-E is a tool that can assist clinicians in making reliable and valid early ASD diagnoses using both asynchronous and synchronous information gathered via telehealth and offers an additional tool within a clinician's assessment toolbox.
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Affiliation(s)
- Michael J Morrier
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA.
| | - Allison J Schwartz
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Catherine E Rice
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Amanda Platner
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Opal Y Ousley
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Sara Kassem
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | | | - Catherine Lord
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
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Genovesi E, Ullmer P, Bhatti L, Meyer P, Memon P, Panchani D, Rafla M, Welford M, Hoekstra RA. Perspectives on children's autistic traits in UK-based British and Egyptian/Sudanese communities. Res Dev Disabil 2023; 140:104576. [PMID: 37535998 DOI: 10.1016/j.ridd.2023.104576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 05/12/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND While most autism research is conducted in White Western samples, culture may affect perceptions and reporting of autistic traits. We explored how UK-based British and Egyptian/Sudanese communities perceive autism features. METHODS AND PROCEDURES Nineteen participants self-identifying as British and 20 as Egyptian/Sudanese participated in focus group discussions on child development norms, and individual interviews on items of the Autism-spectrum Quotient: Children's version (AQ-Child; Auyeung et al., 2007), measuring autistic traits. Data were analysed using template analysis. OUTCOMES AND RESULTS Three themes were developed: 1) Value judgements of behaviours; 2) Considerations on differences between children; 3) Problematic interpretations of AQ-Child items. These processes may affect how parents and community members report on children's autistic traits. Cross-cultural comparisons suggested subtle differences in interpretations and judgements, and British participants referred to age expectations and comparisons with other children more than Egyptian/Sudanese participants. However, within-group variability, sometimes attributed to socioeconomic status and generation, appeared larger than cross-cultural differences. CONCLUSIONS AND IMPLICATIONS Our findings further the insights on influence of culture and within-community factors on reporting children's behaviour relevant to autism. These can inform the adaptation of screening tools in multi-cultural settings, to promote better autism recognition in communities where it may be underdiagnosed.
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Affiliation(s)
- Elisa Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK.
| | - Philippa Ullmer
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Laila Bhatti
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Pauline Meyer
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Perah Memon
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Dimple Panchani
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Monica Rafla
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Maya Welford
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Addison House, Guy's Campus, King's College London, London SE11UL, UK
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3
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Becerra MA. Closing the Diagnostic Gap: Early Autism Spectrum Disorder Screening for Every Child. Health Soc Work 2022; 47:87-91. [PMID: 35253848 DOI: 10.1093/hsw/hlac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
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4
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Zwaigenbaum L, Bishop S, Stone WL, Ibanez L, Halladay A, Goldman S, Kelly A, Klaiman C, Lai MC, Miller M, Saulnier C, Siper P, Sohl K, Warren Z, Wetherby A. Rethinking autism spectrum disorder assessment for children during COVID-19 and beyond. Autism Res 2021; 14:2251-2259. [PMID: 34553489 PMCID: PMC8646364 DOI: 10.1002/aur.2615] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic has posed unique challenges for families and caregivers, as well as for autism-focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in-person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family-centered system of care. LAY SUMMARY: Physical distancing and the abrupt end to in-person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family-centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Lisa Ibanez
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Alycia Halladay
- Autism Science Foundation, New York, New York, USA.,Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Sylvie Goldman
- Department of Neurology, G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA
| | - Amy Kelly
- Devereux Advanced Behavioral Health, Villanova, Pennsylvania, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia, USA
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis, California, USA
| | - Celine Saulnier
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia, USA.,Neurodevelopmental Assessment & Consulting Services, Decatur, Georgia, USA
| | - Paige Siper
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy Wetherby
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, Florida, USA
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Koly KN, Martin-Herz SP, Islam MS, Sharmin N, Blencowe H, Naheed A. Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review. PLoS One 2021; 16:e0247432. [PMID: 33705420 PMCID: PMC7951928 DOI: 10.1371/journal.pone.0247432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 02/07/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high. METHODS A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data. OUTCOMES MEASURES The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review. RESULTS A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children. CONCLUSION This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.
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Affiliation(s)
- Kamrun Nahar Koly
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Susanne P. Martin-Herz
- Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Md. Saimul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nusrat Sharmin
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Psychology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Dhaka, Bangladesh
| | - Hannah Blencowe
- Maternal Adolescent Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- * E-mail:
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Brookman-Frazee L, Chlebowski C, Villodas M, Roesch S, Martinez K. Training Community Therapists to Deliver an Individualized Mental Health Intervention for Autism Spectrum Disorder: Changes in Caregiver Outcomes and Mediating Role on Child Outcomes. J Am Acad Child Adolesc Psychiatry 2021; 60:355-366. [PMID: 32755632 DOI: 10.1016/j.jaac.2020.07.896] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examines the impact of training therapists to deliver "An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)" (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes. METHOD Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists' caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months. RESULTS A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months. CONCLUSION Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention. CLINICAL TRIAL REGISTRATION INFORMATION Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/; NCT02416323.
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Affiliation(s)
- Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; Rady Children's Hospital, San Diego, California
| | - Colby Chlebowski
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego.
| | - Miguel Villodas
- Child and Adolescent Services Research Center, San Diego, California; San Diego State University, California
| | | | - Kassandra Martinez
- Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; San Diego State University, California
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Samadi SA, McConkey R, Mahmoodizadeh A. Identifying children with autism spectrum disorders in Iran using the Autism Diagnostic Interview-Revised. Autism 2020; 25:1009-1019. [PMID: 33246364 DOI: 10.1177/1362361320974558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The diagnosis of autism spectrum disorder is a challenging task. Most of the current assessment scales have been developed in the West. The present study examines the applicability of one of the most used scales (the Autism Diagnostic Interview-Revised) in a Middle-Eastern culture. Two studies were undertaken. In the first, the Autism Diagnostic Interview-Revised ratings given to 420 children with autism spectrum disorder, aged 4-11 years, and 110 typically developing children were contrasted. In Study 2, the Autism Diagnostic Interview-Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disabilities to find out whether the Autism Diagnostic Interview-Revised scale would discriminate between these two types of developmental disabilities. The studies confirmed the acceptability of the scale to Iranian parents and assessors. However, the summary scores used to determine whether a child was likely to have autism spectrum disorder were recalculated on the two domains of social communication and repetitive behaviours, which were identified in the statistical analyses that are recommended for the evaluation of assessment scales. Thus the translated scale with the modified domain scoring proved very suitable for identifying Iranian children with autism spectrum disorder. Having a common tool such as Autism Diagnostic Interview-Revised will strengthen the opportunities to undertake cross-cultural research into the impact of autism spectrum disorder on the child and families.
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Javadfar Z, Abdollahzad H, Moludi J, Rezaeian S, Amirian H, Foroughi AA, Nachvak SM, Goharmehr N, Mostafai R. Effects of vitamin D supplementation on core symptoms, serum serotonin, and interleukin-6 in children with autism spectrum disorders: A randomized clinical trial. Nutrition 2020; 79-80:110986. [DOI: 10.1016/j.nut.2020.110986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/25/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
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9
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Hyde C, Pizzano M, McDonald NM, Nelson CA, Kasari C, Thiele EA, Jeste SS. A telehealth approach to improving clinical trial access for infants with tuberous sclerosis complex. J Neurodev Disord 2020; 12:3. [PMID: 31969108 PMCID: PMC6977334 DOI: 10.1186/s11689-019-9302-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/13/2019] [Indexed: 01/25/2023] Open
Abstract
Background Research in rare genetic syndromes associated with ASD is often hampered by the wide geographic distribution of families and the presence of medical comorbidities, such as epilepsy, that may preclude travel to clinical sites. These challenges can limit the sample size and generalizability of the cohorts included in both natural history studies and clinical trials. Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers an elevated risk for autism spectrum disorder (ASD), with social communication delays identified in this population as early as 12 months of age. Early identification of risk necessitates parallel testing of early intervention, prompting the first randomized controlled clinical trial of behavioral intervention for infants with TSC (NCT03422367). However, considerable early recruitment challenges have mandated the systematic identification of enrollment barriers followed by modification of the study design to address these barriers. Methods Caregivers were interviewed regarding barriers to enrollment (phase 1). Adaptations to the intervention were made to address these barriers (phase 2). Outcomes based on this modification to the study design were defined by enrollment rate and participant demographics. Results Qualitative reports from caregivers indicated that distance and time were the primary barriers to clinical trial enrollment. The intervention was then modified to a remote model, with at-home, parent-delivered intervention, and weekly video conferencing with interventionists at the study sites. Enrollment increased 10-fold (from 3 to 30 participants) within 1 year and included a more diverse and clinically representative cohort of infants. Conclusion The design and implementation of more scalable methods to disseminate research remotely can substantially improve access to clinical trials in rare neurodevelopmental disorders. The lessons learned from this trial can serve as a model for future studies not only in rare conditions, but in other populations that lack adequate access, such as families with limited financial or clinical resources. Continued efforts will further refine delivery methods to enhance efficiency and ease of these delivery systems for families.
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Affiliation(s)
- Carly Hyde
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA.
| | - Maria Pizzano
- UCLA Graduate School of Education and Information Studies, Los Angeles, CA, 90095, USA
| | | | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Harvard Graduate School of Education, Boston, MA, 02115, USA
| | | | - Elizabeth A Thiele
- Massachusetts General Hospital and Harvard Medical School, Herscot Center for Tuberous Sclerosis Complex, Boston, MA, 02114, USA
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Nordahl‐Hansen A, Donolato E, Lervåg A, Norbury CF, Melby‐Lervåg M. PROTOCOL: Language interventions for improving oral language outcomes in children with neurodevelopmental disorders: A systematic review. Campbell Syst Rev 2019; 15:e1062. [PMID: 37131855 PMCID: PMC8356503 DOI: 10.1002/cl2.1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - Enrica Donolato
- Department of Special Needs EducationUniversity of OsloOsloNorway
| | - Arne Lervåg
- Institute of EducationUniversity of OsloOsloNorway
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Safer-Lichtenstein J, Hamilton JC, McIntyre LL. Examining Demographics in Randomized Controlled Trials of Group-Based Social Skills Interventions for Individuals with Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:3453-3461. [PMID: 31119512 DOI: 10.1007/s10803-019-04063-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We reviewed the demographic reporting practices and diversity of participants in published randomized controlled trial studies of group-based social skills interventions (GSSIs) for individuals with autism spectrum disorder (ASD). A total of 17 studies met inclusionary criteria. Results of this review suggest that the majority of published RCTs reported on participant gender and race/ethnicity, with fewer studies including details on household income and caregiver education. Study samples generally lacked diversity, with an overrepresentation of participants who were male, White, and from upper-middle class backgrounds. Additionally, we found that nearly all GSSI studies focused on participants with average or high IQs, or were specifically classified as having a higher functioning sub-diagnosis within ASD. Implications and future directions for research are discussed.
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Affiliation(s)
| | - Jillian C Hamilton
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Laura Lee McIntyre
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
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12
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Factor RS, Ollendick TH, Cooper LD, Dunsmore JC, Rea HM, Scarpa A. All in the Family: A Systematic Review of the Effect of Caregiver-Administered Autism Spectrum Disorder Interventions on Family Functioning and Relationships. Clin Child Fam Psychol Rev 2019; 22:433-457. [DOI: 10.1007/s10567-019-00297-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Determining diagnostic stability of ASD, as well stability of functioning in early childhood, is relevant to prevalence, best practices for communicating early ASD diagnoses to caregivers, families' experiences, and developmental trajectories. Generalizability of findings from prior research has been limited by small and homogenous samples, short follow-up time intervals, and inconsistent diagnostic procedures. This report presents follow-up evaluations of 60 children (86.7% male, mean age: 51.3 months) with diverse backgrounds (79.7% racial/ethnic minorities) who received initial ASD diagnoses before 36 months of age (mean age: 27 months). Fifty-three children (88.3%) met diagnostic criteria for ASD at follow-up, a proportion consistent with previous studies. On average, children demonstrated significant cognitive gains and ASD symptom improvement. Clinical implications of findings are discussed.
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Abstract
Allied health professionals (AHPs) are trusted sources of information and intervention for clients with autism spectrum disorder. However, the level of implementation of empirically-supported therapies and the accuracy of the knowledge they use to inform intervention selection is largely unknown. The present study explored the accuracy of AHPs' knowledge and use of practices, and explored links to individual attitudes and organisational culture. Overall results from the 156 AHPs surveyed suggested general accuracy of knowledge, and use of empirically supported treatments, with accuracy linked to use. Use of practices unsupported by research was linked to organisational culture and openness to new interventions. The presence of misinformation and the impact on selection and use of effective practices are discussed.
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Affiliation(s)
- Jessica Paynter
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, 4222, Australia.
- School of Applied Psychology, Griffith University, Southport, QLD, 4222, Australia.
| | - Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, 4222, Australia
| | - Sarah Luskin-Saxby
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, 4222, Australia
| | - David Trembath
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, 4222, Australia
| | - Deb Keen
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Mt Gravatt, 4122, Australia
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Thurm A, Farmer C, Salzman E, Lord C, Bishop S. State of the Field: Differentiating Intellectual Disability From Autism Spectrum Disorder. Front Psychiatry 2019; 10:526. [PMID: 31417436 PMCID: PMC6683759 DOI: 10.3389/fpsyt.2019.00526] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023] Open
Abstract
The topic of this special issue on secondary versus idiopathic autism allows for discussion of how different groups may come to manifest autism spectrum disorder (ASD) or ASD-like symptoms despite important etiological differences. A related issue is that, because many of the social communication deficits that define ASD represent a failure to acquire developmentally expected skills, these same deficits would be expected to occur to some extent in all individuals with intellectual disability (ID). Thus, regardless of etiology, ASD symptoms may appear across groups of individuals with vastly different profiles of underlying deficits and strengths. In this focused review, we consider the impact of ID on the diagnosis of ASD. We discuss behavioral distinctions between ID and ASD, in light of the diagnostic criterion mandating that ASD should not be diagnosed if symptoms are accounted for by ID or general developmental delay. We review the evolution of the autism diagnosis and ASD diagnostic tools to understand how this distinction has been conceptualized previously. We then consider ways that operationalized criteria may be beneficial for making the clinical distinction between ID with and without ASD. Finally, we consider the impact of the blurred diagnostic boundaries between ID and ASD on the study of secondary versus idiopathic ASD. Especially pertinent to this discussion are findings that a diagnosis of ID in the context of an ASD diagnosis may be one of the strongest indicators that an associated condition or specific etiological factor is present (i.e., secondary autism).
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Affiliation(s)
- Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Cristan Farmer
- Neurodevelopmental and Behavioral Phenotyping Service, Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Emma Salzman
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Catherine Lord
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Somer Bishop
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Magallón-Neri E, Vila D, Santiago K, García P, Canino G. The Prevalence of Psychiatric Disorders and Mental Health Services Utilization by Parents and Relatives Living With Individuals With Autism Spectrum Disorders in Puerto Rico. J Nerv Ment Dis 2018; 206:226-230. [PMID: 29112530 DOI: 10.1097/nmd.0000000000000760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knowledge about prevalence rates of psychiatric disorders and mental health services use among parents and relatives of persons with autism spectrum disorder (ASD) is limited, particularly when referring to epidemiologic samples. The current study is based on an island-wide probabilistic multistage cluster sample of adult individuals (N = 3062) living in Puerto Rico. Results showed a significantly higher rate of attention deficit hyperactivity disorder and serious mental illness in parents (n = 34) or relatives (n = 34) of ASD individuals, as compared with the Puerto Rico adult population as a whole. Although not definitive because of the small sample size, the fact that the rates of mental health utilization were similar to the population sample suggests a need for greater attention by health professionals attending children with ASD to the needs for mental health services of both parents and relatives of individuals with ASD.
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Nowell KP, Goin-kochel R, Mcquillin S, Mire SS. Intellectual Functioning and Autism Spectrum Disorder: Can Profiles Inform Identification of Subpopulations? Rev J Autism Dev Disord 2017; 4:339-49. [DOI: 10.1007/s40489-017-0118-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wade J, Weitlauf A, Broderick N, Swanson A, Zhang L, Bian D, Sarkar M, Warren Z, Sarkar N. A Pilot Study Assessing Performance and Visual Attention of Teenagers with ASD in a Novel Adaptive Driving Simulator. J Autism Dev Disord 2017; 47:3405-3417. [PMID: 28756550 DOI: 10.1007/s10803-017-3261-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD), compared to typically-developed peers, may demonstrate behaviors that are counter to safe driving. The current work examines the use of a novel simulator in two separate studies. Study 1 demonstrates statistically significant performance differences between individuals with (N = 7) and without ASD (N = 7) with regards to the number of turning-related driving errors (p < 0.01). Study 2 shows that both the performance-based feedback group (N = 9) and combined performance- and gaze-sensitive feedback group (N = 8) achieved statistically significant reductions in driving errors following training (p < 0.05). These studies are the first to present results of fine-grained measures of visual attention of drivers and an adaptive driving intervention for individuals with ASD.
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Affiliation(s)
- Joshua Wade
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Amy Weitlauf
- Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University, Nashville, TN, USA
| | - Neill Broderick
- Department of Pediatrics and Psychiatry, Vanderbilt University, Nashville, TN, USA
| | - Amy Swanson
- Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University, Nashville, TN, USA
| | - Lian Zhang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dayi Bian
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Medha Sarkar
- Department of Computer Science, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Zachary Warren
- Department of Pediatrics and Psychiatry, Vanderbilt University, Nashville, TN, USA
| | - Nilanjan Sarkar
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Kaboski J, Mcdonnell CG, Valentino K. Resilience and Autism Spectrum Disorder: Applying Developmental Psychopathology to Optimal Outcome. Rev J Autism Dev Disord 2017; 4:175-89. [DOI: 10.1007/s40489-017-0106-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Cox AD, Virues-Ortega J, Julio F, Martin TL. Establishing motion control in children with autism and intellectual disability: Applications for anatomical and functional MRI. J Appl Behav Anal 2016; 50:8-26. [DOI: 10.1002/jaba.351] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 04/20/2016] [Indexed: 11/09/2022]
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Abstract
Canadian autism policy has been unusually contentious, with parents resorting to litigation to secure services for their children in several provinces. To ascertain whether consensus was possible on improving services, we conducted an in-depth qualitative interview study with 39 parents, policymakers and researchers across the country. Parents vividly described the stresses of caring for their children, with considerable sympathy from researchers. Policymakers in turn struggled to balance the needs of all children. Yet participants agreed on the need for more comprehensive services across the spectrum and throughout the lifespan, and on the need to “do more for all” children. Our findings suggest that there is an emerging consensus on improving autism services in Canada—which should greatly benefit children.
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Affiliation(s)
- Cody A Shepherd
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, 2435-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Charlotte Waddell
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, 2435-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Gonzales ELT, Jang JH, Mabunga DFN, Kim JW, Ko MJ, Cho KS, Bahn GH, Hong M, Ryu JH, Kim HJ, Cheong JH, Shin CY. Supplementation of Korean Red Ginseng improves behavior deviations in animal models of autism. Food Nutr Res 2016; 60:29245. [PMID: 26837496 PMCID: PMC4737717 DOI: 10.3402/fnr.v60.29245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 11/17/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is heterogeneous neurodevelopmental disorders that primarily display social and communication impairments and restricted/repetitive behaviors. ASD prevalence has increased in recent years, yet very limited therapeutic targets and treatments are available to counteract the incapacitating disorder. Korean Red Ginseng (KRG) is a popular herbal plant in South Korea known for its wide range of therapeutic effects and nutritional benefits and has recently been gaining great scientific attention, particularly for its positive effects in the central nervous system. Objectives Thus, in this study, we investigated the therapeutic potential of KRG in alleviating the neurobehavioral deficits found in the valproic acid (VPA)-exposed mice models of ASD. Design Starting at 21 days old (P21), VPA-exposed mice were given daily oral administrations of KRG solution (100 or 200 mg/kg) until the termination of all experiments. From P28, mice behaviors were assessed in terms of social interaction capacity (P28–29), locomotor activity (P30), repetitive behaviors (P32), short-term spatial working memory (P34), motor coordination (P36), and seizure susceptibility (P38). Results VPA-exposed mice showed sociability and social novelty preference deficits, hyperactivity, increased repetitive behavior, impaired spatial working memory, slightly affected motor coordination, and high seizure susceptibility. Remarkably, long-term KRG treatment in both dosages normalized all the ASD-related behaviors in VPA-exposed mice, except motor coordination ability. Conclusion As a food and herbal supplement with various known benefits, KRG demonstrated its therapeutic potential in rescuing abnormal behaviors related to autism caused by prenatal environmental exposure to VPA.
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Affiliation(s)
- Edson Luck T Gonzales
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea
| | - Jong-Hwa Jang
- Department of Dental Hygiene, Hanseo University, Seosan, Korea
| | - Darine Froy N Mabunga
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea
| | - Ji-Woon Kim
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea
| | - Mee Jung Ko
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea
| | - Kyu Suk Cho
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea
| | - Geon Ho Bahn
- Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, School of Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jong Hoon Ryu
- Department of Oriental Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Jin Kim
- Department of Pharmacy, Sahmyook University, Seoul, Korea
| | | | - Chan Young Shin
- Department of Neuroscience, School of Medicine, Konkuk University, Seoul, Korea.,Neuroscience Research Center, IABS, Konkuk University, Seoul, Korea.,KU Open Innovation Center, Konkuk University, Seoul, Korea;
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Volden J, Duku E, Shepherd C, Ba, Georgiades S, Bennett T, Di Rezze B, Szatmari P, Bryson S, Fombonne E, Mirenda P, Roberts W, Smith IM, Vaillancourt T, Waddell C, Zwaigenbaum L, Elsabbagh M. Service utilization in a sample of preschool children with autism spectrum disorder: A Canadian snapshot. Paediatr Child Health 2016; 20:e43-7. [PMID: 26744563 DOI: 10.1093/pch/20.8.e43] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe services received by preschool children diagnosed with autism spectrum disorder (ASD) during the five-year period following their diagnosis. METHOD An inception cohort of preschoolers diagnosed with ASD from Halifax (Nova Scotia), Montreal (Quebec), Hamilton (Ontario), Edmonton (Alberta) and Vancouver (British Columbia) were invited to participate. Parents/caregivers (n=414) described the services provided to their children at four time points: baseline (T1; within four months of diagnosis; mean age three years); six months later (T2); 12 months later (T3); and at school entry (T4). Data were first coded into 11 service types and subsequently combined into four broader categories (no services, behavioural, developmental and general) for analysis. RESULTS More than 80% of children at T1, and almost 95% at T4 received some type of service, with a significant number receiving >1 type of service at each assessment point. At T1, the most common service was developmental (eg, speech-language therapy). Subsequently, the most common services were a combination of behavioural and developmental (eg, intensive therapy based on applied behaviour analysis and speech-language therapy). Service provision varied across provinces and over time. DISCUSSION Although most preschool children with ASD residing in urban centres were able to access specialized services shortly after diagnosis, marked variation in services across provinces remains a concern.
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Affiliation(s)
- J Volden
- University of Alberta, Edmonton, Alberta
| | - E Duku
- McMaster University, Hamilton
| | - C Shepherd
- University of Alberta, Edmonton, Alberta
| | - Ba
- McMaster University, Hamilton
| | | | | | | | | | - S Bryson
- Dalhousie University, Halifax, Nova Scotia
| | - E Fombonne
- Oregon Health and Sciences University, Portland, Oregon, USA
| | - P Mirenda
- University of British Columbia, Vancouver, British Columbia
| | - W Roberts
- University of Toronto, Toronto, Ontario
| | - I M Smith
- Dalhousie University, Halifax, Nova Scotia
| | | | - C Waddell
- Simon Fraser University, Burnaby, British Columbia
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Poirier N, Cappe É. Les dispositifs scolaires québécois et français offerts aux élèves ayant un trouble du spectre de l’autisme. ACTA ACUST UNITED AC 2016. [DOI: 10.3917/bupsy.544.0267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Johnson NL, Burkett K, Reinhold J, Bultas MW. Translating Research to Practice for Children With Autism Spectrum Disorder: Part I: Definition, Associated Behaviors, Prevalence, Diagnostic Process, and Interventions. J Pediatr Health Care 2016; 30:15-26. [PMID: 26530271 DOI: 10.1016/j.pedhc.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/12/2015] [Accepted: 09/12/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The number of children with autism spectrum disorder (ASD) is rising, along with the potential for challenging behaviors during health care encounters. METHOD We present an overview of the emerging science related to ASD diagnosis and interventions for children with ASD. RESULTS Emerging science on ASD reveals common associated challenging behaviors, increasing prevalence, emphasis on early diagnosis at 18 to 24 months of age, changes in the diagnostic process with criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and interventions with medication, education, and behavior management. DISCUSSION Family and health care provider preparation strategies facilitate care of children with ASD and their families. Early diagnosis at 18 to 24 months of age and evidence-based interventions contribute to best outcomes for children and families. Health care providers must be aware of the state of the science for diagnosis and best practices to provide family-centered care for this growing population.
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Drahota A, Stadnick N, Brookman-Frazee L. Therapist perspectives on training in a package of evidence-based practice strategies for children with autism spectrum disorders served in community mental health clinics. Adm Policy Ment Health 2014; 41:114-25. [PMID: 23086499 DOI: 10.1007/s10488-012-0441-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASDs) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD.
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Malcolm-Smith S, Hoogenhout M, Ing N, Thomas KG, de Vries P. Autism spectrum disorders-Global challenges and local opportunities. J Child Adolesc Ment Health 2015; 25:1-5. [PMID: 25860302 DOI: 10.2989/17280583.2013.767804] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Susan Malcolm-Smith
- a ACSENT Laboratory Department of Psychology , University of Cape Town , South Africa
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Abstract
Newborn breastfeeding behaviors have not been characterized in children later diagnosed with autism spectrum disorder (ASD). In a qualitative interview, 16 mothers (28-56 years) of children with ASD described their 19 full-term infants' (38-42 weeks' gestational age) breastfeeding behaviors. Nine mothers described their infants as demonstrating a dysregulated breastfeeding pattern of sucking without stopping of their own volition. The infants' latch, weight gain, and other behaviors were recalled as not problematic. This feature of dysregulated feeding pattern in infancy has not been reported previously for children with ASD. If supported by future research, the pattern of a dysregulated feeding pattern in newborns could be evaluated by clinicians in the general pediatric population and/or at-risk infant siblings of children with ASD.
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Adams RE, Fredstrom BK, Duncan AW, Holleb LJ, Bishop SL. Using self- and parent-reports to test the association between peer victimization and internalizing symptoms in verbally fluent adolescents with ASD. J Autism Dev Disord 2014; 44:861-72. [PMID: 24005987 DOI: 10.1007/s10803-013-1938-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The current study tested the associations between peer victimization and internalizing symptoms in 54 verbally fluent adolescent males with a diagnosis of autism spectrum disorder. Adolescent- and parent-reports of multiple types of peer victimization and internalizing symptoms were used. First, the validity and reliability of the adolescent-report measure of peer victimization were successfully tested, with some exceptions. Then, structural equation models showed that adolescent-reports of peer victimization were associated with a latent construct of internalizing symptoms even after controlling for parent-reports of peer victimization. Discussion focuses on the importance of considering adolescent-reports of negative peer experience, such as peer victimization, rather than relying exclusively on parent reports.
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Payakachat N, Tilford JM, Kuhlthau KA, van Exel NJ, Kovacs E, Bellando J, Pyne JM, Brouwer WBF. Predicting health utilities for children with autism spectrum disorders. Autism Res 2014; 7:649-63. [PMID: 25255789 DOI: 10.1002/aur.1409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/01/2014] [Indexed: 11/09/2022]
Abstract
Comparative effectiveness of interventions for children with autism spectrum disorders (ASDs) that incorporates costs is lacking due to the scarcity of information on health utility scores or preference-weighted outcomes typically used for calculating quality-adjusted life years (QALYs). This study created algorithms for mapping clinical and behavioral measures for children with ASDs to health utility scores. The algorithms could be useful for estimating the value of different interventions and treatments used in the care of children with ASDs. Participants were recruited from two Autism Treatment Network sites. Health utility data based on the Health Utilities Index Mark 3 (HUI3) for the child were obtained from the primary caregiver (proxy-reported) through a survey (N = 224). During the initial clinic visit, proxy-reported measures of the Child Behavior Checklist, Vineland II Adaptive Behavior Scales, and the Pediatric Quality of Life Inventory 4.0 (start measures) were obtained and then merged with the survey data. Nine mapping algorithms were developed using the HUI3 scores as dependent variables in ordinary least squares regressions along with the start measures, the Autism Diagnostic Observation Schedule, to measure severity, child age, and cognitive ability as independent predictors. In-sample cross-validation was conducted to evaluate predictive accuracy. Multiple imputation techniques were used for missing data. The average age for children with ASDs in this study was 8.4 (standard deviation = 3.5) years. Almost half of the children (47%) had cognitive impairment (IQ ≤ 70). Total scores for all of the outcome measures were significantly associated with the HUI3 score. The algorithms can be applied to clinical studies containing start measures of children with ASDs to predict QALYs gained from interventions.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Edwards K, Towle PO, Levitz B. Incorporating life course theory and social determinants of health into the LEND curriculum. Matern Child Health J 2014; 18:431-42. [PMID: 23852429 DOI: 10.1007/s10995-013-1283-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of this paper is to describe strategies for revising LEND curricula to incorporate a stronger focus on life course theory and social determinants of health (LCT/SDOH). The Maternal and Child Health Bureau (MCHB) includes a central focus on LCT/SDOH and states that a goal of Maternal and Child Health (MCH) training is to "Prepare and empower MCH leaders to promote health equity…and reduce disparities in health and health care." Two LEND programs engaged in a comprehensive process to strengthen LCT/SDOH in their curricula that included choosing content and themes and developing instructional strategies congruent with MCH Leadership Competencies and with the learning needs of LEND trainees. We describe: key elements of LCT/SDOH; the relationship of these to children with disabilities and to the MCH Leadership Competencies; LCT/SDOH resources for the LEND curriculum; a collaborative curriculum revision process for faculty; and LCT/SDOH content and themes for the LEND Curriculum and strategies for incorporating them. We present the results of our work in a format that may be used by other LEND programs undertaking curriculum revision to incorporate LCT/SDOH.
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Abstract
This pilot ethnomethodological study examined perceptions of parents/caregivers of children diagnosed with autistic spectrum disorders concerning actions, norms, understandings, and assumptions related to adjustment to this chronic illness. The sample included 14 caregivers (75% Hispanic of various ethnic groups). Maximum variation sampling was used to compare participants on variables that were inductively derived via constant comparative methods of analysis. The following action categories emerged: "Seeking Diagnosis," "Engaging in Routines to Control behavior," "Finding Therapies (Types of Therapies)," "Finding School Accommodations," "Educating Others," "Rising to Challenges," and "Finding the Role of Spiritual and Religious Belief."
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Solomon O, Lawlor MC. "And I look down and he is gone": narrating autism, elopement and wandering in Los Angeles. Soc Sci Med 2013; 94:106-14. [PMID: 23890970 PMCID: PMC3788703 DOI: 10.1016/j.socscimed.2013.06.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
'Wandering' and 'elopement' have been identified as common in autism, affecting half of all diagnosed children ages four to ten, yet families rarely receive advice from practitioners even after the fact. Family perspectives have been missing from the literature as well as from public health and policy debates on how and when to respond to this problem. The problem of 'wandering' and 'elopement' reveals a complex intersection of larger issues encountered by families of children with autism. To consider these issues, this article examines 'wandering' and 'elopement' from the perspectives of African American mothers of children with autism, an underrepresented group in autism research. We consider how the mothers experience these behaviors and the response to these behaviors by professionals, such as service coordinators and law enforcement personnel working within various jurisdictions that become involved with the problem. We analyze the mothers' narratives about 'wandering' and 'elopement' drawn from ethnographic interviews that were collected between October 1, 2009 and August 31, 2012. These interviews were part of a larger project on disparities in autism diagnosis and services that followed a cohort of 25 four to ten-year old children. Drawing on narrative, phenomenological and interpretive traditions, we trace the mothers' developing understandings of 'wandering' and 'elopement' over time, and show how these understandings become elaborated and transformed. This article provides a nuanced, moment-to-moment and longitudinal picture of the mothers' experiences of 'wandering' and 'elopement' that enriches the cross-sectional view of large-scale surveys about the problem and contributes unique insights at the family and community levels. Implications for professional awareness, clinical practice and service provision are also suggested.
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Affiliation(s)
- Olga Solomon
- University of Southern California, Los Angeles, CA 90089, USA.
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Siller M, Hutman T, Sigman M. A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: a randomized clinical trial. J Autism Dev Disord 2013; 43:540-55. [PMID: 22825926 DOI: 10.1007/s10803-012-1584-y] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder. To investigate the underlying causal mechanisms, we conducted a randomized clinical trial of an experimental intervention (Focused Playtime Intervention, FPI) that aims to enhance responsive parental communication (N = 70). Results showed a significant treatment effect of FPI on responsive parental behaviors. Findings also revealed a conditional effect of FPI on children's expressive language outcomes at 12-month follow up, suggesting that children with baseline language skills below 12 months (n = 24) are most likely to benefit from FPI. Parents of children with more advanced language skills may require intervention strategies that go beyond FPI's focus on responsive communication.
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Affiliation(s)
- Michael Siller
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, USA.
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Torres EB, Isenhower RW, Yanovich P, Rehrig G, Stigler K, Nurnberger J, José JV. Strategies to develop putative biomarkers to characterize the female phenotype with autism spectrum disorders. J Neurophysiol 2013; 110:1646-62. [PMID: 23864377 DOI: 10.1152/jn.00059.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Current observational inventories used to diagnose autism spectrum disorders (ASD) apply similar criteria to females and males alike, despite developmental differences between the sexes. Recent work investigating the chronology of diagnosis in ASD has raised the concern that females run the risk of receiving a delayed diagnosis, potentially missing a window of opportunity for early intervention. Here, we retake this issue in the context of the objective measurements of natural behaviors that involve decision-making processes. Within this context, we quantified movement variability in typically developing (TD) individuals and those diagnosed with ASD across different ages. We extracted the latencies of the decision movements and velocity-dependent parameters as the hand movements unfolded for two movement segments within the reach: movements intended toward the target and withdrawing movements that spontaneously, without instruction, occurred incidentally. The stochastic signatures of the movement decision latencies and the percent of time to maximum speed differed between males and females with ASD. This feature was also observed in the empirically estimated probability distributions of the maximum speed values, independent of limb size. Females with ASD showed different dispersion than males with ASD. The distinctions found for females with ASD were better appreciated compared with those of TD females. In light of these results, behavioral assessment of autistic traits in females should be performed relative to TD females to increase the chance of detection.
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Maenner MJ, Schieve LA, Rice CE, Cunniff C, Giarelli E, Kirby RS, Lee LC, Nicholas JS, Wingate MS, Durkin MS. Frequency and pattern of documented diagnostic features and the age of autism identification. J Am Acad Child Adolesc Psychiatry 2013; 52:401-413.e8. [PMID: 23582871 PMCID: PMC4051284 DOI: 10.1016/j.jaac.2013.01.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 01/28/2013] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The DSM-IV-TR specifies 12 behavioral features that can occur in hundreds of possible combinations to meet diagnostic criteria for autism spectrum disorder (ASD). This paper describes the frequency and variability with which the 12 behavioral features are documented in a population-based cohort of 8-year-old children under surveillance for ASD, and examines whether documentation of certain features, alone or in combination with other features, is associated with earlier age of community identification of ASD. METHOD Statistical analysis of behavioral features documented for a population-based sample of 2,757 children, 8 years old, with ASD in 11 geographically-defined areas in the US participating in the Autism and Developmental Disabilities Monitoring Network in 2006. RESULTS The median age at ASD identification was inversely associated with the number of documented behavioral features, decreasing from 8.2 years for children with only seven behavioral features to 3.8 years for children with all 12. Documented impairments in nonverbal communication, pretend play, inflexible routines, and repetitive motor behaviors were associated with earlier identification, whereas impairments in peer relations, conversational ability, and idiosyncratic speech were associated with later identification. CONCLUSIONS The age dependence of some of the behavioral features leading to an autism diagnosis, as well as the inverse association between age at identification and number of behavioral features documented, have implications for efforts to improve early identification. Progress in achieving early identification and provision of services for children with autism may be limited for those with fewer ASD behavioral features, as well as features likely to be detected at later ages.
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Payakachat N, Tilford JM, Kovacs E, Kuhlthau K. Autism spectrum disorders: a review of measures for clinical, health services and cost-effectiveness applications. Expert Rev Pharmacoecon Outcomes Res 2013; 12:485-503. [PMID: 22971035 DOI: 10.1586/erp.12.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autism spectrum disorders (ASDs) are characterized by impairments in social interaction, communication and behavioral functioning that can affect the health-related quality-of-life outcomes of the affected child and the family. ASDs have increased in prevalence, leading to a demand for improved understanding of the comparative effectiveness of different pharmacologic, behavioral, medical and alternative treatments for children as well as systems for providing services. This review describes outcome instruments that can be used for clinical, health services and cost-effectiveness applications. There is a pressing need to identify the most appropriate instruments for measuring health-related quality-of-life outcomes in this population. Studies evaluating the cost-effectiveness of interventions or treatments for children with ASDs using the cost per quality-adjusted life year metric are lacking. Researchers have the potential to contribute greatly to the field of autism by quantifying outcomes that can inform optimal treatment strategies.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, USA.
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Sansosti FJ, Sansosti JM. EFFECTIVE SCHOOL-BASED SERVICE DELIVERY FOR STUDENTS WITH AUTISM SPECTRUM DISORDERS: WHERE WE ARE AND WHERE WE NEED TO GO. Psychol Schs 2013. [DOI: 10.1002/pits.21669] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rice CE, Rosanoff M, Dawson G, Durkin MS, Croen LA, Singer A, Yeargin-Allsopp M. Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs). Public Health Rev 2012; 34:1-22. [PMID: 26236074 DOI: 10.1007/bf03391685] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Autism spectrum disorders (ASDs) are estimated to occur among about one percent of children in the United States. This estimate is in line with estimates from other industrialized countries. However, the identified prevalence of ASDs has increased significantly in a short time period based on data from multiple studies including the U.S. Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network. Whether increases in ASD prevalence are partly attributable to a true increase in the risk of developing ASD or solely to changes in community awareness and identification patterns is not known. It is clear that more children are identified with an ASD now than in the past and the impact on individuals, families, and communities is significant. However, disentangling the many potential reasons for ASD prevalence increases has been challenging. Understanding the relative contribution of multiple factors such as variation in study methods, changes in diagnostic and community identification, and potential changes in risk factors is an important priority for the ADDM Network and for CDC. This article summarizes the discussion from a workshop that was co-sponsored by CDC and Autism Speaks as a forum for sharing knowledge and opinions of a diverse range of stakeholders about changes in ASD prevalence. Panelists discussed recommendations for building on existing infrastructure and developing new initiatives to better understand ASD trends. The information, research, and opinions shared during this workshop add to the knowledge base about ASD prevalence in an effort to stimulate further work to understand the multiple reasons behind increasing ASD prevalence.
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Affiliation(s)
- Catherine E Rice
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
| | | | - Geraldine Dawson
- Autism Speaks, USA ; University of North Carolina at Chapel Hill, USA
| | | | | | | | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
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Reaven J, Blakeley-Smith A, Leuthe E, Moody E, Hepburn S. Facing your fears in adolescence: cognitive-behavioral therapy for high-functioning autism spectrum disorders and anxiety. Autism Res Treat 2012; 2012:423905. [PMID: 23091719 DOI: 10.1155/2012/423905] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 07/16/2012] [Accepted: 08/29/2012] [Indexed: 11/23/2022]
Abstract
Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13–18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed.
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Affiliation(s)
- Brian Scassellati
- Department of Computer Science, Yale University, New Haven, Connecticut 06520;
| | - Henny Admoni
- Department of Computer Science, Yale University, New Haven, Connecticut 06520;
| | - Maja Matarić
- Departments of Computer Science and Pediatrics, University of Southern California, Los Angeles, California 90089-1450;
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Golnik A, Maccabee-Ryaboy N, Scal P, Wey A, Gaillard P. Shared decision making: improving care for children with autism. Intellect Dev Disabil 2012; 50:322-331. [PMID: 22861133 DOI: 10.1352/1934-9556-50.4.322] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We assessed the extent to which parents of children with autism spectrum disorder report that they are engaged in shared decision making. We measured the association between shared decision making and (a) satisfaction with care, (b) perceived guidance regarding controversial issues in autism spectrum disorder, and (c) perceived assistance navigating the multitude of treatment options. Surveys assessing primary medical care and decision-making processes were developed on the basis of the U.S. Department of Health and Human Service's Consumer Assessment of Healthcare Providers and Systems survey. In May 2009, after pilot testing, we sent surveys to 203 parents of children from ages 3 to 18 with International Classification of Diseases-9 and parent-confirmed autism spectrum disorder diagnoses. The response rate was 64%. Controlling for key demographic variables, parents of children with autism spectrum disorder reporting higher levels of shared decision making reported significantly greater satisfaction with the overall quality of their child's health care (p ≤ .0001). Parents reporting higher levels of shared decision making were also significantly more likely to report receiving guidance on the many treatment options (p = .0002) and controversial issues related to autism spectrum disorder (p = .0322). In this study, shared decision making was associated with higher parent satisfaction and improved guidance regarding treatments and controversial issues within primary care for children with autism spectrum disorder.
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Abstract
Research on the identification and evaluation of autism spectrum disorders is reviewed, and best practices for clinical work are discussed. The latest research on diagnostic tools, and their recommended use, is also reviewed. Recommendations include the use of instruments designed to assess multiple domains of functioning and behavior, the inclusion of parents and caregivers as active partners, and the consideration of developmental factors throughout the diagnostic process.
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Maljaars J, Noens I, Scholte E, van Berckelaer-Onnes I. Evaluation of the criterion and convergent validity of the Diagnostic Interview for Social and Communication Disorders in young and low-functioning children. Autism 2011; 16:487-97. [DOI: 10.1177/1362361311402857] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reaven J. The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents. Brain Res 2011; 1380:255-63. [PMID: 20875799 DOI: 10.1016/j.brainres.2010.09.075] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 11/21/2022]
Abstract
Anxiety symptoms are one of the most common mental health conditions in childhood. Children and adolescents with Autism Spectrum Disorders (ASD) are at risk for developing mental health symptoms and anxiety in particular, especially when compared with their peers - both in the general population as well as when compared to youth with other developmental disabilities. Cognitive behavior therapy (CBT) has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and an emerging body of literature indicates that modified CBT for youth with ASD can be effective in reducing anxiety symptoms. In a review of these modified treatment protocols, parent involvement is emphasized as an important component of interventions for youth with ASD and anxiety. However, the majority of these studies only briefly describe the parent's role, and little mention is made with regard to how the parent's role evolves over time as children age into adolescence. In this paper, the parent's role in the treatment of anxiety symptoms in children and adolescents with high-functioning ASD will be discussed with a particular emphasis on considerations for parents of teenagers. Specific recommendations for parent involvement will be provided.
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Abstract
The social movement surrounding autism in the U.S. has been rightly defined a ray of light in the history of social progress. The movement is inspired by a true understanding of neuro-diversity and is capable of bringing about desirable change in political discourse. At several points along the way, however, the legal reforms prompted by the autism movement have been grafted onto preexisting patterns of inequality in the allocation of welfare, education, and medical services. In a context most recently complicated by economic recession, autism-driven change bears the mark of political and legal fragmentation. Distributively, it yields ambivalent results that have not yet received systemic attention. This article aims to fill this analytical vacuum by offering, first, a synoptic view of the several legal transformations brought about or advocated for by the autism movement and, second, a framework for investigating their distributive consequences.
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