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Arthur KC, Mendez Sanchez A, Tamayo Montero A, Delgado P, Rosas Ramos O, Orlich F, Desai AD. Identifying adaptations for a mindfulness program for Spanish-speaking mothers of children with chronic conditions or disabilities. Health Educ Res 2024; 39:68-83. [PMID: 38183268 PMCID: PMC10805378 DOI: 10.1093/her/cyad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 01/08/2024]
Abstract
Mothers of children with chronic conditions or disabilities have benefited from mindfulness programs, yet culturally relevant mindfulness programs for Spanish-speaking mothers are lacking. We aimed to explore how this population experienced a peer-led mindfulness program to inform adaptations. Sixteen mothers attended a 6-week program and completed semi-structured interviews. Using a realist evaluation framework, we explored relationships between participants' context, the program's mechanisms and outcomes. Our thematic analysis found that four contextual factors-faith, self-concept as a woman and mother, trauma, and level of social support-influenced how participants experienced the mechanisms. Mechanisms included having positive experiences when trying practices, engaging in self-reflection, and sharing life experiences and learning in community. The mechanisms led to four outcomes: emotion regulation, savoring daily life experiences, empowerment to practice self-care and common humanity. Faith was an important enabling factor because participants had positive experiences when integrating their faith with program content. Future research should examine adaptations that invite participants to explore this synergy. Self-reflection should also be emphasized because it increased motivation to use practices and helped address barriers to engagement. Because the four contextual factors apply to many Spanish-speaking immigrants, these adaptations could enhance mindfulness programs for this population more broadly.
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Affiliation(s)
- Kimberly C Arthur
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Araceli Mendez Sanchez
- Seattle Children’s Odessa Brown Children’s Clinic, 3939 S Othello St., Suite 101, Seattle, WA 98118, USA
| | - Angie Tamayo Montero
- Seattle Children’s Odessa Brown Children’s Clinic, 3939 S Othello St., Suite 101, Seattle, WA 98118, USA
| | - Patricia Delgado
- The Arc of King County, 660 SW 39th St #205, Renton, WA 98057, USA
| | | | - Felice Orlich
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
| | - Arti D Desai
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Kahn NF, Sequeira GM, Reyes V, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Mental Health of Youth With Autism Spectrum Disorder and Gender Dysphoria. Pediatrics 2023; 152:e2023063289. [PMID: 37909059 DOI: 10.1542/peds.2023-063289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Kahn NF, Sequeira GM, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents. Pediatrics 2023; 152:e2023061363. [PMID: 37395084 DOI: 10.1542/peds.2023-061363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. METHODS This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. RESULTS Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. CONCLUSIONS Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Dean M, Chang YC, Shih W, Orlich F, Kasari C. Social engagement and loneliness in school-age autistic girls and boys. Womens Health (Lond) 2023; 19:17455057231170973. [PMID: 37129160 PMCID: PMC10159247 DOI: 10.1177/17455057231170973] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study examines the relationship between social engagement and loneliness in female and male autistic children and adolescents in school-based social settings. Secondary aims sought to explore the emergence of loneliness across different age groups and differences in social engagement and loneliness between genders. METHODS This study conducted an analysis of previously collected data from two multi-site randomized control trials. This study included 58 autistic students (29 females, 29 males) between the ages 6 through 18 years. Female and male participants were matched on age and intelligence quotient. Concurrent mixed methods were used to examine participants' social engagement and loneliness. RESULTS Findings revealed a significant relationship between joint engagement and loneliness, such that autistic students reported more loneliness when they were mutually engaged with social groups than when they were isolated or alone. Positive correlations between joint engage and loneliness were identified in elementary-age girls and secondary-age boys, suggesting that being mutually engaged with peers leads to increased loneliness. Negative correlations between parallel and loneliness identified in secondary-age boys suggested that boys in close proximity to peers felt less lonely than boys who were mutually engaged with peers. Qualitative analysis of social behaviors indicated that elementary girls and secondary boys were more likely to be mutually engaged or in close proximity to activities, but they had difficulty sustaining this engagement throughout the entire social period. Secondary girls and elementary boys, on the other hand, were more likely to be solitary and less likely to engage with peer groups. CONCLUSION Study findings highlight the relationship between social engagement and loneliness in school-based autistic populations, and that more engagement itself can lead to more loneliness for younger girls and older boys. The influence of age and gender on engagement and loneliness highlights a need to tailor social interventions to leverage existing social strengths.
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Affiliation(s)
- Michelle Dean
- California State University (CSU) Channel Islands, Camarillo, CA, USA
| | - Ya-Chih Chang
- California State University (CSU), Los Angeles, Los Angeles, CA, USA
| | - Wendy Shih
- Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, CA, USA
| | - Felice Orlich
- Seattle Children's Autism Center (CAC), Seattle, WA, USA
| | - Connie Kasari
- Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, CA, USA
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Pham A, Kasenic A, Hayden L, Inwards-Breland DJ, Sumerwell C, Twible H, Ahrens KR, Orlich F. A Case Series on Disordered Eating Among Transgender Youth With Autism Spectrum Disorder. J Adolesc Health 2021; 68:1215-1219. [PMID: 33707147 DOI: 10.1016/j.jadohealth.2020.12.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/16/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Transgender youth with autism spectrum disorder (ASD) may experience complex relationships with eating because of cognitive rigidity, including inflexible thoughts and behaviors around food and/or their body. Yet, there is no research that provides guidance to clinicians providing care for youth with the unique triad of gender dysphoria, ASD, and disordered eating. This case series discusses trends in presentation and management of three cases from a multidisciplinary gender care clinic. All three individuals endorsed rigid thoughts around food and/or body appearance, which affected nutritional intake; however, their presenting eating disorder behaviors, described etiology for disordered thoughts, diagnosis, and level of engagement in a multidisciplinary treatment model varied. Based on these cases we hypothesize several strategies including early engagement with ASD specialists, proactive screening and discussions around eating with all transgender youth with suspected/confirmed ASD, continued discussions throughout care, as disordered eating behaviors may change after the initiation of gender-affirming medications, dietician visits early in treatment regardless of endorsed thoughts and behaviors, tailored management to the unique needs of each individual and their eating thoughts/behaviors, and consistent multidisciplinary collaboration.
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Affiliation(s)
- An Pham
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Ash Kasenic
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Lara Hayden
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David J Inwards-Breland
- Division of Adolescent and Young Adult Medicine, Rady Children's Hospital, San Diego, California
| | - Catherine Sumerwell
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Heather Twible
- Seattle Children's Hospital, Department of Clinical Nutrition, Seattle, Washington
| | - Kym R Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Hospital, Autism Center, Seattle, Washington
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Dean M, Williams J, Orlich F, Kasari C. Adolescents with autism spectrum disorder and social skills groups at school: A randomized trial comparing intervention environment and peer composition. School Psych Rev 2020; 49:60-73. [PMID: 33041430 DOI: 10.1080/2372966x.2020.1716636] [Citation(s) in RCA: 10] [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] [Indexed: 10/23/2022]
Abstract
This study used a randomized controlled trial to compare two distinct models of group social skills interventions with adolescents with autism spectrum disorder (ASD). Participants had a confirmed diagnosis of ASD, an IQ greater than or equal to 70, and were educated in the general education setting. Data from 62 adolescent participants who were randomized to one of two treatment conditions (SKILLS vs. ENGAGE) were analyzed. SKILLS participants had a diagnosis of ASD, or social difficulties. ENGAGE groups included adolescents with ASD and typically developing (TD) peer mentors. SKILLS and ENGAGE participants both improved joint engagement and reduced solitary engagement, however, SKILLS participants reported higher social stress and lower quality interpersonal relationships at exit, and increased emotional symptoms and problem behaviors at follow-up compared to the ENGAGE group. The findings suggest that within inclusive secondary school settings, it may be beneficial to include TD peers in social intervention groups.
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Karp EA, Dudovitz R, Nelson BB, Shih W, Gulsrud A, Orlich F, Colombi C, Kuo AA. Family Characteristics and Children's Receipt of Autism Services in Low-Resourced Families. Pediatrics 2018; 141:S280-S286. [PMID: 29610408 DOI: 10.1542/peds.2016-4300d] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Parents of children with autism spectrum disorder (ASD) face competing demands when caring for their child and fulfilling family commitments. It remains unknown whether family obligations and parental stress might decrease the use of intervention services for young children with ASD. METHODS The current study is a secondary analysis of baseline date from a published randomized control trial with 147 low-resourced caregiver-child dyads. Demographic information, data on service use, maternal employment, parent's perception of their child's development, and parental stress were collected for primary caregivers of 2- to 5-year-old children with ASD from 5 sites. Multiple logistic regressions of accessing any intervention services or more than 1 services on familial characteristics were performed, controlling for demographic and contextual variables. RESULTS Twenty-five percent of children were receiving no intervention service; 26% were receiving 1 service; and 49% were receiving 2 or more services. Perceived developmental delay and not having a sibling in the home were associated with higher odds of receiving intervention services. Children were more likely to receive more than 1 service if their parents had at least a college education and low levels of stress. CONCLUSIONS Factors including perceived developmental level, parental stress, and caring for siblings may play a role in accessing services for children with ASD. Results reveal that competing family needs may be barriers to service use. Mothers of children with ASD with multiple children in the home, low levels of education, and high levels of stress may need additional supports or alternative service delivery models.
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Affiliation(s)
- Elizabeth A Karp
- Department of Psychology, University of Washington, Seattle, Washington;
| | - Rebecca Dudovitz
- Department of Pediatrics and Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children's Hospital
| | - Bergen B Nelson
- Children's Hospital of Richmond and Virginia Commonwealth University, Richmond, Virginia
| | - Wendy Shih
- Center for Autism Research and Treatment, and
| | | | - Felice Orlich
- Seattle Children's Hospital Autism Center, Seattle, Washington; and
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Alice A Kuo
- Department of Pediatrics and Children's Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children's Hospital.,Department of Medicine, University of California, Los Angeles, Los Angeles, California
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Kasari C, Dean M, Kretzmann M, Shih W, Orlich F, Whitney R, Landa R, Lord C, King B. Children with autism spectrum disorder and social skills groups at school: a randomized trial comparing intervention approach and peer composition. J Child Psychol Psychiatry 2016; 57:171-9. [PMID: 26391889 DOI: 10.1111/jcpp.12460] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [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] [Accepted: 07/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Peer relationships improve for children with autism spectrum disorder (ASD) in clinic-based social skills groups but rarely generalize to real world contexts. This study compares child outcomes of two social skills interventions conducted in schools with children in Kindergarten through fifth grade. METHOD Children with ASD were randomized to one of two interventions that varied on group composition (mixed typical and ASD vs. all ASD or social difficulties) and intervention approach (didactic SKILLS based vs. activity-based ENGAGE groups). Interventions were implemented at school for 8 weeks (16 sessions) with an 8-week follow-up. Innovative measures of peer nomination and playground peer engagement, as well as teacher reports of child behavior problems and teacher-child relationship were analyzed for 137 children with ASD across four sites. RESULTS On the primary outcome of social network connections from the peer nomination measure, there was no main effect of treatment, but there were moderator effects. Children with low teacher-child closeness or high conflict improved more in their social connections if they received the SKILLS intervention, whereas children with higher teacher-child closeness improved more if they received the ENGAGE intervention. Only two secondary outcome measures yielded significant effects of treatment. Children in the SKILLS groups increased peer engagement and decreased isolation during recess. Child behavior problems and teacher-child closeness moderated peer engagement such that children with higher behavior problems and lower closeness benefitted more from SKILLS groups. CONCLUSIONS These findings suggest that social skills groups conducted at school can affect both peer engagement during recess as well as peer acceptability. Child characteristics and teacher-child relationship prior to intervention yield important information on who might benefit from a specific social skills intervention.
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Affiliation(s)
- Connie Kasari
- Center for Autism Research and Treatment, University of California, Los Angeles, CA, USA
| | - Michelle Dean
- Department of Special Education, California State University, Channel Islands, CA, USA
| | - Mark Kretzmann
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Wendy Shih
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Felice Orlich
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Rondalyn Whitney
- Department of Occupational Therapy, Clarkson University, Potsdam, NY, USA
| | - Rebecca Landa
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine Lord
- Center for Autism and the Developing Brain, Weill Cornell Medical College, White Plains, NY, USA
| | - Bryan King
- Department of Psychiatry, University of California, Los Angeles, CA, USA
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Dean M, Kasari C, Shih W, Frankel F, Whitney R, Landa R, Lord C, Orlich F, King B, Harwood R. The peer relationships of girls with ASD at school: comparison to boys and girls with and without ASD. J Child Psychol Psychiatry 2014; 55:1218-25. [PMID: 25039696 PMCID: PMC4269475 DOI: 10.1111/jcpp.12242] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [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] [Accepted: 02/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examines the social relationships of elementary school children with high-functioning autism, focusing on how gender relates to social preferences and acceptance, social connections, reciprocal friendships, and rejection. METHOD Peer nomination data were analyzed for girls with and without ASD (n = 50) and boys with and without ASD (n = 50). Girls and boys with ASD were matched by age, gender, and IQ. Each child with ASD was matched by age and gender to a typically developing classmate. RESULTS Consistent with typically developing populations, children with ASD preferred, were accepted by, and primarily socialized with same-gender friends. With fewer nominations and social relationships, girls and boys with ASD appear more socially similar to each other than to the same-gender control group. Additionally, girls and boys with ASD showed higher rates of social exclusion than their typically developing peers. However, boys with ASD were more overtly socially excluded compared to girls with ASD, who seemed to be overlooked, rather than rejected. CONCLUSIONS Our data suggest a number of interesting findings in the social relationships of children with ASD in schools. Like typically developing populations, children with ASD identify with their own gender when socializing and choosing friends. But given the social differences between genders, it is likely that girls with ASD are experiencing social challenges that are different from boys with ASD. Therefore, gender is an important environmental factor to consider when planning social skills interventions at school.
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Affiliation(s)
- Michelle Dean
- Center for Autism Research and Treatment; University of California; Los Angeles CA USA
| | - Connie Kasari
- Center for Autism Research and Treatment; University of California; Los Angeles CA USA
- Human Development and Psychology; University of California; Los Angeles CA USA
| | - Wendy Shih
- Center for Autism Research and Treatment; University of California; Los Angeles CA USA
| | - Fred Frankel
- Center for Autism Research and Treatment; University of California; Los Angeles CA USA
| | - Rondalyn Whitney
- Kennedy Krieger Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Rebecca Landa
- Kennedy Krieger Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Catherine Lord
- Center for Autism and the Developing Brain; Weill Cornell Medical College; New York NY USA
| | - Felice Orlich
- Seattle Children's Hospital; University of Washington; Seattle WC USA
| | - Bryan King
- Seattle Children's Hospital; University of Washington; Seattle WC USA
| | - Robin Harwood
- Health Resources and Services Administration; Rockville MD USA
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Kasari C, Lawton K, Shih W, Barker TV, Landa R, Lord C, Orlich F, King B, Wetherby A, Senturk D. Caregiver-mediated intervention for low-resourced preschoolers with autism: an RCT. Pediatrics 2014; 134:e72-9. [PMID: 24958585 PMCID: PMC4531276 DOI: 10.1542/peds.2013-3229] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare 2 short-term, community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low resources. Low resource was defined by the US Department of Housing and Urban Development low-income index or 1 "indicator," (e.g., Medicaid eligibility). Child outcomes focused on joint engagement, joint attention, and play. METHODS Participants included 112 families of a child who had Autism Spectrum Disorder who met criteria for being low-resourced and who were randomly assigned to 1 of 2 3-month interventions, group caregiver education or individualized caregiver-mediated intervention (CMM). Children were assessed for social communication skills pre- and post-treatment, and followed up at 3 months. RESULTS All children improved in joint engagement and initiating joint attention, with significantly greater improvement by the CMM group. Outcomes on play skills were mixed, with improvement of symbolic play for the CMM group and no change in functional play skills. Joint engagement maintained over time for the CMM group, and initiating joint attention maintained for both groups over time. CONCLUSIONS This study is among the first randomized trials comparing 2 active interventions with a large sample of low-resourced families. Results suggest improvements in core autism deficits of joint engagement, joint attention, and symbolic play with relatively brief, caregiver-mediated interventions, but additional support is necessary to maintain and generalize these gains over time.
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Affiliation(s)
- Connie Kasari
- Human Development & Psychology,Center for Autism Research & Treatment, and
| | - Kathy Lawton
- The Ohio State University Nisonger Center, andThe Ohio State University Special Education Department, Columbus, Ohio
| | - Wendy Shih
- Biostatistics, University of California, Los Angeles, Los Angeles, California
| | - Tyson V Barker
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | | | - Felice Orlich
- Children's Hospital of Seattle, Seattle, Washington; and
| | - Bryan King
- Children's Hospital of Seattle, Seattle, Washington; and
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University, Tallahassee, Florida
| | - Damla Senturk
- Biostatistics, University of California, Los Angeles, Los Angeles, California
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Kuhlthau K, Orlich F, Hall TA, Sikora D, Kovacs EA, Delahaye J, Clemons TE. Health-Related Quality of Life in children with autism spectrum disorders: results from the autism treatment network. J Autism Dev Disord 2010; 40:721-9. [PMID: 20033762 DOI: 10.1007/s10803-009-0921-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined data collected as a part of the Autism Treatment Network, a group of 15 autism centers across the United States and Canada. Mean Health-Related Quality of Life (HRQoL) scores of the 286 children assessed were significantly lower than those of healthy populations (according to published norms). When compared to normative data from children with chronic conditions, children with ASD demonstrated worse HRQoL for total, psychosocial, emotional and social functioning, but did not demonstrate differing scores for physical and school functioning. HRQoL was not consistently related to ASD diagnosis or intellectual ability. However, it was consistently related to internalizing and externalizing problems as well as repetitive behaviors, social responsiveness, and adaptive behaviors. Associations among HRQoL and behavioral characteristics suggest that treatments aimed at improvements in these behaviors may improve HRQoL.
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Affiliation(s)
- Karen Kuhlthau
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, MA, USA.
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12
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Orlich F, Fleisher BE, Rhine W, Van Meurs K. Neurodevelopmental outcome of neonatal ECMO survivors. Infant Behav Dev 1996. [DOI: 10.1016/s0163-6383(96)90717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brenes-Sáenz A, Lobo-Sanahuja F, García I, Vargas G, Orlich F. [Results of the treatment of osteosarcoma at the National Children's Hospital of Costa Rica]. Bol Med Hosp Infant Mex 1986; 43:544-9. [PMID: 3466600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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