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Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
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Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
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Yang Y, Wang H, Xu H, Yao M, Yu D. Randomized, controlled trial of a mixed early start Denver model for toddlers and preschoolers with autism. Autism Res 2023; 16:1640-1649. [PMID: 37565317 DOI: 10.1002/aur.3006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
The early start Denver model (ESDM) has been extensively studied as a promising early intervention approach for young children with autism spectrum disorder (ASD). Various methodological drawbacks from earlier ESDM investigations must be rectified to expand the application scopes. For this purpose, the present study recruited a very large sample of 249 autistic children (aged 24-47 months), and used a randomized controlled design to compare outcomes from a mixed ESDM (M-ESDM) intervention with a mixed discrete trial teaching (M-DTT) intervention which remains one of the most commonly-used programming for early intervention. Over the course of a 12-week period, both groups (i.e., M-ESDM and M-DTT groups) received 25 h of intensive intervention per week using individual, group, and parent coaching techniques. Findings showed that: (i) the M-ESDM significantly outperformed the M-DTT in enhancing children's developmental abilities in gross motor and personal-social skills for toddlers and preschoolers, as well as in language for preschoolers with mild/moderate ASD and toddlers; and (ii) the M-ESDM dramatically reduced the severity of autistic symptoms in toddlers with severe ASD only, when compared to the M-DTT. However, the M-ESDM did not outperform the M-DTT in terms of improving children's developmental abilities in adaptability and fine motor for toddlers and preschoolers, as well as in language for preschoolers with severe ASD. In addition, when compared to the M-DTT, the M-ESDM did not show an advantage in reducing the severity of autistic symptoms in toddlers with mild/moderate ASD and preschoolers. Clinical Trial Registration: Chinese Clinical Trial Registry. Registration number ChiCTR200039492.
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Affiliation(s)
- Yanyan Yang
- Henan Provincial Medical Key Lab of Child Developmental Behavior and Learning, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hongan Wang
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Haiping Xu
- Henan Provincial Medical Key Lab of Child Developmental Behavior and Learning, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Meiling Yao
- Henan Provincial Medical Key Lab of Child Developmental Behavior and Learning, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dongchuan Yu
- Henan Provincial Medical Key Lab of Child Developmental Behavior and Learning, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
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Nakhal MM, Jayaprakash P, Aburuz S, Sadek B, Akour A. Canagliflozin Ameliorates Oxidative Stress and Autistic-like Features in Valproic-Acid-Induced Autism in Rats: Comparison with Aripiprazole Action. Pharmaceuticals (Basel) 2023; 16:ph16050769. [PMID: 37242552 DOI: 10.3390/ph16050769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Based on their proven anti-inflammatory and antioxidant effects, recent studies have examined the therapeutic potential of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in neurodevelopmental disorders such as autism spectrum disorder (ASD). Therefore, the aim of this study is to assess the effects of subchronic systemic treatment with intraperitoneal (i.p.) canagliflozin (20, 50, and 100 mg/kg) compared to aripiprazole (ARP) (3 mg/g, i.p.) in a valproic acid (VPA)-induced rat model of autism. The behavioral characteristics of ASD, oxidative stress, and acetylcholinesterase (AChE) activity in rats with ASD-like behaviors, which were induced by prenatal exposure to VPA, were evaluated. The behavioral assessment methods used for this study were the open field test (OFT), the marble-burying test (MBT), and the nestlet-shredding test (NST) to examine their exploratory, anxiety, and compulsiveness-like actions, while the biochemical assessment used for this study was an ELISA colorimetric assay to measure ASD biomarker activity in the hippocampus, prefrontal cortex, and cerebellum. Rats that were pretreated with 100 mg/kg of canagliflozin displayed a significantly lower percentage of shredding (1.12 ± 0.6%, p < 0.01) compared to the ARP group (3.52 ± 1.6%). Pretreatment with (20 mg/kg, 50 mg/kg, and 100 mg/kg) canagliflozin reversed anxiety levels and hyperactivity and reduced hyper-locomotor activity significantly (161 ± 34.9 s, p < 0.05; 154 ± 44.7 s, p < 0.05; 147 ± 33.6 s, p < 0.05) when compared with the VPA group (303 ± 140 s). Moreover, canagliflozin and ARP mitigated oxidative stress status by restoring levels of glutathione (GSH) and catalase (CAT) and increasing the levels of malondialdehyde (MDA) in all tested brain regions. The observed results propose repurposing of canagliflozin in the therapeutic management of ASD. However, further investigations are still required to verify the clinical relevance of canagliflozin in ASD.
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Affiliation(s)
- Mohammed Moutaz Nakhal
- Department of Biochemistry and Molecular Biology Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Petrilla Jayaprakash
- Department of Pharmacology & Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Salahdein Aburuz
- Department of Pharmacology & Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 17666, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Bassem Sadek
- Department of Pharmacology & Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 17666, United Arab Emirates
| | - Amal Akour
- Department of Pharmacology & Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 17666, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
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Zhang J, Guo X, Zhang W, Liu D, Chen P, Zhang Y, Ru X. Maternal Variability of Amplitudes of Frequency Fluctuations Is Related to the Progressive Self-Other Transposition Group Intervention in Autistic Children. Brain Sci 2023; 13:774. [PMID: 37239246 PMCID: PMC10216674 DOI: 10.3390/brainsci13050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/03/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
The self-to-other model of empathy (SOME) states that a key reason for the empathic deficiency in autistic individuals is the imbalance of the self-other switch. The existing interventions of theory of mind contain training of self-other transposition ability but combined with other cognitive trainings. The self-other distinction brain areas of autistic individuals have been revealed, but the brain areas of the self-other transposition ability and its intervention have not been investigated. There are normalized amplitudes of low-frequency fluctuations (mALFFs) within 0.01-0.1 Hz and many normalized amplitudes of frequency fluctuations (mAFFs) within 0-0.01, 0.01-0.05, 0.05-0.1, 0.1-0.15, 0.15-0.2, and 0.2-0.25 Hz. Therefore, the current study established a progressive self-other transposition group intervention to specifically and systematically improve autistic children's self-other transposition abilities. The transposition test with a three mountains test, an unexpected location test, and a deception test was used to directly measure autistic children's transposition abilities. The Interpersonal Responsiveness Index Empathy Questionnaire with perspective-taking and fantasy subscales (IRI-T) was used to indirectly measure autistic children's transposition abilities. The Autism Treatment Evaluation Checklist (ATEC) was used to measure autistic children's autism symptoms. The experiment was designed with two (intervention: experimental group vs. control group) independent variables and two (test time: pretest vs. posttest or tracking test) × three (test: transposition test vs. IRI-T test vs. ATEC test) dependent variables. Furthermore, it used eyes-closed resting-state functional magnetic resonance imaging to investigate and compare the relevant maternal mALFFs and average energy rank and energy rank variability of mAFFs of autistic children's transposition abilities, autism symptoms, and intervention effects. The results showed the following: (1) There were many improvements (pretest vs. posttest or tracking test) greater than chance 0 in the experimental group, such as the three mountains, lie, transposition, PT, IRI-T, PT tracking, cognition, behavior, ATEC, language tracking, cognition tracking, behavior tracking, and ATEC tracking improvements. However, there was no improvement greater than chance 0 in the control group. (2) The maternal mALFFs and maternal average energy rank and energy rank variability of mAFFs could predict the autistic children's transposition abilities, autism symptoms, and intervention effects with some overlap and some difference in maternal self-other distinction, sensorimotor, visual, facial expression recognition, language, memory and emotion, and self-consciousness networks. These results indicated that the progressive self-other transposition group intervention successfully improved autistic children's transposition abilities and reduced their autism symptoms; the intervention effects could be applied to daily life and last up to a month. The maternal mALFFs, average energy rank, and energy rank variability of mAFFs were three effective neural indictors of autistic children's transposition abilities, autism symptoms, and intervention effects, and the average energy rank and energy rank variability of mAFFs were two new neural indictors established in the current study. The maternal neural markers of the progressive self-other transposition group intervention effects for autistic children were found in part.
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Affiliation(s)
- Jianxin Zhang
- The Autism Research Center, Soochow University, Suzhou 215123, China;
- School of Education, Jiangnan University, Wuxi 214122, China
| | - Xiaorong Guo
- Department of Radiology, Dushu Lake Public Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215123, China; (X.G.); (W.Z.)
| | - Weiguo Zhang
- Department of Radiology, Dushu Lake Public Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215123, China; (X.G.); (W.Z.)
| | - Dianzhi Liu
- The Autism Research Center, Soochow University, Suzhou 215123, China;
- School of Education, Soochow University, Suzhou 215123, China; (P.C.); (Y.Z.); (X.R.)
| | - Peiqi Chen
- School of Education, Soochow University, Suzhou 215123, China; (P.C.); (Y.Z.); (X.R.)
| | - Yuqing Zhang
- School of Education, Soochow University, Suzhou 215123, China; (P.C.); (Y.Z.); (X.R.)
| | - Xiaoyuan Ru
- School of Education, Soochow University, Suzhou 215123, China; (P.C.); (Y.Z.); (X.R.)
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55
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Ni Z, Qian Y, Yao Z, Zhang S. Understanding the Adoption of Dietary Interventions Within a Chinese Autism Online Community: A Diffusion of Innovations Perspective. HEALTH COMMUNICATION 2023; 38:1266-1277. [PMID: 35260013 DOI: 10.1080/10410236.2022.2048469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dietary interventions are common but controversial treatments for autistic people. This study aims to understand the adoption of dietary interventions based on diffusion of innovations theory in the autism online community from four aspects: popularity, adoption process, the influence of opinion leaders, and post-adoption feedback. Our data was extracted from a Chinese autism community named Baidu Tieba autism forum. We applied a mixed-method including four analytical approaches: descriptive statistics for popularity analysis; machine learning models for automatic data classification and topic detection; social network analysis for exploring the influence of opinion leaders on the adoption phase; content analysis for revealing the family caregiver-reported feedback after adoption. Dietary interventions have become increasingly popular in the autism online community since 2018. Analysis of the adoption process revealed that family caregivers at different stages of adoption focused on different topics, and the number of interactions with opinion leaders had a significant effect on the highest level (p < .001) and stage span (p < .001) of health information adoption. According to findings from the feedback of family caregivers, the effects of dietary interventions varied from individuals with autism. Our study revealed the diffusion of unproven interventions, which is of great significance in promoting evidence-based practices.
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Affiliation(s)
- Zhenni Ni
- School of Information Management, Wuhan University
- Center for Studies of Information Resources, Wuhan University
- Big Data Institute, Wuhan University
| | - Yuxing Qian
- School of Information Management, Wuhan University
- Center for Studies of Information Resources, Wuhan University
- Big Data Institute, Wuhan University
- Wee Kim Wee School of Communication and Information, Nanyang Technological University
| | - Zhizhen Yao
- School of Information Management, Wuhan University
- Center for Studies of Information Resources, Wuhan University
- Department of Information Systems, College of Business, City University of Hong Kong
| | - Shuai Zhang
- School of Information Management, Wuhan University
- Center for Studies of Information Resources, Wuhan University
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56
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Vacca RA, Augello A, Gallo L, Caggianese G, Malizia V, La Grutta S, Murero M, Valenti D, Tullo A, Balech B, Marzano F, Ghezzo A, Tancredi G, Turchetta A, Riccio MP, Bravaccio C, Scala I. Serious Games in the new era of digital-health interventions: A narrative review of their therapeutic applications to manage neurobehavior in neurodevelopmental disorders. Neurosci Biobehav Rev 2023; 149:105156. [PMID: 37019246 DOI: 10.1016/j.neubiorev.2023.105156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/10/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
Children and adolescents with neurodevelopmental disorders generally show adaptive, cognitive and motor skills impairments associated with behavioral problems, i.e., alterations in attention, anxiety and stress regulation, emotional and social relationships, which strongly limit their quality of life. This narrative review aims at providing a critical overview of the current knowledge in the field of serious games (SGs), known as digital instructional interactive videogames, applied to neurodevelopmental disorders. Indeed, a growing number of studies is drawing attention to SGs as innovative and promising interventions in managing neurobehavioral and cognitive disturbs in children with neurodevelopmental disorders. Accordingly, we provide a literature overview of the current evidence regarding the actions and the effects of SGs. In addition, we describe neurobehavioral alterations occurring in some specific neurodevelopmental disorders for which a possible therapeutic use of SGs has been suggested. Finally, we discuss findings obtained in clinical trials using SGs as digital therapeutics in neurodevelopment disorders and suggest new directions and hypotheses for future studies to bridge the gaps between clinical research and clinical practice.
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Bertamini G, Perzolli S, Bentenuto A, Paolizzi E, Furlanello C, Venuti P. Child-therapist interaction features impact Autism treatment response trajectories. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104452. [PMID: 36796270 DOI: 10.1016/j.ridd.2023.104452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AIMS The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. METHODS AND PROCEDURES N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. OUTCOMES AND RESULTS Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. CONCLUSIONS AND IMPLICATIONS Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.
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Affiliation(s)
- Giulio Bertamini
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; Department of Child and Adolescent Psychiatry, Pitie-Salpetriere University Hospital, Sorbonne University, 75013 Paris, France; Data Science for Health (DSH), Bruno Kessler Foundation, 38123 Trento, Italy; Institute for Ingelligent Systems and Robotics (ISIR), Sorbonne University, 75005 Paris, France.
| | - Silvia Perzolli
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Eleonora Paolizzi
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Cesare Furlanello
- Orobix Life Sciences, 24121 Bergamo, Italy; HK3Lab, 38068 Rovereto, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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Eckes T, Buhlmann U, Holling HD, Möllmann A. Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder - a meta-analysis. BMC Psychiatry 2023; 23:133. [PMID: 36864429 PMCID: PMC9983163 DOI: 10.1186/s12888-022-04412-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Many studies display promising results for interventions that are based on Applied Behavior Analysis (ABA) in the treatment of autism spectrum disorder (ASD). METHODS This meta-analysis assessed the effects of such treatments on developmental outcomes in children with ASD and on parental stress based on 11 studies with 632 participants. RESULTS Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning (standardized mean difference SMD = 0.51, 95% CI [0.09; 0.92]) and adaptive behavior (SMD = 0.37, 95% CI [0.03; 0.70]). Language abilities, symptom severity or parental stress did not improve beyond the improvement in control groups. Moderator analyses indicate that language abilities at intake could influence the effect sizes and the influence of treatment intensity might decrease with older age. CONCLUSIONS Practical implications and limitations are discussed.
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Affiliation(s)
- Theresa Eckes
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Heinz-Dieter Holling
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Anne Möllmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany.
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany.
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59
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Rollins PR, De Froy AM. Reexamining Pathways Early Autism Intervention in Children Before and After the Third Birthday: A Randomized Control Trial. J Autism Dev Disord 2023; 53:1189-1201. [PMID: 35596830 PMCID: PMC9123830 DOI: 10.1007/s10803-022-05599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
We reexamined the efficacy of Pathways early autism intervention using generalized measures of social communication and language skills administered by an unfamiliar adult in a novel environment. Generalized measures improve on sources of measurement bias. Sixty-seven autistic children blocked on age (under versus over 3 years) were randomly assigned to 15 weeks of Pathways or services-as-usual. Age moderated the effects of Pathways for social communication. Specifically, Pathways had a significantly large effect for children under 3 and a small effect that approached significance for children over 3. Pathways also had a small effect on expressive speech/language skills. Results replicate previous findings of the efficacy of Pathways on proximal and distal skills and support the importance of early intervention.
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Affiliation(s)
- Pamela Rosenthal Rollins
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1966 Inwood Road, Dallas, TX, 75235, USA.
| | - Adrienne M De Froy
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1966 Inwood Road, Dallas, TX, 75235, USA
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60
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Eapen V, Karlov L, John JR, Beneytez C, Grimes PZ, Kang YQ, Mardare I, Minca DG, Voicu L, Malek KA, Ramkumar A, Stefanik K, Gyori M, Volgyesi-Molnar M. Quality of life in parents of autistic children: A transcultural perspective. Front Psychol 2023; 14:1022094. [PMID: 36910746 PMCID: PMC9996029 DOI: 10.3389/fpsyg.2023.1022094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The concepts of health, illness, and disability as well as the perceptions of autism and quality of life (QoL) vary greatly across cultures and across time. This study sought to explore the interplay of culture on QoL and impact on parents caring for autistic children. Methods We used a transcultural dataset from seven countries (Australia, Hungary, Malaysia, Romania, Singapore, Spain, and the United Kingdom) with participating parents/carers reporting on the Quality of Life in Autism (QoLA) questionnaire. The QoLA questionnaire is a validated measure of QoL for parents of autistic children, with Part A subscale measuring parental QoL and part B subscale assessing the parental impact of the child's autism spectrum disorder (ASD) symptoms or features. We used the Quade's ranked analysis of covariance to determine significant differences between the countries in relation to QoLA Part A and Part B scores while adjusting for baseline differences using covariates such as parents' gender, child's age, and gender. Additionally, a post-hoc analysis with Bonferroni correction was also conducted to examine multiple pairwise comparisons. Results and conclusion We found that while the effect of features of ASD (Part B subscale) stayed strongly comparable between cultures, the self-reported parental QoL was most likely determined by different aspects of culture in different countries. It is concluded that while the ASD symptoms or features appear to affect parents in the same way across different countries, the parental QoL may be a culturally informed construct.
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Affiliation(s)
- Valsamma Eapen
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Karlov
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmen Beneytez
- Equipo Especifico Alteraciones Graves del Desarrollo, Consejería de Educación de Madrid, Madrid, Spain
| | - Poppy Z. Grimes
- Swalcliffe Park School CIO, Oxfordshire, United Kingdom
- Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Ying Qi Kang
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute (KTP-NUCMI), National University Hospital, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ileana Mardare
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dana Galieta Minca
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Laura Voicu
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Aishworiya Ramkumar
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute (KTP-NUCMI), National University Hospital, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Krisztina Stefanik
- Institute of Special Needs Education for People with Atypical Behavior and Cognition, ELTE University Budapest, Budapest, Hungary
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
| | - Miklos Gyori
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
- Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Marta Volgyesi-Molnar
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
- Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
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Abstract
Relative to males, women with autism spectrum disorder (ASD) have neurobiological and clinical presentation differences. Recent research suggests that the male/female ASD prevalence gap is smaller than previously reported. Sex differences in symptom presentation as well as the male bias of ASD account for delayed/missed diagnosis among women. Investigating ASD and providing psychological evaluation referrals for women who are struggling socially and present with complex mental health conditions (e.g., ADHD, depression), even when they do not show typical autistic characteristics, is important. Accurate diagnosis facilitates understanding of challenges, increases access to treatments, and alleviates the burden of ASD.
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Affiliation(s)
- Cesar Ochoa-Lubinoff
- Rush University Medical Center, 1725 West Harrison Street, Suite 710, Chicago, IL 60612, USA.
| | - Bridget A Makol
- Rush University Medical Center, 1653 West Congress Parkway, 12 Kellogg, Chicago, IL 60612, USA
| | - Emily F Dillon
- Rush University Medical Center, 1645 West Jackson Boulevard, Chicago, IL 60612, USA
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62
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Roberts MY, Sone BJ, Jones M, Grauzer J, Sudec L, Stern YS, Kwok E, Losh M, Kaat A. One size does not fit all for parent-mediated autism interventions: A randomized clinical trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:443-455. [PMID: 35695680 PMCID: PMC9744957 DOI: 10.1177/13623613221102736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
LAY ABSTRACT Parent-mediated interventions support parents' use of language facilitation strategies to improve their autistic child's communication and language development. To improve the effectiveness of parent-mediated interventions, it is important to individualize interventions. This article evaluates how different components of parent-mediated interventions and mothers' learning styles influence the effectiveness of the intervention. In a randomized clinical trial, mothers were taught to use one of two types of language facilitation strategies: responsive and directive. Mothers' learning styles were characterized by the Broad Autism Phenotype (BAP) and their natural tendency to use language facilitation strategies before intervention. Findings suggest that it was easier for all mothers (irrespective of learning style) to use responsive strategies compared to directive strategies. In addition, mothers with learning styles that were not consistent with the BAP were more likely to benefit from the intervention if they did not naturally use strategies before the intervention. In contrast, mothers with learning styles that were consistent with the BAP were more likely to benefit from the intervention if they did naturally use strategies before the intervention. Teaching mothers to use responsive strategies results in greater strategy use. Consideration of BAP and mothers' natural use of language facilitation strategies may inform intervention individualization.
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Affiliation(s)
- Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
- Feinberg School of Medicine; Department of Medical Social Sciences, Northwestern University
| | - Bailey J. Sone
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Maranda Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Laura Sudec
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Elaine Kwok
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
- Feinberg School of Medicine; Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Aaron Kaat
- Feinberg School of Medicine; Department of Medical Social Sciences, Northwestern University
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63
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Bowman-Perrott L, Gilson C, Boon RT, Ingles KE. Peer-Mediated Interventions for Students with Intellectual and Developmental Disabilities: A Systematic Review of Reviews of Social and Behavioral Outcomes. Dev Neurorehabil 2023; 26:134-154. [PMID: 36892164 DOI: 10.1080/17518423.2023.2169878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Peer-mediated interventions (PMIs) have been firmly established as evidence-based approaches for facilitating peer relationships among students with and without disabilities. We conducted a review of reviews evaluating PMI studies to support social skills and positive behavioral outcomes for children, adolescents, and young adults with intellectual and developmental disabilities (IDD). A total of 4,254 individuals with IDD were participants across 43 reviews of the literature, reflecting 357 unique studies. This review includes coding related to participant demographic information, intervention characteristics, implementation fidelity, social validity, and social outcomes addressed by PMIs across reviews. Our findings suggest that PMIs yield positive social and behavioral outcomes for individuals with IDD, mostly in the areas of peer engagement and initiating social interactions. Specific skills, motor behaviors, and challenging as well as prosocial behaviors were less likely to be examined across studies. Implications for research and practice to support the implementation of PMIs will be discussed.
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Affiliation(s)
- Lisa Bowman-Perrott
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Carly Gilson
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Richard T Boon
- Department of Interdisciplinary Learning and Teaching, The University of Texas at San Antonio San Antonio, TX, USA
| | - Kristina E Ingles
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
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64
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Kavanaugh BC, Schremp CA, Jones RN, Best CR, Sheinkopf SJ, Morrow EM. Moderators of Age of Diagnosis in > 20,000 Females with Autism in Two Large US Studies. J Autism Dev Disord 2023; 53:864-869. [PMID: 33961180 DOI: 10.1007/s10803-021-05026-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to determine the clinical features that moderate a later age at ASD diagnosis in females in a large sample of females with ASD. Within two large and independent ASD datasets (> 20,000 females), females were first diagnosed with ASD 14-months later relative to males. This later age at diagnosis was moderated by a mild or atypical presentation, wherein repetitive behaviors were limited, IQ and language were broadly intact, and recognized symptoms emerged later in development. Females are at risk for a later age at ASD diagnosis and treatment implementation, and modification of early childhood ASD screening methods for females may be warranted.
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Affiliation(s)
- Brian C Kavanaugh
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Christine A Schremp
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Carrie R Best
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Stephen J Sheinkopf
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric M Morrow
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA. .,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI, USA. .,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, RI, USA. .,Laboratories for Molecular Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA.
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65
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Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
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66
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Torralbas-Ortega J, Valls-Ibáñez V, Roca J, Sastre-Rus M, Campoy-Guerrero C, Sala-Corbinos D, Sánchez-Fernández M. Affectivity and Sexuality in Adolescents with Autism Spectrum Disorder from the Perspective of Education and Healthcare Professionals: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2497. [PMID: 36767863 PMCID: PMC9915282 DOI: 10.3390/ijerph20032497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
People with autism spectrum disorder (ASD) present several different characteristics that predispose them to greater difficulties with intimate emotional and sexual relationships. This qualitative study uncovers the perspective of education and healthcare professionals on the affective and sexual needs of young people with ASD by analysing their narratives in semi-structured focus group sessions. Professionals highlight the inadequate training they receive in this aspect of health. They consider it should be commonplace for professionals working with autistic people as it would aid their collaborative efforts when treating children and adolescents with ASD. They show that, by working together with the families to establish joint objectives, these professionals can appropriately address sex and affective education, preventing risky behaviours among young people with ASD, and improving the interactions these individuals have with others. Sex and affective education is described as an indispensable tool at this stage of development and should be specially adapted for those with ASD.
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Affiliation(s)
- Jordi Torralbas-Ortega
- Hospital de la Santa Creu i Sant Pau, Nursing Care Research Group, Sant Pau Biomedical Research Institute (IIB SANT PAU), 08041 Barcelona, Spain
| | | | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain
- Research Group of Health Care (GRECS), IRB Lleida, 25198 Lleida, Spain
| | - Meritxell Sastre-Rus
- Hospital de la Santa Creu i Sant Pau, Nursing Care Research Group, Sant Pau Biomedical Research Institute (IIB SANT PAU), 08041 Barcelona, Spain
| | | | - Dolores Sala-Corbinos
- Child and Adolescent Day Hospital, Sant Joan de Déu-Terres de Lleida, 25001 Lleida, Spain
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de Voss S, Wilson P, Saxild S, Overbeck G. Increasing the psychosocial focus in child developmental assessments: a qualitative study. BMC Pediatr 2023; 23:44. [PMID: 36698093 PMCID: PMC9875422 DOI: 10.1186/s12887-023-03849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Previous studies have indicated a need for increased psychosocial focus on children and their families to improve children's wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments. METHODS This is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory. RESULTS General practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent-child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians' ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme. CONCLUSION Clinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent-child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation. TRIAL REGISTRATION Trial registry number for the FamilieTrivsel (Family Wellbeing) trial: NCT04129359.
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Affiliation(s)
- Sarah de Voss
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Philip Wilson
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark ,grid.7107.10000 0004 1936 7291Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Old Perth Road Inverness, IV2 3JH Aberdeen, Scotland
| | - Sofie Saxild
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Gritt Overbeck
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
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68
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Roberts MY, Stern YS, Grauzer J, Nietfeld J, Thompson S, Jones M, Kaat AJ, Kaiser AP. Teaching Caregivers to Support Social Communication: Results From a Randomized Clinical Trial of Autistic Toddlers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:115-127. [PMID: 36525627 PMCID: PMC10023141 DOI: 10.1044/2022_ajslp-22-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Studies of early caregiver-mediated interventions targeting social communication of young autistic children have yielded variable child outcomes. This study examined the effects of combining two caregiver-mediated interventions on caregiver strategy use and child social communication and language outcomes. METHOD This was a multisite parallel randomized controlled trial. Participants included 120 caregivers and their autistic children between 24 and 36 months of age. Dyads were randomly assigned to receive a hybrid intervention that combined Enhanced Milieu Teaching (EMT) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) or to a behavior management control condition, each delivered over 6 months. Caregivers in the JASP-EMT group received twice-weekly, in-home, and hour-long sessions. Outcomes were measured at baseline, the end of intervention (T1), and 6 months later (T2) and included a naturalistic language sample procedure, standardized measures, and caregiver report measures. This trial was registered at clinicaltrials.gov (NCT02595697). RESULTS Child outcomes did not differ between conditions at T1 or T2 for child primary (social communication) or secondary (language, play, and autism symptoms) outcomes. Relative to control group caregivers, intervention group caregivers demonstrated significantly higher use of JASP-EMT strategies at T1 and T2, with the exception of two strategies (Responsiveness and Matched Responsiveness), which were used significantly more by control group caregivers. Neither autism severity nor baseline caregiver responsiveness moderated outcomes. Post hoc analyses revealed significant correlations between specific strategies and all child outcomes. CONCLUSIONS Twice-weekly caregiver-mediated intervention that taught caregivers of autistic children to use social communication support strategies did not yield significant child outcomes. Future studies should examine possible sources for the lack of main effects including unexpected differences in linguistic features of caregiver input, changes in control group caregiver behavior, and insufficient intervention dosage. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21714278.
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Affiliation(s)
- Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jennifer Nietfeld
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Suzanne Thompson
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Maranda Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ann P. Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN
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Maksimović S, Marisavljević M, Stanojević N, Ćirović M, Punišić S, Adamović T, Đorđević J, Krgović I, Subotić M. Importance of Early Intervention in Reducing Autistic Symptoms and Speech-Language Deficits in Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010122. [PMID: 36670672 PMCID: PMC9857540 DOI: 10.3390/children10010122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/05/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
The intervention focused on starting treatment at an early age to develop the child’s full potential, which is known as early intervention. Given that autistic symptoms and language deficits occur at an early age and affect other areas of development in children with autistic spectrum disorder, we wanted to examine if early intervention is more effective in the reduction in autistic symptoms and language deficits in children aged 36−47 months old when compared to children 48−60 months old. The sample consisted of 29 children diagnosed with ASD who were admitted for integrative therapy. All participants were divided into two groups based on age: G1: 36−47 months old children, and G2: 48−60 months old children. To estimate the presence of autistic symptoms, we used the GARS-3, and for the assessment of speech−language abilities, we used the subscale Estimated Speech and Language Development (ESLD). Our results regarding the effect of the group on the difference in the scores at two time points showed that there was a statistically significant effect of the group on the reduction in autistic symptoms (p < 0.05) but no effect of the group on the differences in speech−language abilities between the two time points (p > 0.05). Our study highlights the importance of emphasizing the exact age when using the terms “early intervention” and “early development” in future studies and practice because it is necessary to determine and establish guidelines about which particular ages are crucial for starting treatment in certain developmental aspects.
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Affiliation(s)
- Slavica Maksimović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Maša Marisavljević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Nina Stanojević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
- Correspondence:
| | - Milica Ćirović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Silvana Punišić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Tatjana Adamović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Jelena Đorđević
- Clinic for Neurology and Psychiatry for Children and Youth, 11000 Belgrade, Serbia
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Krgović
- Institute for Children’s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
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Ji Y, Ji Y, Zhu HL, Cheng SM, Zou XB, Zhu FL. Examine sex differences in autism spectrum disorder in school-aged children and adolescents with fluent language. Front Psychiatry 2023; 14:1151596. [PMID: 37091718 PMCID: PMC10117662 DOI: 10.3389/fpsyt.2023.1151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
There are noteworthy sex disparities in the prevalence of autism spectrum disorders (ASD), while findings regarding the sex differences in core symptoms are inconsistent. There are few relevant studies on sex differences in mainland China. This study was dedicated to a deeper understanding of the impact of sex differences on the clinical presentation of ASD with fluent language. We retrospectively studied 301 children with ASD (58 females) and utilized raw scores from the ADI-R and ADOS and the intelligence quotient (IQ) to measure symptomatology. Based on the Full-Scale IQ (FS-IQ), a binary split of average, above-average IQ (high-IQ), and below-average IQ (low IQ) occurs at 85. Across the entire sample, males and females are comparable in the FS-IQ, while males scored higher in the Perceptual Reasoning Index (PRI) (F = 7.812, p = 0.006). ADI-R did not find any statistically significant sex differences in the diagnostic cutoff score satisfaction or the raw domain scores. While a significant effect of sex on ADOS social affect domain scores was found in the total sample [λ = 0.970, partial η2 = 0.030, F (3,295) = 3.019, p = 0.030]. Tests of between-subjects effects revealed that males scored higher than females mainly in the ADOS reciprocal social interaction subcategory (partial η2 = 0.022, F = 6.563, p = 0.011). Stratified analysis revealed that the effect of sex on ADOS reciprocal social interaction subcategory scores only significant in the low-IQ children with ASD (partial η2 = 0.092, F = 10.088, p = 0.002). In general, overall cognitive functioning is similar across males and females with ASD, while males have a higher perceptual reasoning ability. Females with ASD are more likely to have comorbid intellectual impairment than males, and they could require additional intervention support. Autistic children with low IQs are more likely to exhibit sex differences in their core symptoms than children with high IQs. Intelligence plays a key role in sex-based differences in the core symptoms of ASD.
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71
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Kwok E, Feiner H, Grauzer J, Kaat A, Roberts MY. Measuring Change During Intervention Using Norm-Referenced, Standardized Measures: A Comparison of Raw Scores, Standard Scores, Age Equivalents, and Growth Scale Values From the Preschool Language Scales-Fifth Edition. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4268-4279. [PMID: 36346974 PMCID: PMC9940886 DOI: 10.1044/2022_jslhr-22-00122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/25/2022] [Accepted: 07/30/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Norm-referenced, standardized measures are tools designed to characterize a child's abilities relative to their same-age peers, but they also have been used to measure changes in skills during intervention. This study compared the psychometric properties of four types of available scores from one commonly used standardized measure, the Preschool Language Scales-Fifth Edition (PLS-5), to detect changes in children's language skills during and after a language intervention. METHOD This study included data from 110 autistic children aged 18-48 months whose mother participated in an 8-week parent-mediated language intervention. Children's language skills were measured at 3 time points using the PLS-5. Changes in children's expressive and receptive language skills were calculated using raw scores, standard scores, age equivalents, and growth scale values (GSVs). RESULTS Analysis of raw scores, age equivalents, and GSVs indicated significant improvement in the scores of autistic children in both receptive and expressive language throughout the study (i.e., during the intervention period and in the 3-month period after the intervention). Standard scores suggested improvement only in the receptive language scale during the intervention period. Standard scores showed a floor effect for children who scored at -3 SD below the mean. CONCLUSIONS Findings suggested that GSVs were not only psychometrically sound but also the most sensitive measure of direct changes in skills compared to raw, standard, and age-equivalent scores. Floor effects may limit the sensitivity of standard scores to detect changes in children's skills. Strengths, limitations, and interpretations of each of the scoring approaches in measuring changes in skills during intervention were discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21498522.
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Affiliation(s)
- Elaine Kwok
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Hannah Feiner
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL
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Asta L, Persico AM. Differential Predictors of Response to Early Start Denver Model vs. Early Intensive Behavioral Intervention in Young Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:1499. [PMID: 36358426 PMCID: PMC9688546 DOI: 10.3390/brainsci12111499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 08/12/2023] Open
Abstract
The effectiveness of early intensive interventions for Autism Spectrum Disorder (ASD) is now well-established, but there continues to be great interindividual variability in treatment response. The purpose of this systematic review is to identify putative predictors of response to two different approaches in behavioral treatment: Early Intensive Behavioral Interventions (EIBI) and the Early Start Denver Model (ESDM). Both are based upon the foundations of Applied Behavioral Analysis (ABA), but the former is more structured and therapist-driven, while the latter is more naturalistic and child-driven. Four databases (EmBase, PubMed, Scopus and WebOfScience) were systematically screened, and an additional search was conducted in the reference lists of relevant articles. Studies were selected if participants were children with ASD aged 12-48 months at intake, receiving either EIBI or ESDM treatment. For each putative predictor, p-values from different studies were combined using Fisher's method. Thirteen studies reporting on EIBI and eleven on ESDM met the inclusion criteria. A higher IQ at intake represents the strongest predictor of positive response to EIBI, while a set of social cognitive skills, including intention to communicate, receptive and expressive language, and attention to faces, most consistently predict response to ESDM. Although more research will be necessary to reach definitive conclusions, these findings begin to shed some light on patient characteristics that are predictive of preferential response to EIBI and ESDM, and may provide clinically useful information to begin personalizing treatment.
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Affiliation(s)
| | - Antonio M. Persico
- Child & Adolescent Neuropsychiatry Program, Modena University Hospital, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Fisher AP, Lynch JD, Jacquez FM, Mitchell MJ, Kamimura-Nishimura KI, Wade SL. A systematic review examining caregivers’ of color experiences with the diagnostic process of autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:876-889. [PMID: 36321366 DOI: 10.1177/13623613221128171] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There are racial/ethnic disparities in the diagnosis of autism spectrum disorder, including delayed diagnosis, discrimination, and a lack of culturally responsive care. The perspectives of caregivers of color are critical in improving delivery of equitable care. We systematically reviewed articles pertaining to experiences with the diagnostic process among caregivers of color. We entered key terms into five databases to identify literature from 2000 to 2021. Fifteen qualitative studies met inclusion criteria, representing 253 caregivers. We used inductive methods to examine themes across racial and ethnic groups and assessed the quality of included studies. Families of color identified multiple factors that negatively affected the diagnostic process. Systems-level factors included long wait lists and financial concerns. Provider-level factors included minimization of caregiver concerns, a “wait and see” approach, biases, and lack of knowledge. Caregivers also described individual (e.g. knowledge) and family factors (e.g. stigma) that delayed diagnosis and complicated the diagnostic process. Communication barriers were commonly reported, which impeded understanding of autism spectrum disorder. Some families described providers, other individuals, community networks, and self-advocacy as facilitators. Interventions targeting systems- (e.g. Medicaid expansion) and provider-level (e.g. increase training in autism spectrum disorder) factors are needed to increase equity in the autism spectrum disorder diagnostic process. Lay abstract Children of color are diagnosed with autism later than White children. Caregivers of color are also more likely than White caregivers to report that their child’s healthcare providers do not treat them as a partner, spend enough time with them, or respect their culture and values. We wanted to better understand the experiences of caregivers of color with the diagnostic process of autism spectrum disorder, from the time they discuss developmental concerns with their child’s primary care provider to when the diagnosis is shared with them. We systematically reviewed the literature and found 15 articles that explored the experiences of caregivers of color. Caregivers of color described that they faced large-scale barriers, such as the cost of appointments, transportation, and long wait lists. They also reported negative experiences with providers, including providers not taking their concerns seriously, making assumptions about caregivers, and delaying referrals for an evaluation. Caregivers stated that their own lack of knowledge of autism spectrum disorder, stigma, their family’s thoughts and opinions, and cultural differences between providers and caregivers served as barriers during the diagnostic process. Communication challenges were discussed and included use of medical and technical jargon, a lack of follow-up, language barriers, and difficulty obtaining high-quality interpreters. Some families described providers, other individuals, community networks, and self-advocacy as helpful during the diagnostic process. Large-scale changes are needed, such as increases in the number of providers who are trained in diagnosing Autism. Provider-level changes (e.g. implicit bias training) are also important for improving caregivers’ experiences.
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Affiliation(s)
- Allison P Fisher
- Cincinnati Children’s Hospital Medical Center, USA
- University of Cincinnati, USA
| | - James D Lynch
- Cincinnati Children’s Hospital Medical Center, USA
- University of Cincinnati, USA
| | | | - Monica J Mitchell
- Cincinnati Children’s Hospital Medical Center, USA
- University of Cincinnati College of Medicine, USA
| | | | - Shari L Wade
- Cincinnati Children’s Hospital Medical Center, USA
- University of Cincinnati College of Medicine, USA
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74
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Baribeau DA, Hoang N, Selvanayagam T, Stavropoulos DJ, Costain G, Scherer SW, Vorstman J. Developmental implications of genetic testing for physical indications. Eur J Hum Genet 2022; 30:1297-1300. [PMID: 36068265 PMCID: PMC9626575 DOI: 10.1038/s41431-022-01181-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023] Open
Abstract
In children undergoing genetic testing for physical health concerns, we examined how often the results also revealed information about their risk for neurodevelopmental disorders. The study sample consisted of 3056 genetic tests (1686 chromosomal microarrays--CMAs, and 1378 next-generation sequencing--NGS panels) ordered at a tertiary pediatric hospital because of a physical/congenital health problem. Tests ordered to investigate developmental concerns were excluded. Pathogenic, or likely pathogenic variants were manually reviewed for diagnostic likelihood, and for evidence of an association with a neurodevelopmental disorder (e.g., autism or intellectual disability). A total of 169 CMAs (10%) and 232 NGS panels (17%) had likely diagnostic results. More than half (52%) of all diagnostic results had established evidence of a neurodevelopmental disorder association. In summary, there is a high prevalence of neurodevelopmental implications from genetic tests ordered for physical/congenital indications. This broad clinical utility suggests a growing need for genetics-first developmental care pathways.
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Affiliation(s)
- Danielle A Baribeau
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Ny Hoang
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - Thanuja Selvanayagam
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - D James Stavropoulos
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gregory Costain
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen W Scherer
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
- The Centre for Applied Genomics, SickKids Research Institute, Toronto, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada.
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada.
- Autism Research Unit, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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75
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Hadders-Algra M. The developing brain: Challenges and opportunities to promote school readiness in young children at risk of neurodevelopmental disorders in low- and middle-income countries. Front Pediatr 2022; 10:989518. [PMID: 36340733 PMCID: PMC9634632 DOI: 10.3389/fped.2022.989518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
This paper discusses possibilities for early detection and early intervention in infants with or at increased risk of neurodevelopmental disorders in low- and middle-income countries (LMICs). The brain's high rate of developmental activity in the early years post-term challenges early detection. It also offers opportunities for early intervention and facilitation of school readiness. The paper proposes that in the first year post-term two early detection options are feasible for LMICs: (a) caregiver screening questionnaires that carry little costs but predict neurodevelopmental disorders only moderately well; (b) the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment (SINDA) which are easy tools that predict neurodisability well but require assessment by health professionals. The young brain's neuroplasticity offers great opportunities for early intervention. Ample evidence indicates that families play a critical role in early intervention of infants at increased risk of neurodevelopmental disorders. Other interventional key elements are responsive parenting and stimulation of infant development. The intervention's composition and delivery mode depend on the infant's risk profile. For instance, in infants with moderately increased risk (e.g., preterm infants) lay community health workers may provide major parts of intervention, whereas in children with neurodisability (e.g., cerebral palsy) health professionals play a larger role.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Theology and Religious Studies, Groningen, The Netherlands
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76
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Song C, Wu L, Hong Y, Chen X, Zhu Z. Factors affecting knowledge of autism spectrum disorder among pediatric residents in eastern China: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:699. [PMID: 36192723 PMCID: PMC9528050 DOI: 10.1186/s12909-022-03770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a global increase in the prevalence of autism spectrum disorder (ASD). Early identification of ASD in children and intervention are key aspects in the management of ASD. However, early identification is partly dependent on knowledge on ASD among pediatricians. This study analyzed the extent of ASD knowledge and its underlying factors among pediatric residents in eastern China, to provide a reference for medical education reforms. METHODS The study employed the Knowledge about Childhood Autism among Health Workers questionnaire. A total of 138 pediatric residents participated in the survey. Descriptive statistics were used to describe demographic characteristics and the four domains of the questionnaire. Univariate analysis was employed to assess impacts of the demographic characteristics on the questionnaire scores. On the other hand, multivariate regression analysis was used to analyze the correlation between the participants' demographic characteristics and the questionnaire scores. RESULTS The average ASD cognitive score of 138 respondents was 13.38 ± 4.48. The ASD cognitive scores in female pediatric residents were higher compared to that in males (p < 0.05). Residents who had obtained professional doctor qualification certificate were more than those without professional doctor qualification certificate (p < 0.05). The ASD knowledge in the group which did not have rotation in both departments was lower than in the group which had rotation in both departments (p < 0.05) as well as the group that had rotation in developmental and behavioral pediatrics department only (p < 0.05). Our multivariate linear regression model demonstrated significant statistical differences (p < 0.05), and showed that gender and systematic exposure to ASD knowledge had significant effects on cognitive scores (p < 0.05). CONCLUSION Most participants had relatively low levels of awareness and knowledge about ASD, especially on ASD comorbidities and age of onset. Women, systematic learning of ASD knowledge in medical school, successful passing of the physician examination, and rotation in the developmental and behavioral pediatrics (DBP) department significantly influence the levels of ASD awareness and knowledge. It is, therefore, important to strengthen ASD education in medical students at the university level and make rotation in the DBP department a requisite for pediatric trainees.
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Affiliation(s)
- Chao Song
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Lingling Wu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Yunxia Hong
- Education Office, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Xiaoyang Chen
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Zhiwei Zhu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
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77
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Schuck RK, Tagavi DM, Baiden KMP, Dwyer P, Williams ZJ, Osuna A, Ferguson EF, Jimenez Muñoz M, Poyser SK, Johnson JF, Vernon TW. Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord 2022; 52:4625-4645. [PMID: 34643863 PMCID: PMC9508016 DOI: 10.1007/s10803-021-05316-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/25/2022]
Abstract
Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA.
| | - Daina M Tagavi
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, CA, USA
- Center for Mind and Brain, University of California, Davis, Davis, CA, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Anthony Osuna
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily F Ferguson
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Maria Jimenez Muñoz
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Samantha K Poyser
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ty W Vernon
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
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78
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Feng Y, Chen K, Zou Y, Zhou X, Liu Q, Zhong D, Deng T, Liu S, Zhang L. Posttraumatic growth and rumination among parents of children with autism spectrum disorder: The mediating role of social support. J Psychiatr Res 2022; 154:11-18. [PMID: 35872463 DOI: 10.1016/j.jpsychires.2022.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
Although rumination and social support are regarded as essential predictors of posttraumatic growth (PTG), few studies have explored the associations among PTG, rumination, and social support in parents of children with autism spectrum disorder (ASD). This study examined whether social support mediates the relationship between rumination and PTG. Cross-sectional questionnaire data were collected from 385 parents of children with ASD from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Event Related Rumination Inventory, and Social Support Rating Scale. Path analyses showed that subjective support partially mediates the relationship between deliberate rumination and PTG (β = 0.073, P < 0.001), and indirect effects account for 15.30% of the total effects. In addition, a negative direct path was found between intrusive and PTG because of the suppression effect of subjective support (β = -0.110, P < 0.01), and indirect effects accounted for 80% of the direct effects. For future studies, it underscores the essential role of subjective support and rumination in promoting PTG in parents of children with ASD.
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Affiliation(s)
- Yongshen Feng
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Kaiyun Chen
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.
| | - Yuanyuan Zou
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.
| | - Xuezhen Zhou
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510200, China.
| | - Qian Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510200, China.
| | - Dongmei Zhong
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Tao Deng
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Shaofei Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China.
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Wallace-Watkin C, Sigafoos J, Waddington H. Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:588-601. [PMID: 36081366 DOI: 10.1177/13623613221123712] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.
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80
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Rollins PR, De Froy AM, Gajardo SA, Brantley S. Pragmatic contributions to early vocabulary and social communication in young autistic children with language and cognitive delays. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106243. [PMID: 35797775 DOI: 10.1016/j.jcomdis.2022.106243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There are limited data on the interrelationships among pragmatic skills and expressive vocabulary and their contribution to later social communication. Understanding these relationships could inform developmental processes and early intervention strategies. This study explored the relationship among pragmatics skills (i.e., communicative intents and responding to parents' preceding utterances) and concurrent expressive vocabulary as well as the predictive nature of these skills on later social communication in young autistic children with language and cognitive delays. METHOD Data from 56 autistic children (age 18-57 months) who participated in a larger randomized control trial of Pathways Early Autism Intervention were used in this secondary analysis. Video recordings of pre-intervention (Time 1) parent-child interactions were analyzed for number of different words (NDW; expressive vocabulary), number of different (ND) communicative intents, and response to parents' preceding utterances. Residual scores from an assessment of social communication were used to measure Time 2 social communication. First-order correlations and hierarchical regression were used for analyses. RESULTS Adjusting for age and receptive language, both ND communicative intents and response to parents' preceding utterances were associated with pre-intervention NDW. Further, adjusting for receptive language age and intervention group, NDW and response to parents' preceding utterances - but not ND communicative intents-was related to Time 2 social communication. NDW, however, was no longer related to Time 2 social communication skills after accounting for response to parents' preceding utterances. CONCLUSIONS This study provides evidence that autistic children with language and cognitive delays use their expressive vocabularies to respond, hence allocating attention to parent speech, a rudimentary form of social orienting. Our results support approaches to intervention that leverage responding as a rudimentary form of social orienting while encouraging more mature forms of social attention (i.e., social orienting to faces and joint attention) within developmentally appropriate activities, such as routines.
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Affiliation(s)
- Pamela Rosenthal Rollins
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
| | - Adrienne M De Froy
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
| | | | - Sara Brantley
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
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Andreou M, Skrimpa V. Re-Examining Labels in Neurocognitive Research: Evidence from Bilingualism and Autism as Spectrum-Trait Cases. Brain Sci 2022; 12:1113. [PMID: 36009175 PMCID: PMC9405985 DOI: 10.3390/brainsci12081113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the fact that the urge to investigate bilingualism and neurodevelopmental disorders as continuous indices rather than categorical ones has been well-voiced among researchers with respect to research methodological approaches, in the recent literature, when it comes to examining language, cognitive skills and neurodivergent characteristics, it is still the case that the most prevalent view is the categorisation of adults or children into groups. In other words, there is a categorisation of individuals, e.g., monolingual vs. bilingual children or children with typical and atypical/non-typical/non-neurotypical development. We believe that this labelling is responsible for the conflicting results that we often come across in studies. The aim of this review is to bring to the surface the importance of individual differences through the study of relevant articles conducted in bilingual children and children with autism, who are ideal for this study. We concur with researchers who already do so, and we further suggest moving away from labels and instead shift towards the view that not everything is either white or black. We provide suggestions as to how this shift could be implemented in research, while mostly aiming at starting a discourse rather than offering a definite path.
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Affiliation(s)
- Maria Andreou
- Department of Speech and Language Therapy, University of Peloponnese, 24100 Kalamata, Greece
| | - Vasileia Skrimpa
- Department of English, School of Arts and Humanities, University of Cologne, 50931 Cologne, Germany
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82
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Stone-Heaberlin M, Hartley N, Lynch JD, Fisher AP, Justice N. Implementation of a Parent-Mediated Discrete Trial Teaching Intervention for Children with Autism Spectrum Disorder. Behav Anal Pract 2022; 16:302-306. [PMID: 35999943 PMCID: PMC9388204 DOI: 10.1007/s40617-022-00735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
For young children with autism spectrum disorder (ASD), early intensive intervention is imperative. The Bridge Skill Development Program is a parent-mediated intervention designed to “bridge the gap” during the period after a diagnosis of ASD while children wait for intensive intervention. This program introduces applied behavior analysis (ABA) teaching techniques, including the use of parent-mediated discrete trial teaching (DTT), to promote skill acquisition of target behaviors. Significant improvements were observed across four target behaviors taught to all participants. The program also aims to connect participants to intensive ABA programming.
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Affiliation(s)
- Meg Stone-Heaberlin
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH USA
| | - Nick Hartley
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - James D. Lynch
- Department of Psychology, University of Cincinnati, Cincinnati, OH USA
| | - Allison P. Fisher
- Department of Psychology, University of Cincinnati, Cincinnati, OH USA
| | - Natalie Justice
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH USA
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83
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Finestack LH, Elmquist M, Kuchler K, Ford AB, Cakir-Dilek B, Riegelman A, Brown SJ, Marsalis S. Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3004-3055. [PMID: 35858263 PMCID: PMC9911096 DOI: 10.1044/2022_jslhr-21-00543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/19/2022] [Accepted: 04/07/2022] [Indexed: 05/19/2023]
Abstract
PURPOSE Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions. METHOD We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence). RESULTS We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures. CONCLUSION Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20289195.
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Bowden N, Gibb S, Audas R, Clendon S, Dacombe J, Kokaua J, Milne BJ, Mujoo H, Murray SW, Smiler K, Stace H, van der Meer L, Taylor BJ. Association Between High-Need Education-Based Funding and School Suspension Rates for Autistic Students in New Zealand. JAMA Pediatr 2022; 176:664-671. [PMID: 35576000 PMCID: PMC9112133 DOI: 10.1001/jamapediatrics.2022.1296] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their potential. OBJECTIVE To quantify differences in suspension rates between autistic and nonautistic students and to assess whether high-need education-based funding for autistic students is associated with reduced rates of school suspension. DESIGN, SETTING, AND PARTICIPANTS This national cohort study used linked health and education data from New Zealand's Integrated Data Infrastructure. Data were obtained for students aged 5 to 16 years from January 1 to December 31, 2018, and analyzed July 7, 2021, to January 1, 2022. A novel case identification method was used to identify autistic students. EXPOSURES High-need education-based funding (Ongoing Resourcing Scheme [ORS]) obtained before 2019. MAIN OUTCOMES AND MEASURES Rates of suspension from school. Crude and adjusted analyses of the association between suspension rates and autism among the full population with adjustment made for sociodemographic characteristics (sex, age, ethnicity, deprivation, and urban or rural profile of residence) were conducted using complete-case, 2-level random intercept logistic multivariable regressions. To assess the association between ORS funding and suspension, analysis was restricted to autistic students. RESULTS Of the 736 911 students in the study population, 9741 (1.3%) were identified as autistic (median [SD] age, 10 [3.2] years; 7710 [79.1%] boys), and 727 170 (98.7%) as nonautistic (median [SD] age, 10 [3.4] years; 369 777 [50.9%] boys). School suspension was experienced by 504 autistic students (5.2%) and 13 845 nonautistic students (1.9%). After adjustment for demographic characteristics, autistic students had significantly higher odds of suspension than their nonautistic peers (adjusted odds ratio, 2.81; 95% CI, 2.55-3.11). Of the 9741 autistic students, 2895 (29.7%) received high-need education-based (ORS) funding. Suspensions were experienced by 57 autistic students (2.0%) with high-need funding and 447 autistic students (6.5%) without high-need funding. After adjustment for demographic characteristics, co-occurring conditions, and level of disability support need, autistic students with high-need funding had significantly lower odds of suspension than autistic students without high-need funding (adjusted odds ratio, 0.29; 95% CI, 0.21-0.40). CONCLUSIONS AND RELEVANCE In this cohort study, the findings of disparities in suspension rates between autistic and nonautistic students underscore the challenges faced in providing inclusive education for all young people, regardless of disability status. This study found that high-need funding was associated with reduced suspension rates among autistic students, suggesting that if appropriate supports are afforded to autistic students, a more inclusive education can be provided.
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Affiliation(s)
- Nicholas Bowden
- A Better Start National Science Challenge, Auckland, New Zealand,Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Sheree Gibb
- A Better Start National Science Challenge, Auckland, New Zealand,Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Richard Audas
- A Better Start National Science Challenge, Auckland, New Zealand,Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Sally Clendon
- Institute of Education, Massey University, Auckland, New Zealand
| | - Joanne Dacombe
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand,Autism New Zealand, Wellington, New Zealand
| | - Jesse Kokaua
- A Better Start National Science Challenge, Auckland, New Zealand,Va’a O Tautai, Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Barry J. Milne
- A Better Start National Science Challenge, Auckland, New Zealand,Centre of Methods and Policy Application in the Social Sciences, Faculty of Arts, University of Auckland, Auckland, New Zealand,School of Social Sciences, Faculty of Arts, University of Auckland, Auckland, New Zealand
| | - Himang Mujoo
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | - Kirsten Smiler
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Hilary Stace
- Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - Larah van der Meer
- Autism New Zealand, Wellington, New Zealand,Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Barry James Taylor
- A Better Start National Science Challenge, Auckland, New Zealand,Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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Ludwig NN, Child AE, Jashar DT, Mostow AJ, Wodka EL. Telehealth diagnosis of autism spectrum disorder through clinical cases. Clin Neuropsychol 2022; 36:960-980. [PMID: 34473008 PMCID: PMC10091235 DOI: 10.1080/13854046.2021.1970228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A diagnosis of autism spectrum disorder (ASD) provides access to interventions that are important for fostering development and improving quality of life. Thus, the timeliness of a diagnosis should not be limited by social-distancing limitations whenever possible. Despite this, clear guidance for transitioning autism diagnostic services to a telehealth model of care in the era of the COVID-19 pandemic is lacking. At our Institute, we have adapted our approach to ASD evaluation to promote continued access to evaluation services during this unprecedented time. The purpose of this case series is to provide examples of three different approaches to ASD differential diagnostic services via telehealth that we have taken at our Institute. We illustrate our methods and clinical decision-making, based on patient characteristics and referral aims, in providing telehealth diagnostic services and discuss the advantages and limitations of telehealth utilization in the differential diagnosis of ASD. At our Institute, telehealth services have provided an invaluable opportunity to continue to confirm (or rule out) an ASD diagnosis when appropriate to facilitate access to services during this time. Future research examining the utility of telehealth in the differential diagnosis of ASD is imperative given the potential advantages of telehealth services beyond the COVID-19 pandemic for some patients.
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Affiliation(s)
- Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda E Child
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dasal Tenzin Jashar
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Allison J Mostow
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ericka L Wodka
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
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86
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Yankowitz LD, Petrulla V, Plate S, Tunc B, Guthrie W, Meera SS, Tena K, Pandey J, Swanson MR, Pruett JR, Cola M, Russell A, Marrus N, Hazlett HC, Botteron K, Constantino JN, Dager SR, Estes A, Zwaigenbaum L, Piven J, Schultz RT, Parish-Morris J. Infants later diagnosed with autism have lower canonical babbling ratios in the first year of life. Mol Autism 2022; 13:28. [PMID: 35761377 PMCID: PMC9235227 DOI: 10.1186/s13229-022-00503-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canonical babbling-producing syllables with a mature consonant, full vowel, and smooth transition-is an important developmental milestone that typically occurs in the first year of life. Some studies indicate delayed or reduced canonical babbling in infants at high familial likelihood for autism spectrum disorder (ASD) or who later receive an ASD diagnosis, but evidence is mixed. More refined characterization of babbling in the first year of life in infants with high likelihood for ASD is needed. METHODS Vocalizations produced at 6 and 12 months by infants (n = 267) taking part in a longitudinal study were coded for canonical and non-canonical syllables. Infants were categorized as low familial likelihood (LL), high familial likelihood diagnosed with ASD at 24 months (HL-ASD) or not diagnosed (HL-Neg). Language delay was assessed based on 24-month expressive and receptive language scores. Canonical babble ratio (CBR) was calculated by dividing the number of canonical syllables by the number of total syllables. Generalized linear (mixed) models were used to assess the relationship between group membership and CBR, controlling for site, sex, and maternal education. Logistic regression was used to assess whether canonical babbling ratios at 6 and 12 months predict 24-month diagnostic outcome. RESULTS No diagnostic group differences in CBR were detected at 6 months, but HL-ASD infants produced significantly lower CBR than both the HL-Neg and LL groups at 12 months. HL-Neg infants with language delay also showed reduced CBR at 12 months. Neither 6- nor 12-month CBR was significant predictors of 24-month diagnostic outcome (ASD versus no ASD) in logistic regression. LIMITATIONS Small numbers of vocalizations produced by infants at 6 months may limit the reliability of CBR estimates. It is not known if results generalize to infants who are not at high familial likelihood, or infants from more diverse racial and socioeconomic backgrounds. CONCLUSIONS Lower canonical babbling ratios are apparent by the end of the first year of life in ASD regardless of later language delay, but are also observed for infants with later language delay without ASD. Canonical babbling may lack specificity as an early marker when used on its own.
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Affiliation(s)
- L D Yankowitz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - V Petrulla
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S Plate
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Tunc
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W Guthrie
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S S Meera
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - K Tena
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Pandey
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M R Swanson
- Department of Psychology, University of Texas at Dallas, Richardson, TX, USA
| | - J R Pruett
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - M Cola
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Russell
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Marrus
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - H C Hazlett
- University of North Carolina, Chapel Hill, NC, USA
| | - K Botteron
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - J N Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - S R Dager
- University of Washington, Seattle, WA, USA
| | - A Estes
- University of Washington, Seattle, WA, USA
| | - L Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - J Piven
- University of North Carolina, Chapel Hill, NC, USA
| | - R T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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87
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Cheung WC, Aleman-Tovar J, Johnston AN, Little LM, Burke MM. A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:353-373. [PMID: 35789590 PMCID: PMC9244129 DOI: 10.1007/s10882-022-09853-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10882-022-09853-w.
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Affiliation(s)
- W. C. Cheung
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - J. Aleman-Tovar
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - A. N. Johnston
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - L. M. Little
- Rush University, 600 S. Paulina St, Chicago, IL 1009A AAC60612 USA
| | - M. M. Burke
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
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88
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Kouroupa A, Laws KR, Irvine K, Mengoni SE, Baird A, Sharma S. The use of social robots with children and young people on the autism spectrum: A systematic review and meta-analysis. PLoS One 2022; 17:e0269800. [PMID: 35731805 PMCID: PMC9216612 DOI: 10.1371/journal.pone.0269800] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Robot-mediated interventions show promise in supporting the development of children on the autism spectrum. OBJECTIVES In this systematic review and meta-analysis, we summarize key features of available evidence on robot-interventions for children and young people on the autism spectrum aged up to 18 years old, as well as consider their efficacy for specific domains of learning. DATA SOURCES PubMed, Scopus, EBSCOhost, Google Scholar, Cochrane Library, ACM Digital Library, and IEEE Xplore. Grey literature was also searched using PsycExtra, OpenGrey, British Library EThOS, and the British Library Catalogue. Databases were searched from inception until April (6th) 2021. SYNTHESIS METHODS Searches undertaken across seven databases yielded 2145 articles. Forty studies met our review inclusion criteria of which 17 were randomized control trials. The methodological quality of studies was conducted with the Quality Assessment Tool for Quantitative Studies. A narrative synthesis summarised the findings. A meta-analysis was conducted with 12 RCTs. RESULTS Most interventions used humanoid (67%) robotic platforms, were predominantly based in clinics (37%) followed home, schools and laboratory (17% respectively) environments and targeted at improving social and communication skills (77%). Focusing on the most common outcomes, a random effects meta-analysis of RCTs showed that robot-mediated interventions significantly improved social functioning (g = 0.35 [95%CI 0.09 to 0.61; k = 7). By contrast, robots did not improve emotional (g = 0.63 [95%CI -1.43 to 2.69]; k = 2) or motor outcomes (g = -0.10 [95%CI -1.08 to 0.89]; k = 3), but the numbers of trials were very small. Meta-regression revealed that age accounted for almost one-third of the variance in effect sizes, with greater benefits being found in younger children. CONCLUSIONS Overall, our findings support the use of robot-mediated interventions for autistic children and youth, and we propose several recommendations for future research to aid learning and enhance implementation in everyday settings. PROSPERO REGISTRATION Our methods were preregistered in the PROSPERO database (CRD42019148981).
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Affiliation(s)
- Athanasia Kouroupa
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
| | - Keith R. Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Karen Irvine
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Silvana E. Mengoni
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Alister Baird
- Division of Psychiatry, University College London, London, United Kingdom
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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89
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Sterrett K, Magaña MT, Gulsrud A, Paparella T, Kasari C. Predictors of Attrition in a Randomized Trial of a Social Communication Intervention for Infant-Toddlers at Risk for Autism. J Autism Dev Disord 2022:10.1007/s10803-022-05616-w. [PMID: 35678946 DOI: 10.1007/s10803-022-05616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Addressing factors that make it more likely for families to attrite from early intervention trials will allow researchers to ensure that families reap the full benefits of participation. This study was an analysis of 78 children (Mage = 18.38 months, SD = 5.78) at risk for autism participating in a university-based randomized controlled trial of two 8-week long early intervention programs. Overall, attrition through 8-weeks was low, approximately 13%, however by the one-year follow-up attrition rates were approximately 50%. The most consistent predictor of attrition was the distance that families had to travel to the university. These data highlight the importance of providing services and support (e.g., financial and logistic) during follow-up to families to maximize their participation. Clincaltrials.gov Identifier: NCT01874327, 6/11/2013.
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Affiliation(s)
- Kyle Sterrett
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States. .,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-262B, 90024, Los Angeles, CA, United States.
| | - Maira Tafolla Magaña
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Amanda Gulsrud
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Tanya Paparella
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Connie Kasari
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
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90
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Boterberg S, Zanatta A, Moerman F, Schaubroeck S, Siew J, De Schryver M, Roeyers H. The impact of COVID-19 measures on parent-reported restricted and repetitive behaviours in pre-school children with autism. Heliyon 2022; 8:e09727. [PMID: 35720765 PMCID: PMC9188681 DOI: 10.1016/j.heliyon.2022.e09727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background COVID-19 restrictive measures have had a considerable impact on daily life routines, which may be especially challenging for families of children with autism. In pre-schoolers with autism, it is likely that the disruption of routines mainly impacts the presence of restrictive and repetitive behaviours (RRBs). Furthermore, influence of comorbid conditions, secondary behavioural difficulties and home environment characteristics on RRBs was explored. Method A cross-sectional online survey design was used to collect parent-report data on 254 children with autism (2.5–6 years) during lockdown in the early months of the pandemic. RRBs were assessed using the Repetitive Behaviour Scale-Revised (RBS-R). Results Parents reported a significant increase in stereotypic, self-injurious, compulsive and ritualistic behaviour, and restricted interests after implementation of COVID-19 restrictions. The presence of a co-occurring condition, such as language impairments or intellectual disability, was associated with more self-injurious and stereotypic behaviour. However, there was no effect of home environment on RRBs. Further, most children showed increases in internalising and/or externalising behaviour. Increased inattentive behaviour was associated with more ritualistic and stereotypic behaviour, and restricted interests. Decreases in hyperactivity were related to more restricted interests. Importantly, in a subset of children, parents reported less behavioural difficulties during the lockdown. Conclusions Findings highlight the importance of flexible implementation and continuity of care for pre-schoolers with autism and support for parents. Further follow-up of children with autism and RRBs, and co-occurring behavioural difficulties is needed and could enhance our understanding of the long-term effects associated with sudden restrictive measures to daily routines.
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Affiliation(s)
- Sofie Boterberg
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- Corresponding author.
| | - Arianna Zanatta
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Floor Moerman
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Sarah Schaubroeck
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Jasmine Siew
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Maarten De Schryver
- Research Support Office, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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91
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McNally Keehn R, Enneking B, James C, Tang Q, Rouse M, Hines E, Raches C, Etling A. Telehealth Evaluation of Pediatric Neurodevelopmental Disabilities During the COVID-19 Pandemic: Clinician and Caregiver Perspectives. J Dev Behav Pediatr 2022; 43:262-272. [PMID: 34954761 DOI: 10.1097/dbp.0000000000001043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to present clinician and caregiver perspectives regarding telehealth neurodevelopmental evaluation delivered at the onset of the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we sought to describe telehealth neurodevelopmental evaluations, examine associations between child characteristics and diagnostic factors, determine the impact of technology and family barriers, and report on clinician and caregiver satisfaction with telehealth evaluation. METHODS In response to the COVID-19 pandemic, in-person clinical services at a large children's hospital neurodevelopmental clinic were transitioned to telehealth. Data are presented for 254 remote evaluations of children (18-212 months; referral concern: 51% autism spectrum disorder [ASD], 24% developmental delay/intellectual disability, 25% other neurodevelopmental concern) conducted from May to July 2020. Data were gathered from electronic health records as well as clinician and caregiver surveys. RESULTS A clinical diagnosis was provided in 72% of telehealth evaluations. Clinicians rated diagnostic certainty as "completely" or "somewhat" certain in 74% of evaluations. Certainty ratings were higher for evaluations in which a diagnosis of ASD was provided. Although technology and family challenges were reported, clinicians rarely identified these as disruptive to the evaluation process. Clinicians reported satisfaction with various aspects of delivering telehealth. Caregivers endorsed high satisfaction with receipt of telehealth and reduced travel burden. CONCLUSION The COVID-19 pandemic has rapidly transformed service delivery for individuals with neurodevelopmental disabilities and provided an unprecedented opportunity to evaluate the deployment of telehealth evaluation to meet the need for ongoing diagnostic care. Our findings suggest that telehealth holds significant promise for neurodevelopmental assessment both within the context of a global pandemic and beyond.
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Affiliation(s)
| | | | | | - Qing Tang
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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Utilizing the Child Behavior Checklist (CBCL) as an Autism Spectrum Disorder Preliminary Screener and Outcome Measure for the PEERS® Intervention for Autistic Adolescents. J Autism Dev Disord 2022; 52:2061-2074. [PMID: 34052960 PMCID: PMC9926906 DOI: 10.1007/s10803-021-05103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/27/2022]
Abstract
Exploration of potential preliminary screeners, and examination of social intervention outcomes for effects on comorbid symptoms is imperative. The Child Behavior Checklist (CBCL; Achenbach & Rescorla, Achenbach and Rescorla, Manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth & Families, 2001) provides a potential ASD screener and intervention outcome evaluation. This study had two aims: (1) to examine CBCL scales scores as a potential ASD screener; (2) to investigate PEERS® outcomes via the CBCL for Autistic adolescents. Results indicated elevated scores on four CBCL scales in the ASD groups, contrasted to a typically-developing group. Furthermore, decreases in the two CBCL scales for adolescents that received the intervention were found. Findings support prior research indicating a unique CBCL elevation pattern as a potential screener for ASD, and provide additional support for the efficaciousness of PEERS®.
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93
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Zhao L, Sun H, Yang F, Wang Z, Zhao Y, Tang W, Bu L. A Multimodal Data Driven Rehabilitation Strategy Auxiliary Feedback Method: A Case Study. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1181-1190. [PMID: 35482695 DOI: 10.1109/tnsre.2022.3170943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In Industry 4.0, medical data present a trend of multisource development. However, in complex information networks, an information gap often exists in data exchange between doctors and patients. In the case of diseases with complex manifestations, doctors often perform qualitative analysis, which is macroscopic and fuzzy, to present treatment recommendations for patients. Improving the reliability of data acquisition and maximizing the potential of data, require attention. To solve these problems, a multimodal data-driven rehabilitation strategy auxiliary feedback method is proposed. In this study, depth sensor and functional near-infrared spectroscopy (fNIRS) were used to obtain ethology and brain function data, and skeleton tracking analysis and ethology discrete statistics were performed to assist the diagnostic feedback of rehabilitation strategies. This study takes rhythm rehabilitation training of autistic children as a case, and results show that the multimodal data-driven rehabilitation strategy auxiliary feedback method can provide effective feedback for individuals or groups. The proposed auxiliary decision method increases the dimension of data analysis and improves the reliability of analysis. Through discrete statistical results, the potential of data are maximized, thereby assisting the proposed rehabilitation strategy diagnostic feedback.
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94
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Shuffrey LC, Pini N, Potter M, Springer P, Lucchini M, Rayport Y, Sania A, Firestein M, Brink L, Isler JR, Odendaal H, Fifer WP. Aperiodic electrophysiological activity in preterm infants is linked to subsequent autism risk. Dev Psychobiol 2022; 64:e22271. [PMID: 35452546 PMCID: PMC9169229 DOI: 10.1002/dev.22271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/31/2022] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
Approximately 7% of preterm infants receive an autism spectrum disorder (ASD) diagnosis. Yet, there is a significant gap in the literature in identifying prospective markers of neurodevelopmental risk in preterm infants. The present study examined two electroencephalography (EEG) parameters during infancy, absolute EEG power and aperiodic activity of the power spectral density (PSD) slope, in association with subsequent autism risk and cognitive ability in a diverse cohort of children born preterm in South Africa. Participants were 71 preterm infants born between 25 and 36 weeks gestation (34.60 ± 2.34 weeks). EEG was collected during sleep between 39 and 41 weeks postmenstrual age adjusted (40.00 ± 0.42 weeks). The Bayley Scales of Infant Development and Brief Infant Toddler Social Emotional Assessment (BITSEA) were administered at approximately 3 years of age adjusted (34 ± 2.7 months). Aperiodic activity, but not the rhythmic oscillatory activity, at multiple electrode sites was associated with subsequent increased autism risk on the BITSEA at three years of age. No associations were found between the PSD slope or absolute EEG power and cognitive development. Our findings highlight the need to examine potential markers of subsequent autism risk in high-risk populations other than infants at familial risk.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Mandy Potter
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Priscilla Springer
- Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Yael Rayport
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Morgan Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Joseph R Isler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
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95
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Eilenberg JS, Kizildag D, Blakey A, Cardona ND, Oberoi A, Broder-Fingert S, Feinberg E, Long KA. Implications of Universal Autism Screening: Perspectives From Culturally Diverse Families With False-Positive Screens. Acad Pediatr 2022; 22:279-288. [PMID: 34963655 PMCID: PMC8939055 DOI: 10.1016/j.acap.2021.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) recommends that pediatricians screen all young children for autism spectrum disorder (ASD). However, the US Preventive Services Task Force stated that there is insufficient evidence about the potential harms and benefits of universal ASD screening. To address this gap, we conducted qualitative interviews with caregivers of children who received a false-positive ASD screen to learn about families' perceptions of the harms and benefits of universal ASD screening. METHODS Culturally diverse caregivers (N = 26) of children with false-positive ASD screens completed qualitative interviews focused on parents' experiences with and recommendations to improve the ASD screening and evaluation process. Interviews were transcribed verbatim, coded, and analyzed using applied thematic analysis. RESULTS Parents explained that the ASD screening and evaluation process increased their knowledge about child development and substantiated existing concerns. The ASD screening and evaluation process resulted in connecting their child to services, which parents felt led to improvements in their child's delays. Parents endorsed anxiety during wait times for the formal developmental assessment. However, all parents expressed that, if given the option, they would repeat the screening and evaluation process again. Caregivers recommended universal screening for ASD and suggested that screening extend beyond the pediatrician to other settings. CONCLUSIONS From parents' perspectives, the connection to developmental services and increased knowledge of child development that resulted from the false-positive ASD screen outweighed the time-limited emotional distress triggered by a positive ASD screen. Overall, parents' preferences for universal ASD screening align with the AAP's recommendations.
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Affiliation(s)
- Jenna Sandler Eilenberg
- Department of Psychological and Brain Sciences, Boston University (JS Eilenberg, D Kizildag, AO Blakey, ND Cardona, A Oberoi, and KA Long), Boston, Mass.
| | - Deniz Kizildag
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Ariel Blakey
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Nicole D. Cardona
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Anjali Oberoi
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Sarabeth Broder-Fingert
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA,Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Kristin A. Long
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
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96
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Self-Directed Web-Based Parent-Mediated Interventions for Autistic Children: A systematic review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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97
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Kryszak EM, Albright CM, Fell LA, Butter EM, Kuhlthau KA. Clinician Perspectives on Telehealth Assessment of Autism Spectrum Disorder During the COVID-19 Pandemic. J Autism Dev Disord 2022; 52:5083-5098. [PMID: 35103899 PMCID: PMC8804366 DOI: 10.1007/s10803-022-05435-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Abstract
This study examined clinician insights into telehealth assessment services for autism spectrum disorder implemented during the COVID-19 pandemic. 35 clinicians from multiple disciplines across 17 sites in the Autism Care Network were interviewed. Themes identified through qualitative analyses included factors related to confidence in diagnosis (impressions of in-home observation; child and family factors that affected diagnostic confidence; changes in rapport); patient and family factors related to telehealth (perceived family benefits of and barriers to telehealth; factors related to healthcare disparities; factors specific to non-native English speakers); and institutional and workplace factors related to transitioning to telehealth (institutional support; changes to efficacy, attendance, and work satisfaction). Results suggest that telehealth has potential to be an effective tool in autism assessment practice.
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Affiliation(s)
- Elizabeth M Kryszak
- Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA. .,Child Development Center, Nationwide Children's Hospital, 187 W. Schrock Rd., Westerville, OH, 43081, USA.
| | - Charles M Albright
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Lucy A Fell
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Eric M Butter
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Karen A Kuhlthau
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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98
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Feng Y, Zhou X, Liu Q, Deng T, Qin X, Chen B, Zhang L. Symptom severity and posttraumatic growth in parents of children with autism spectrum disorder: The moderating role of social support. Autism Res 2022; 15:602-613. [PMID: 35048558 DOI: 10.1002/aur.2673] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022]
Abstract
Parents of children with autism spectrum disorder (ASD) experience posttraumatic growth (PTG). No study has investigated the moderating effect of social support and family function between symptom severity and PTG. The study aims to examine whether social support and family function moderate the relationship between symptom severity and PTG among parents of children with ASD. Using a cross-sectional design, a total of 385 parents of children with ASD were recruited from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Social Support Rating Scale, Autism Behavior Checklist, and Family Apgar Index. Both social support (r = 0.354, p < 0.01) and family function (r = 0.379, p < 0.05) were significantly related to PTG. Although symptom severity was not significantly related to PTG (p > 0.05), social support moderated the correlation between symptom severity and PTG [β(SE) = -0.134 (0.719), p < 0.01, 95% CI = (-3.552, -0.723)]; the positive association was stronger for low social support [β(SE) = 0.145 (0.054), t = 2.675, p < 0.01, 95% CI = (0.038, 0.252)], while the negative association was weaker for high social support [β(SE) = -0.121 (0.051), t = -2.378, p < 0.05, 95% CI = (-0.221, -0.021)]. Family function did not moderate the relationship (p > 0.05). Higher social support appears to buffer the detrimental effect of symptom severity on PTG, and social support seems to be an important factor when delivering interventions aimed at decreasing symptom severity and improving positive growth. LAY SUMMARY: Both social support and family function were positively associated with PTG. Providing sufficient perceived social support and enhancing family function promoted parents' positive psychological experience. Higher social support seemed to buffer the detrimental effect of symptom severity on PTG, and it could be an important intervention target for improving the psychological growth of parents of children with ASD.
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Affiliation(s)
- Yongshen Feng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xuezhen Zhou
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qian Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Deng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiuqun Qin
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Biyuan Chen
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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99
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Experiences and Attitudes on Early Identification Practices of Autism: A Preliminary Survey of Pediatric Professionals in Ecuador. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020123. [PMID: 35204844 PMCID: PMC8869979 DOI: 10.3390/children9020123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
Abstract
Early identification of children with autism is necessary to support their social and communicative skills and cognitive, verbal, and adaptive development. Researchers have identified several barriers to early diagnosis. Data collected in low- and middle-income contexts—where the vast majority of children in the world live—is scarce. In Ecuador, as in many other countries, estimates are lower compared to the global prevalence. Health authorities estimate a prevalence of 0.28% (0.18%–0.41%) in children aged five years old or less. Based on the hypothesis that, as in many parts of the world, children in Ecuador are not routinely screened and that this situation may result from poor recognition of this condition, our objective was to identify potential obstacles to case identification in pediatric settings. Several barriers, consistent with those identified in other countries, were reported by 153 participants on a survey, including lack of time, lack of resources to refer, fear of unnecessarily alarming families, and lack of information to guide families with concerns. The vast majority of participants are aware of the need for a screening tool for autism detection but report a lack of knowledge of its formal application. Most of the barriers reported in this study could be overcome by educational programs tailored to professional needs in order to support the well-being of children with autism and their families.
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100
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Rogers SJ, Stahmer A, Talbott M, Young G, Fuller E, Pellecchia M, Barber A, Griffith E. Feasibility of delivering parent-implemented NDBI interventions in low-resource regions: a pilot randomized controlled study. J Neurodev Disord 2022; 14:3. [PMID: 34986782 PMCID: PMC8903494 DOI: 10.1186/s11689-021-09410-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This implementation feasibility study was conducted to determine whether an evidence-based parent-implemented distance-learning intervention model for young children at high likelihood of having ASD could be implemented at fidelity by Part C community providers and by parents in low-resource communities. METHODS The study used a community-academic partnership model to adapt an evidence-based intervention tested in the current pilot trial involving randomization by agency in four states and enrollment of 35 coaches and 34 parent-family dyads. After baseline data were gathered, providers in the experimental group received 12-15 h of training while control providers received six webinars on early development. Providers delivered 6 months of intervention with children-families, concluding with data collection. Regression analyses were used to model outcomes of the coach behaviors, the parent fidelity ratings, and child outcomes. RESULTS A block design model-building approach was used to test the null model followed by the inclusion of group as a predictor, and finally the inclusion of the planned covariates. Model fit was examined using changes in R2 and F-statistic. As hypothesized, results demonstrated significant gains in (1) experimental provider fidelity of coaching implementation compared to the control group; and (2) experimental parent fidelity of implementation compared to the control group. There were no significant differences between groups on child developmental scores. CONCLUSIONS Even though the experimental parent group averaged less than 30 min of intervention weekly with providers in the 6 months, both providers and parents demonstrated statistically significant gains on the fidelity of implementation scores with moderate effect sizes compared to control groups. Since child changes in parent-mediated models are dependent upon the parents' ability to deliver the intervention, and since parent delivery is dependent upon providers who are coaching the parents, these results demonstrated that two of these three links of the chain were positively affected by the experimental implementation model. However, a lack of significant differences in child group gains suggests that further work is needed on this model. Factors to consider include the amount of contact with the provider, the amount of practice children experience, the amount of contact both providers and parents spend on training materials, and motivational strategies for parents, among others. TRIAL REGISTRATION Registry of Efficacy and Effectiveness Studies: #4360, registered 1xx, October, 2020 - Retrospectively registered, https://sreereg.icpsr.umich.edu/sreereg/.
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Affiliation(s)
- Sally J Rogers
- Department of Psychiatry Behavioral Sciences, MIND Institute, University California Davis, Davis, USA.
| | - Aubyn Stahmer
- Department of Psychiatry Behavioral Sciences, MIND Institute, University California Davis, Davis, USA
| | - Meagan Talbott
- Department of Psychiatry Behavioral Sciences, MIND Institute, University California Davis, Davis, USA
| | - Gregory Young
- Department of Psychiatry Behavioral Sciences, MIND Institute, University California Davis, Davis, USA
| | - Elizabeth Fuller
- Department of Psychiatry Behavioral Sciences, MIND Institute, University California Davis, Davis, USA
| | - Melanie Pellecchia
- Perelman School of Medicine, Center for Mental Health, University of Pennsylvania, Philadelphia, USA
| | - Angela Barber
- Department of Communicative Disorders, University of Alabama, Tuscaloosa, USA
| | - Elizabeth Griffith
- Department of Developmental Pediatrics, University of Colorado, Anschutz Medical Campus, Boulder, USA
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