151
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McGrath K, Bonuck K, Mann M. Exploratory spatial analysis of autism rates in New York school districts: role of sociodemographic and language differences. J Neurodev Disord 2020; 12:35. [PMID: 33327937 PMCID: PMC7745507 DOI: 10.1186/s11689-020-09338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background Literature on autism spectrum disorder (ASD) suggests lower ASD prevalence and higher age of diagnosis among children of color, from lower socioeconomic backgrounds, and from families with lower educational levels. These disparities have been attributed to factors such as limited access to diagnostic and treatment services, less opportunity for upward mobility to locales with ample resources, and linguistic barriers. However, few studies describe prevalence and geographic differences of ASD diagnoses by English Language Learner (ELL) status. Objectives The primary objectives of this study are to (1) spatially explore the prevalence of ASD among New York State school districts and (2) examine differences of ASD prevalence rates between ELLs and native English-speaking peers. Methods Using the 2016–2017 district-level data on public and non-public school age students (3–21 years old) receiving special education services in New York, we analyzed sociodemographic trends among school districts with varying percentages (low, medium, and high ranges) of students with ASD and ELLs. To do this, we conducted exploratory spatial analyses using GIS software, analysis of school district level demographic data, and multivariate linear regression. Results In contrast to prior research on ASD prevalence among minority groups, we found disproportionately higher rates of ASD among school districts with higher proportions of Black and Hispanic students. Geographic analysis revealed statistically significant clustering of school districts with high ASD rates in New York City and Albany. Higher proportions of ELLs tended to be concentrated in densely populated, urban, and geographically smaller school districts and had higher proportions of Black, Hispanic, and Asian students. Conclusions Schools with higher rates of ASD and ELL students tend to be concentrated in urban regions throughout New York and have higher representation of Black and Hispanic/Latino students, as well as higher rates of learning disabilities in general. Further research is warranted to explore possible reasons for this phenomenon.
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Affiliation(s)
- Kathleen McGrath
- Albert Einstein College of Medicine, New York City, USA. .,CUNY Graduate Center, New York City, USA.
| | - Karen Bonuck
- Albert Einstein College of Medicine, New York City, USA
| | - Mana Mann
- Albert Einstein College of Medicine, New York City, USA
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152
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Dijk HH, Freriks RD, Alessie RJM, Mierau JO. The persistence of child and adolescence mental healthcare: results from registry data. BMC Health Serv Res 2020; 20:1113. [PMID: 33267875 PMCID: PMC7709232 DOI: 10.1186/s12913-020-05962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Previous studies on the persistence of child and adolescent mental healthcare do not consider the role of time-invariant individual characteristics. Estimating persistence of healthcare using standard linear models yields biased estimates due to unobserved heterogeneity and the autoregressive structure of the model. This study provides estimates of the persistence of child and adolescent mental healthcare taking these statistical issues into account. Methods We use registry data of more than 80,000 Dutch children and adolescents between 2000 and 2012 from the Psychiatric Case Registry Northern Netherlands (PCR-NN). In order to account for autocorrelation due to the presence of a lagged dependent variable and to distinguish between persistence caused by time-invariant individual characteristics and a direct care effect we use difference GMM-IV estimation. In further analyses we assess the robustness of our results to policy reforms, different definitions of care and diagnosis decomposition. Results All estimation results for the direct care effect (true state-dependence) show a positive coefficient smaller than unity with a main effect of 0.215 (p<0.01), which indicates that the process is stable. Persistence of care is found to be 0.065 (p<0.05) higher for females. Additionally, the majority of persistence of care appears to be associated with time-invariant characteristics. Further analyses indicate that (1) results are robust to different definitions of care and (2) persistence of care does not differ significantly across subgroups. Conclusions The results indicate that the majority of mental healthcare persistence for children and adolescents is due to time-invariant individuals characteristics. Additionally, we find that in the absence of further shocks a sudden increase of 10 care contacts in the present year is associated with an average of less than 3 additional care contacts at some point in the future. This result provides essential information about the necessity of budget increases for future years in the case of exogenous increases in healthcare use.
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Affiliation(s)
- Hermien H Dijk
- Department of Economics, Econometrics & Finance, University of Groningen, Nettelbosje 2, Groningen, 9747, AE, The Netherlands.,Aletta Jacobs School of Public Health, University of Groningen, Landleven 1, Groningen, 9747, AD, The Netherlands
| | - Roel D Freriks
- Department of Economics, Econometrics & Finance, University of Groningen, Nettelbosje 2, Groningen, 9747, AE, The Netherlands. .,Aletta Jacobs School of Public Health, University of Groningen, Landleven 1, Groningen, 9747, AD, The Netherlands.
| | - Rob J M Alessie
- Department of Economics, Econometrics & Finance, University of Groningen, Nettelbosje 2, Groningen, 9747, AE, The Netherlands
| | - Jochen O Mierau
- Department of Economics, Econometrics & Finance, University of Groningen, Nettelbosje 2, Groningen, 9747, AE, The Netherlands.,Aletta Jacobs School of Public Health, University of Groningen, Landleven 1, Groningen, 9747, AD, The Netherlands
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153
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Pharmacotherapy of resistant enteric pathogens in combination with medicinal plants extracts and antibiotics. APPLIED NANOSCIENCE 2020. [DOI: 10.1007/s13204-020-01409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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154
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Winter AS, Fountain C, Cheslack-Postava K, Bearman PS. The social patterning of autism diagnoses reversed in California between 1992 and 2018. Proc Natl Acad Sci U S A 2020; 117:30295-30302. [PMID: 33199592 DOI: 10.1073/pnas.2015762117/-/dcsupplemental] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California's Department of Developmental Services. California's diagnosed autism incidence rate rose from 0.49 per 1,000 3-6 y olds in 1998 to 3.49 per 1,000 3-6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.
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Affiliation(s)
- Alix S Winter
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027
| | - Christine Fountain
- Department of Sociology & Anthropology, Fordham University at Lincoln Center, New York, NY 10023
| | | | - Peter S Bearman
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027;
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155
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Winter AS, Fountain C, Cheslack-Postava K, Bearman PS. The social patterning of autism diagnoses reversed in California between 1992 and 2018. Proc Natl Acad Sci U S A 2020; 117:30295-30302. [PMID: 33199592 PMCID: PMC7720167 DOI: 10.1073/pnas.2015762117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California's Department of Developmental Services. California's diagnosed autism incidence rate rose from 0.49 per 1,000 3-6 y olds in 1998 to 3.49 per 1,000 3-6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.
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Affiliation(s)
- Alix S Winter
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027
| | - Christine Fountain
- Department of Sociology & Anthropology, Fordham University at Lincoln Center, New York, NY 10023
| | | | - Peter S Bearman
- Interdisciplinary Center for Innovative Theory and Empirics, Columbia University, New York, NY 10027;
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156
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Affiliation(s)
- Kevin M Simon
- From Boston Children's Hospital and Harvard Medical School - both in Boston
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157
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McDonnell CG, DeLucia EA, Hayden EP, Penner M, Curcin K, Anagnostou E, Nicolson R, Kelley E, Georgiades S, Liu X, Stevenson RA. Sex Differences in Age of Diagnosis and First Concern among Children with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:645-655. [PMID: 33136459 DOI: 10.1080/15374416.2020.1823850] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Early identification of autism spectrum disorder (ASD) is an essential healthcare priority. Girls may be at risk for late diagnosis, although research is equivocal regarding how sex and other factors relate to ASD identification. The goals of the current investigation were to (1) identify how child sex, cognitive abilities, and demographic factors relate to age of first concern (AOC) and age of diagnosis (AOD), (2) evaluate trends in AOC/AOD over time, and (3) consider whether main effects of sex on AOC/AOD are moderated by cognitive abilities or time. METHOD Children (N = 365; 20% female; 85.6% identified as White) with ASD participated through the Province of Ontario Neurodevelopmental Disorders (POND) Network. Study records included AOD, date/timing of diagnosis (between 1996 and 2017), age of first parent concern, demographics, and standardized cognitive testing results (24.7% of children had IQ scores below standard scores of 70). RESULTS Average AOC occurred before 2 years of age whereas average AOD occurred after 5 years of age. Girls did not differ on AOC but had a later AOD than boys. Higher verbal IQ was associated with later AOD more strongly in girls than boys. Regarding time-related changes, average AOC and AOD increased across the study period, more strongly for girls. CONCLUSIONS Results support that sex is a key factor underlying delays in ASD identification and highlight the urgent need to improve diagnostic practices among girls. Limitations and implications for improving the diagnostic process are discussed. Abbreviations: ASD=autism spectrum disorder; IQ=intelligence quotient; AOC=parental report of age of first concern; AOD=age of diagnosis.
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Affiliation(s)
| | | | - Elizabeth P Hayden
- Department of Psychology and Brain and Mind Institute, Western University
| | - Melanie Penner
- Department of Pediatrics and Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Kristina Curcin
- Department of Psychology and Brain and Mind Institute, Western University
| | - Evdokia Anagnostou
- Department of Pediatrics and Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | | | | | - Stelios Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University
| | - Xudong Liu
- Department of Psychiatry, Queens University
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158
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Kelleher BL, Wheeler AC. Introduction to Special Issue on Outcome Measures for IDD: Where We Have Been, Where We Are Now, and Where We Are Heading. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:413-417. [PMID: 33211811 DOI: 10.1352/1944-7558-125.6.413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Bridgette L Kelleher
- Bridgette L. Kelleher, Purdue University Department of Psychological Sciences
- Guest Editors
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159
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Kerub O, Haas EJ, Meiri G, Bilenko N, Flusser H, Michaelovski A, Dinstein I, Davidovitch N, Menashe I. Ethnic Disparities in the Diagnosis of Autism in Southern Israel. Autism Res 2020; 14:193-201. [DOI: 10.1002/aur.2421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/02/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Orly Kerub
- Department of Health Systems Management Ben‐Gurion University of the Negev Beer‐Sheva Israel
- Southern district Ministry of Health Beer‐Sheva Israel
| | - Eric J. Haas
- Southern district Ministry of Health Beer‐Sheva Israel
| | - Gal Meiri
- Pre‐School Psychiatry Unit Soroka University Medical Center Beer‐Sheva Israel
| | - Natalya Bilenko
- Southern district Ministry of Health Beer‐Sheva Israel
- Department of Public Health Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Hagit Flusser
- Zusman Child Developmental Center Soroka University Medical Center Beer‐Sheva Israel
| | - Analya Michaelovski
- Zusman Child Developmental Center Soroka University Medical Center Beer‐Sheva Israel
| | - Ilan Dinstein
- Department of Psychology Ben‐Gurion University of the Negev Beer‐Sheva Israel
- Zlotowski Center for Neuroscience Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Nadav Davidovitch
- Department of Health Systems Management Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Idan Menashe
- Department of Public Health Ben‐Gurion University of the Negev Beer‐Sheva Israel
- Zlotowski Center for Neuroscience Ben‐Gurion University of the Negev Beer‐Sheva Israel
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160
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Hong JS, Singh V, Kalb L. Attention Deficit Hyperactivity Disorder Symptoms in Young Children with Autism Spectrum Disorder. Autism Res 2020; 14:182-192. [PMID: 33073542 DOI: 10.1002/aur.2414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/11/2022]
Abstract
The purpose of the current study was to examine the prevalence of attention deficit hyperactivity disorder (ADHD) symptoms among young children with autism spectrum disorder (ASD), child and parent-related demographic and clinical correlates of ADHD symptoms, and the relationships between co-occurring mental health problems and ADHD symptoms. Data for this cross-sectional study came from 979 toddlers and preschoolers, ages 1.5-5 years, with ASD. The primary outcome, ADHD symptoms, was measured using the Child Behavior Check List 1.5-5 (CBCL). Additional information from the medical record included demographics, parenting stress, and Autism Diagnostic Observation Schedule Second Edition. Descriptive and bivariate (ANOVA, Chi-Square) statistics and multivariate, multinomial regression analyses were used to examine demographic and clinical differences between low, moderate, and high ADHD symptom groups, as defined by 2 ADHD-related subscales. There were 418 (43%) children in the low ADHD symptom group, 294 (30%) in the moderate ADHD symptom group, and 267 (27%) in the high ADHD symptom group. Those with high ADHD symptoms were less likely to be Black or Hispanic and less likely to have parents with a graduate-level education compared to those with low ADHD symptoms. Parenting stress and all CBCL DSM-oriented subscales were positively associated with increasing ADHD symptoms. Among young children with ASD, ADHD symptoms were highly prevalent. The presence of ADHD symptoms was associated with increasing parenting stress and greater levels of other psychopathologies. These data suggest that young children with ASD should be evaluated for ADHD, and mental health as a whole. LAY SUMMARY: We investigated attention deficit hyperactivity disorder (ADHD) symptoms in toddlers and preschoolers with autism spectrum disorder (ASD) from a large sample with diverse race and socioeconomic background. In our study, we found that ADHD symptoms are highly prevalent in young children with ASD and are associated with increasing parenting stress and greater level of other psychopathologies, both internalizing and externalizing problems.
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Affiliation(s)
- Ji S Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Luke Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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161
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Gemegah E, Hartas D, Totsika V. Public attitudes to people with ASD: contact, knowledge and ethnicity. ADVANCES IN AUTISM 2020. [DOI: 10.1108/aia-01-2020-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The increase in autism prevalence and presentation in the media suggests a rise in public awareness. This paper aims to explore what factors (contact, knowledge and ethnicity) may be associated to positive attitudes towards individuals with autism spectrum disorder (ASD).
Design/methodology/approach
An online survey examined contact with and knowledge of ASD among Black, Asian and White ethnic groups to predict public attitudes to people with ASD.
Findings
In multiple regression models, the results suggested that the level of contact predicts positive attitudes towards autism when demographic factors were accounted. The level of knowledge about autism were significantly associated to attitudes, but not consistently when demographic factors were accounted. However, differences in knowledge and attitudes to people with ASD were identified amongst Black, Asian and White ethnic groups.
Research limitations/implications
These findings have implications for policy and public health and education campaigns, including ensuring contact and knowledge of autism among the public.
Originality/value
These findings have implications for policy and public health and education campaigns, including ensuring contact and knowledge of autism among the public. Additionally, further effort is required to target public knowledge and attitudes to autism, particularly among ethnic groups. Institutional support tailored to encourage structured and unstructured contact across public domains such as education, health, social and care practices could effectively reduce prejudice between the public and people with ASD over time.
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162
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Doyle N. Neurodiversity at work: a biopsychosocial model and the impact on working adults. Br Med Bull 2020; 135:108-125. [PMID: 32996572 PMCID: PMC7732033 DOI: 10.1093/bmb/ldaa021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations. SOURCES OF DATA Literature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article. AREAS OF AGREEMENT There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a 'spiky profile' of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic. AREAS OF CONTROVERSY The developing nomenclature is debated and the application of disability status versus naturally occurring difference. Diagnosis and legal protections vary geographically, resulting in heretofore unclear guidance for practitioners and employers. GROWING POINTS The evolutionary critique of the medical model, recognizing and updating clinical approaches considering the emerging consensus and paradigmatic shift. AREAS TIMELY FOR DEVELOPING RESEARCH It is recommended that research addresses more functional, occupational concerns and includes the experiences of stakeholders in research development, moving away from diagnosis and deficit towards multi-disciplinary collaboration within a biopsychosocial model.
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Affiliation(s)
- Nancy Doyle
- Department of Organizational Psychology, Birkbeck University of London, London, UK
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163
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Klin A, Micheletti M, Klaiman C, Shultz S, Constantino JN, Jones W. Affording autism an early brain development re-definition. Dev Psychopathol 2020; 32:1175-1189. [PMID: 32938507 PMCID: PMC7880583 DOI: 10.1017/s0954579420000802] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Megan Micheletti
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Cheryl Klaiman
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - John N. Constantino
- Departments of Psychiatry and Pediatrics, Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St Louis,MO
| | - Warren Jones
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
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164
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Identifying Individuals With Intellectual Disability Within a Population Study. Nurs Res 2020; 69:436-447. [PMID: 32969948 DOI: 10.1097/nnr.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge. OBJECTIVE Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID. METHODS We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves I to III. RESULTS This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave I, the mean age of this subsample of adolescents with ID was 16.1 years. About half of the adolescents were male and from minority racial groups. Their parents were predominately female, were married, had less than a high school education, and had a median age of 41.62 years. The adolescents' mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6, and all demonstrated at least one adaptive functioning limitation. DISCUSSION This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population data sets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.
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165
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School-Based Autism Rates by State: An Analysis of Demographics, Political Leanings, and Differential Identification. J Autism Dev Disord 2020; 51:2271-2283. [PMID: 32926306 DOI: 10.1007/s10803-020-04700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We reviewed federal special education data to determine school-identified prevalence of Autism Spectrum Disorder (ASD) and other disability categories by U.S. state. We also examined whether state-level policies, demographic factors, and rates of other eligibility categories are predictive of these state ASD rates. Results indicate that overall, 1 of 81 school-aged children are served under an ASD special education eligibility. State-level demographic factors, such as socioeconomic status and political leanings were highly predictive of rates of ASD. States with higher rates of ASD had lower rates of intellectual and learning disabilities, but higher rates of Other Health Impairment (OHI).
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166
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Jariwala-Parikh K, Barnard M, Holmes ER, West-Strum D, Bentley JP, Banahan B, Khanna R. Autism Prevalence in the Medicaid Program and Healthcare Utilization and Costs Among Adult Enrollees Diagnosed with Autism. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:768-776. [PMID: 31352637 DOI: 10.1007/s10488-019-00960-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the number of individuals diagnosed with autism increases, there is an increase in demand to provide support throughout their lifespan. This study aimed to: (1) estimate trends in the prevalence of autism diagnoses and medical services use in adults with autism diagnoses; (2) assess predictors of healthcare utilization and costs among adults with autism diagnoses enrolled in Medicaid. A retrospective analysis of 2006-2008 Medicaid claims for 39 states was conducted. There was a 38% increase in the prevalence of autism diagnoses from 2006 to 2008. Total expenditures and outpatient and ER visits varied significantly by demographic variables.
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Affiliation(s)
- Krutika Jariwala-Parikh
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA.
- Life Sciences, IBM Watson Health, Ann Arbor, MI, 48108, USA.
| | - Marie Barnard
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Erin R Holmes
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Donna West-Strum
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Benjamin Banahan
- Department of Pharmacy Administration and Center for Pharmaceutical Marketing and Management, University of Mississippi, University, MS, USA
| | - Rahul Khanna
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson Co., New Brunswick, NJ, USA
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167
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Quebles I, Solomon O, Smith KA, Rao SR, Lu F, Azen C, Anaya G, Yin L. Racial and Ethnic Differences in Behavioral Problems and Medication Use Among Children With Autism Spectrum Disorders. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:369-388. [PMID: 32936891 PMCID: PMC8423191 DOI: 10.1352/1944-7558-125.5.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2020] [Indexed: 06/03/2023]
Abstract
We examined racial and ethnic differences in the prevalence of behavioral problems measured by the Child Behavioral Checklist (CBCL), sleep disturbances measured by the Child Sleep Habits Questionnaire (CSHQ), and medication use among children with Autism Spectrum Disorders (ASD). We analyzed data from the Autism Treatment Network (ATN) dataset for 2,576 children ages 6 to 18 years of age diagnosed with ASD. Multivariable logistic regression accounting for age, gender, Diagnostic and Statistical Manual of Mental Disorders (4th Edition - Text Revision), diagnosis (Autistic Disorder, PDD-NOS, Asperger's Disorder), and parents' education did not show any racial or ethnic differences in behavioral challenges, conduct problems, or sleep disturbances for any of the groups, but Black children had lower odds of Total Problem Behaviors and Asian children had lower odds of Hyperactivity compared to White children. As a group, children from racial and ethnic minorities had lower odds of Total Problem Behaviors and Conduct Problems compared to White children. Hispanic children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct Problems. Asian children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, and Hyperactivity; and had close to lower odds in medication use for Conduct Problems. Black children had lower odds for medication use for Total Problem Behaviors only. As a group, children from racial and ethnic minorities had lower odds for medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct problems, but not for Sleep Disturbances. While these results are consistent with previous studies showing that White children are significantly more likely to receive psychotropic medication compared to children from racial and ethnic minority groups, we found no such differences for sleep challenges, suggesting that they are more consistently identified and equitably treated than other behavioral problems associated with ASD. We draw upon Andersen's (1995) Behavioral Model of Healthcare Use to suggest predisposing, enabling, and needs factors that may contribute to this pattern of racial and ethnic differences in the use of medications among children ASD.
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Affiliation(s)
- Irina Quebles
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Olga Solomon
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Kathryn A Smith
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Sowmya R Rao
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Frances Lu
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Colleen Azen
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Grace Anaya
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Larry Yin
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
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168
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Constantino JN, Abbacchi AM, Saulnier C, Klaiman C, Mandell DS, Zhang Y, Hawks Z, Bates J, Klin A, Shattuck P, Molholm S, Fitzgerald R, Roux A, Lowe JK, Geschwind DH. Timing of the Diagnosis of Autism in African American Children. Pediatrics 2020; 146:peds.2019-3629. [PMID: 32839243 PMCID: PMC7461218 DOI: 10.1542/peds.2019-3629] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this study was to analyze data from the largest-available repository of diagnostic and phenotypic information on AA children with ASD, and to explore the wide variation in outcome within the cohort as a function of sociodemographic risk and specific obstacles to service access for the purpose of informing a national approach to resolution of these disparities. METHODS Parents of 584 AA children with autism consecutively enrolled in the Autism Genetic Resource Exchange across 4 US data collection sites completed event history calendar interviews of the diagnostic odysseys for their children with ASD. These data were examined in relation to developmental outcomes of the children with autism and their unaffected siblings. RESULTS The average age of ASD diagnosis was 64.9 months (±49.6), on average 42.3 months (±45.1) after parents' first concerns about their children's development. The relationship between timing of diagnosis and ASD severity was complex, and ID comorbidity was not predicted in a straightforward manner by familial factors associated with cognitive variation in the general population. CONCLUSIONS These findings document significant opportunity to expedite diagnosis, the need to further understand causes of ID comorbidity, and the necessity to identify effective approaches to the resolution of disparities in severity-of-outcome for AA children with autism.
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Affiliation(s)
- John N. Constantino
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri;,Contributed equally as co-first authors
| | - Anna M. Abbacchi
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri;,Contributed equally as co-first authors
| | - Celine Saulnier
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia;,Neurodevelopmental Assessment and Consulting
Services, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia
| | - David S. Mandell
- Department of Psychiatry, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yi Zhang
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Zoe Hawks
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Julianna Bates
- Departments of Pediatrics, Neuroscience, and
Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx,
New York
| | - Ami Klin
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia
| | - Paul Shattuck
- Drexel Autism Institute, Drexel University,
Philadelphia, Pennsylvania; and
| | - Sophie Molholm
- Departments of Pediatrics, Neuroscience, and
Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx,
New York
| | - Robert Fitzgerald
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Anne Roux
- Drexel Autism Institute, Drexel University,
Philadelphia, Pennsylvania; and
| | - Jennifer K. Lowe
- Departments of Neurology, Psychiatry, and Human
Genetics, David Geffen School of Medicine, University of California, Los
Angeles, California
| | - Daniel H. Geschwind
- Departments of Neurology, Psychiatry, and Human
Genetics, David Geffen School of Medicine, University of California, Los
Angeles, California
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169
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Dickson KS, Chlebowski C, Haine-Schlagel R, Ganger B, Brookman-Frazee L. Impact of Therapist Training on Parent Attendance in Mental Health Services for Children with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:230-241. [PMID: 32816564 DOI: 10.1080/15374416.2020.1796682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The current study explored the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) on parent attendance in their children's therapy sessions. We also examined family, therapist, and program factors as potential moderators. METHOD Data were drawn from a cluster-randomized community effectiveness trial of "An Individualized Mental Health Intervention for ASD (AIM HI)". Participants included 168 therapists yoked with 189 children recruited from publicly-funded mental health services. Data included family (caregiver strain, parent sense of competence, race/ethnicity), therapist (background, experience), and program (service setting) characteristics, and parent session attendance. Multilevel models were used to evaluate the effectiveness of AIM HI therapist training on caregiver attendance and identify moderators of training effects on parent attendance. RESULTS Parents attended a higher percentage of sessions in the AIM HI training condition compared to the Usual Care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition. CONCLUSIONS Effective strategies to promote parent engagement, especially in service settings such as schools, are warranted. Findings support the effectiveness of AIM HI training in promoting parent attendance across multiple publicly-funded mental health service settings. The larger effect in school-based programs supports the utility of training in evidence-based interventions such as AIM HI to increase the feasibility of parent attendance in such services.
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Affiliation(s)
- Kelsey S Dickson
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Colby Chlebowski
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego
| | - Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Services Research Center
| | - Bill Ganger
- Child and Adolescent Services Research Center.,San Diego State University Research Foundation
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center.,Department of Psychiatry, University of California San Diego.,Autism Discovery Institute at Rady Children's Hospital San Diego
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170
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Azim A, Rdesinski RE, Phelps R, Zuckerman KE. Nonclinical Factors in Autism Diagnosis: Results From a National Health Care Provider Survey. J Dev Behav Pediatr 2020; 41:428-435. [PMID: 32251041 DOI: 10.1097/dbp.0000000000000797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The prevalence of autism spectrum disorder (ASD) has increased 10-fold in the past 40 years, and disparities have been noted by race/ethnicity and socioeconomic status, prompting concern about diagnostic accuracy. Provider perceptions of ASD diagnostic accuracy are not known. We conducted a survey of providers who diagnose ASD assessing how nonclinical factors might affect ASD diagnostic rates. METHODS The mixed-mode survey was sent to the members of the Society of Developmental and Behavioral Pediatrics with clinical interest in ASD (n = 400). Respondents used a Likert-type scale to address how often they and their colleagues overdiagnosed or underdiagnosed ASD. They were also asked how families grouped by race/ethnicity, education, socioeconomic status, and urbanicity perceived an ASD diagnosis. RESULTS Sixty-three percent of providers completed the survey. Eight point seven percent of providers self-reported that they overdiagnose ASD at least sometimes. However, 58% of providers reported that local colleagues overdiagnose ASD at least sometimes. Seven point eight percent of providers self-reported underdiagnosing ASD at least sometimes and cited parents not wanting a diagnosis as one of the most common reasons they may underdiagnose. Providers reported that non-white and rural families were more likely to think that ASD diagnosis was "a bad thing" than "a good thing" than white and urban and suburban families, respectively. CONCLUSION Providers report moderate rates of ASD misdiagnosis and perceive differences in diagnostic preferences according to family characteristics. The study results may help explain the trends and disparities in ASD diagnosis.
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Affiliation(s)
- Aniqa Azim
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Rebecca E Rdesinski
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Randall Phelps
- Child Development and Rehabilitation Center, Institute on Development and Disabilities, Oregon Health & Science University, Eugene, OR and Portland, OR
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171
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McNally Keehn R, Ciccarelli M, Szczepaniak D, Tomlin A, Lock T, Swigonski N. A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder. Pediatrics 2020; 146:peds.2019-3876. [PMID: 32632023 DOI: 10.1542/peds.2019-3876] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.
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Affiliation(s)
- Rebecca McNally Keehn
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Mary Ciccarelli
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Angela Tomlin
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Thomas Lock
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Nancy Swigonski
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and.,Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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172
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Hormonal contraceptives and autism epidemics. Med Hypotheses 2020; 141:109729. [DOI: 10.1016/j.mehy.2020.109729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/24/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022]
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173
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Dimian AF, Symons FJ, Wolff JJ. Delay to Early Intensive Behavioral Intervention and Educational Outcomes for a Medicaid-Enrolled Cohort of Children with Autism. J Autism Dev Disord 2020; 51:1054-1066. [DOI: 10.1007/s10803-020-04586-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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174
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Abstract
Abstract. Screening measures for autism spectrum disorder (ASD) are important tools for clinicians and researchers. However, where a measure developed and validated for one population is used with another, its performance in this new context must be carefully examined. The RAADS-14, a brief ASD screen developed in Sweden, was evaluated with a sample of New Zealand adults ( N = 387), 41 of whom self-reported a prior diagnosis of ASD. The convergent validity of the RAADS-14 (Hypothesis 2) was supported by a strong positive correlation with the AQ-10 (short version of the Autism Spectrum Quotient), r = .81. Discriminant validity (Hypothesis 3) was also supported by a strong negative correlation with the EQ-Short (short version of the Empathy Quotient), r = −.75. However, the measure did not meet inferential criteria for internal consistency (Hypothesis 1), and confirmatory factor analysis (CFA) found a poor fit of the proposed three-factor model (Hypothesis 4) to the data. A cut-off score of 14/42 provided adequate sensitivity (95%) to detect participants with self-reported ASD diagnoses, but not adequate specificity (70%), suggesting a very high rate of false positives should be expected if relying on RAADS-14 scores alone to interpret presence of ASD. In sum, our results do not provide sufficient evidence of reliability and validity to support the use of the RAADS-14 with the New Zealand population. We provide suggestions for refinement of the RAADS-14 that may lead to increased reliability and validity.
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Affiliation(s)
- Sarah M. Kember
- Department of Psychology, Massey University, Auckland, New Zealand
| | - Matt N. Williams
- Department of Psychology, Massey University, Auckland, New Zealand
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175
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Tromans S, Chester V, Gemegah E, Roberts K, Morgan Z, Yao GL, Brugha T. Autism identification across ethnic groups: a narrative review. ADVANCES IN AUTISM 2020. [DOI: 10.1108/aia-03-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of the paper is to review autism identification across different ethnic groups. Diagnosis of autism may be missed or delayed in certain ethnic groups, leading to such groups being underserved relative to their needs. This can result in members of such groups being effectively denied essential avenues of support that can substantially improve the quality of life of autistic persons as well as those whom care for them.
Design/methodology/approach
A literature search for articles reporting autism identification across ethnic groups was undertaken. Data are compared, with a special focus on possible explanations for any inter-group variation.
Findings
Autism identification appears to be generally lower in minority ethnic groups relative to the majority population. Individuals presenting with autism from minority groups appear to have more severe forms of the condition.
Originality/value
There are a multitude of potential explanations for inter-ethnicity variation in autism identification, including health care-related factors, broader environmental influences, cultural factors and possible biological differences. Implications for clinical practice and public health include a need to look at means of ensuring equitable access to relevant autism diagnostic and support services across ethnic groups. Further work is required to better understand the belief systems that operate within specific ethnic groups, how this may potentially impact upon autism identification and measures to address the concerns of such groups.
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176
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Delehanty A, Lee J, Hooker JL, Cortese J, Woods J. Exploring message framing to engage parents in early screening for autism spectrum disorder. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30342-6. [PMID: 32622690 DOI: 10.1016/j.pec.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE With the average age of diagnosis of autism hovering between 4 and 5 years of age, many children do not receive critical early intervention. Health information messages may be useful for increasing parents' understanding of the importance of early autism screening. METHODS Messages promoting autism screening were presented to 282 parents in a 2 (message frame: gain, loss) x 3 (evidence type: narrative, statistical, and hybrid), online, between-participants factorial design. Participants' involvement, affective responses, perceived threat to behavioral freedom, attitudes, and intentions to discuss screening with a healthcare provider were analyzed. RESULTS Loss-framed messages that included a hybrid of first-person narrative and statistical evidence were related to favorable ratings for most outcomes. Levels of perceived threat to behavioral freedom partially mediated involvement and attitudes, in a negative direction, for loss-framed narrative messages. CONCLUSION Results of this preliminary study supported the inclusion of both evidence types in messages developed to encourage parents to engage in early screening for autism, and partially supported focusing these messages on the potential costs of not screening. PRACTICE IMPLICATIONS Effective use of messaging with parents could help to increase knowledge and facilitate shared decision-making with health care providers to engage in early screening for autism.
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Affiliation(s)
- Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, 600 Forbes Ave Pittsburgh, PA 15282, USA.
| | - Jaejin Lee
- School of Communication Florida State University 4100 University Center, Building C Tallahassee, FL, 32306 USA.
| | - Jessica L Hooker
- Autism Institute, College of Medicine Florida State University, 2312 Killearn Center Blvd, Building A, Tallahassee, FL, 32308 USA.
| | - Juliann Cortese
- School of Communication Florida State University 4100 University Center, Building C Tallahassee, FL, 32306 USA.
| | - Juliann Woods
- Autism Institute, College of Medicine Florida State University, 2312 Killearn Center Blvd, Building A, Tallahassee, FL, 32308 USA.
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177
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Drahota A, Sadler R, Hippensteel C, Ingersoll B, Bishop L. Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2008-2020. [PMID: 32564619 DOI: 10.1177/1362361320931265] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers' availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
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Affiliation(s)
- Amy Drahota
- Michigan State University, USA.,Child and Adolescent Services Research Center, USA
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178
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P. Nowell K, Christopher K, Sohl K. Equipping Community Based Psychologists to Deliver Best Practice ASD Diagnoses Using The ECHO Autism Model. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1771564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Kerri P. Nowell
- Department of Health Psychology, Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kourtney Christopher
- Department of Health Psychology, Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, MO, USA
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179
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Papoudi D, Jørgensen CR, Guldberg K, Meadan H. Perceptions, Experiences, and Needs of Parents of Culturally and Linguistically Diverse Children with Autism: a Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00210-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractA scoping review of studies carried out in the UK and the USA was conducted to explore the perceptions, experiences, and needs of culturally and linguistically diverse families of children with autism. Overall, 32 articles met the inclusion criteria, 25 studies were conducted in the USA and 7 studies in the UK. Four themes emerged including (a) knowledge and beliefs about autism and their impact on the family; (b) autism and family life; (c) family experiences of accessing services and support, and parents’ needs; and (d) multilanguage. Findings highlighted that family perceptions of autism are influenced by an often-reported lack of knowledge; experiences include social stigma as well as difficulties in having access to services. Needs indicate the development of culturally sensitive interventions, information in multiple languages, and parent–professional collaboration. Implications for research, policy, and practice are included.
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180
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Robinson LA, Menezes M, Mullin B, Cook BL. A Comparison of Health Care Expenditures for Medicaid-Insured Children with Autism Spectrum Disorder and Asthma in an Expanding Accountable Care Organization. J Autism Dev Disord 2020; 50:1031-1044. [PMID: 31836944 DOI: 10.1007/s10803-019-04327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As value-based care continues to expand, more children with autism spectrum disorder (ASD) will be treated by accountable care organizations (ACOs), provider organizations seeking to improve population health while reducing costs. To inform ACO strategies for children with ASD, this study compared health care expenditures of children insured by a Medicaid managed care organization, empaneled to a safety net ACO, with ASD, asthma, and neither diagnosis. Compared to other study groups, children with ASD were more costly, had lower rates of acute care, and had higher rates of "leaked" care provided by home- and community-based mental health agencies outside of the ACO. These findings highlight the need for unique value-based strategies for children with ASD in a public sector ACO.
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Affiliation(s)
- Lee A Robinson
- Cambridge Health Alliance, Cambridge, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | | | | | - Benjamin Lê Cook
- Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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181
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Do Implicit and Explicit Racial Biases Influence Autism Identification and Stigma? An Implicit Association Test Study. J Autism Dev Disord 2020; 51:106-128. [PMID: 32415531 DOI: 10.1007/s10803-020-04507-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Are implicit and explicit biases related to ASD identification and/or stigma? College students (N = 493) completed two IATs assessing implicit stigma and racial biases. They evaluated vignettes depicting a child with ASD or conduct disorder (CD) paired with a photo of a Black or White child. CD was more implicitly and explicitly stigmatized than ASD. Accurately identifying ASD was associated with reduced explicit stigma; identifying CD led to more stigma. Participants who identified as White implicitly associated the White child with ASD and the Black child with CD. A trend in the reverse direction was observed among Black participants. Implicit and explicit biases were unrelated. Findings highlight a need for trainings to ameliorate biases favoring one's in-group.
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182
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Howard J, Copeland JN, Gifford EJ, Lawson J, Bai Y, Heilbron N, Maslow G. Brief Report: Classifying Rates of Students with Autism and Intellectual Disability in North Carolina: Roles of Race and Economic Disadvantage. J Autism Dev Disord 2020; 51:307-314. [PMID: 32405902 DOI: 10.1007/s10803-020-04527-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined special education classifications among students aged 3-21 in North Carolina public schools, highlighting autism spectrum disorder (ASD) and intellectual disability (ID). Results revealed variability by county in ASD and ID prevalence, and in county-level ratios of ID vs. ASD classifications. Sociodemographic characteristics predicted proportion of ASD or ID within a county; correlations showed an association between race and ID, but not ASD. County's median household income predicted proportion of students classified as ASD and ID (opposite directions), controlling for number of students and gender. Variability was unlikely related to biological incidence, and more likely related to district/school practices, or differences in resources. Disparities warrant further examination to ensure that North Carolina's youth with disabilities access necessary, appropriate resources.
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Affiliation(s)
- Jill Howard
- Duke University School of Medicine, Durham, NC, USA.
| | | | | | | | - Yu Bai
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | | | - Gary Maslow
- Duke University School of Medicine, Durham, NC, USA
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183
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Making Autism Research Inclusive by Attending to Intersectionality: a Review of the Research Ethics Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00204-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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184
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Girolamo TM, Rice ML, Warren SF. Assessment of Language Abilities in Minority Adolescents and Young Adults With Autism Spectrum Disorder and Extensive Special Education Needs: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:804-818. [PMID: 32324427 PMCID: PMC7842863 DOI: 10.1044/2020_ajslp-19-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/29/2019] [Accepted: 01/21/2020] [Indexed: 05/22/2023]
Abstract
Purpose Little is known about the language abilities of adolescents and young adults with autism spectrum disorder (ASD) despite the importance of language in their other life outcomes. Even less is known about the language abilities of racial/ethnic minorities with ASD and extensive special education needs. These gaps limit our understanding of adolescents and young adults with ASD. Method A pilot study evaluated the efficacy of individualized age-referenced language assessment for minority adolescents and young adults with ASD in self-contained special education settings. Participants (n = 10) completed the Clinical Evaluation of Language Fundamentals-Third Edition, Test for Early Grammatical Impairment (TEGI), Columbia Mental Maturity Scale, and Wechsler Intelligence Scale for Children-Third Edition Digit Span. Results Clinical Evaluation of Language Fundamentals-Third Edition scores showed little variation, with most participants showing a floor effect. TEGI, Columbia Mental Maturity Scale, and Digit Span scores showed greater variation. Some participants had ceiling TEGI scores, and some had variable assessment profiles. Conclusion Assessment was sensitive to variability across some measures. The pilot study outcomes support the feasibility and potential informativeness of additional investigation of conventional language assessments and change over time.
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Affiliation(s)
| | - Mabel L. Rice
- Child Language Doctoral Program, The University of Kansas, Lawrence
| | - Steven F. Warren
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
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185
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Jones SH, St. Peter CC, Ruckle MM. Reporting of demographic variables in the Journal of Applied Behavior Analysis. J Appl Behav Anal 2020; 53:1304-1315. [PMID: 32383188 DOI: 10.1002/jaba.722] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/12/2022]
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186
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Mirza M, Magaña S, Stoffel A, Xu Y, Kim Y. Piloting a Family-Centered Intervention to Promote Participation Among Latino Children With Autism Spectrum Disorder: A Comparison of Two Delivery Modes. ACTA ACUST UNITED AC 2020. [DOI: 10.3928/24761222-20191018-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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187
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DiBari JN, Azuine RE, Linares DE, Rocha I, Park HY, Raskin Ramos L, Kogan MD, Kavanagh L. Maternal and Child Health Bureau's Autism Research Program. Pediatrics 2020; 145:S5-S12. [PMID: 32238526 DOI: 10.1542/peds.2019-1895c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview and quantitatively demonstrate the reach of the Health Resources and Services Administration's Maternal and Child Health Bureau autism research program. METHODS We reviewed program reports and internal data from 59 autism research grantees. The US federal Interagency Autism Coordinating Committee's strategic plan questions were used as a framework to highlight the contributions of the autism research program in advancing the field. RESULTS The autism research program grantees advance research in several ways. Grantees have strengthened the evidence for autism interventions by conducting 89 studies at 79 distinct research sites. A total of 212 708 participants have enrolled in autism research program studies and 361 researchers have contributed to furthering autism research. The program addresses topics that align with the majority of the Interagency Autism Coordinating Committee's priority topic areas, including advancements in treatments and interventions, services and supports, and identifying risk factors. Grantee products include 387 peer-reviewed publications, 19 tools, and 13 practice guidelines for improving care and intervention practices. CONCLUSIONS The autism research program has contributed to medical advances in research, leveraged innovative training platforms to provide specialized training, and provided access to health services through research-based screening and diagnostic procedures. Autism research program studies have contributed to the development of evidence-based practice guidelines, informed policy guidelines, and quality improvement efforts to bolster advancements in the field. Although disparities still exist, the Health Resources and Services Administration's Maternal and Child Health Bureau can reduce gaps in screening and diagnosis by targeting interventions to underserved populations including minority and rural communities.
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Affiliation(s)
| | | | | | | | - Hae Young Park
- Division of Maternal and Child Health Workforce Development
| | | | | | - Laura Kavanagh
- Office of the Associate Administrator, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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188
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Lopez K, Marroquin JM, Gutierrez C. Methods to Decrease Disparities in Age of Autism Diagnosis and Treatment Access among Latinx Children. SOCIAL WORK 2020; 65:140-148. [PMID: 32248232 DOI: 10.1093/sw/swaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 06/11/2023]
Abstract
Autism spectrum disorder (ASD) affects a substantial number of individuals and their families. Early diagnosis followed by intensive behavioral services is critical to reducing social communication deficits and behavioral challenges. Research has continually demonstrated health disparities with Latinx families that perpetuate lower ASD prevalence rates, later ASD diagnosis, and limited access to treatment compared with white children. Moreover, Latinx children who are diagnosed with ASD receive less intense and fewer treatment services. Given the number of Latinx children and those with ASD, social workers are likely to encounter the intersection throughout their careers. Thus, it is critical for social workers to have general knowledge about autism and the complexity of accessing diagnostic and treatment services. In this article, the authors review the literature on Latinx children and ASD, and identify opportunities for social workers to be innovative in their use of frameworks, theories, and practice approaches to reduce disparities in ASD diagnosis and treatment among Latinx children.
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Affiliation(s)
- Kristina Lopez
- School of Social Work, Arizona State University, Phoenix
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189
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Smith KA, Gehricke JG, Iadarola S, Wolfe A, Kuhlthau KA. Disparities in Service Use Among Children With Autism: A Systematic Review. Pediatrics 2020; 145:S35-S46. [PMID: 32238530 DOI: 10.1542/peds.2019-1895g] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services. OBJECTIVE We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status. DATA SOURCES Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services. STUDY SELECTION Included studies addressed at least one key question and met eligibility criteria. DATA EXTRACTION Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate. RESULTS Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care. LIMITATIONS The body of literature on this topic is small; hence it served as a limitation to this review. CONCLUSIONS The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions.
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Affiliation(s)
- Kathryn A Smith
- Children's Hospital Los Angeles, Los Angeles, California; .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jean-G Gehricke
- Center for Autism & Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, California
| | - Suzannah Iadarola
- Department of Developmental Behavioral Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Audrey Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Departments of Physical Medicine and Rehabilitation and
| | - Karen A Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
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190
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Habayeb S, Dababnah S, John A, Rich B. Cultural Experiences of Arab American Caregivers Raising Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:51-62. [PMID: 31529239 DOI: 10.1007/s10803-019-04218-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research on families' experiences raising children with Autism Spectrum Disorder (ASD) is limited in minority ethnic and cultural groups, such as the Arab American community. Twenty Arab American caregivers raising children with ASD completed online questionnaires regarding their experiences with stigma and acculturation. Nine participants completed follow-up phone interviews. Perceived stigma fell in the low to moderate range. Acculturation related to social interactions indicated slightly greater assimilation compared to separation, and slightly greater integration over marginalization. During interviews, participants discussed the impact of disability stigma, distancing from their communities, and parent gender roles. By better understanding Arab American families raising children with ASD professionals can work towards improving clinical services for these families.
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Affiliation(s)
- Serene Habayeb
- Division of Pediatric Neuropsychology, Children's National Health System, Center for Autism Spectrum Disorder, 15245 Shady Grove Rd., Suite 350, Rockville, MD, 20850, USA. .,The Catholic University of America, 620 Michigan Ave., N.E., Washington, DC, 20064, USA.
| | - Sarah Dababnah
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Aesha John
- Texas Christian University, 2800 W Bowie St, Fort Worth, TX, 76109, USA
| | - Brendan Rich
- The Catholic University of America, 620 Michigan Ave., N.E., Washington, DC, 20064, USA
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191
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Wiggins LD, Durkin M, Esler A, Lee LC, Zahorodny W, Rice C, Yeargin-Allsopp M, Dowling NF, Hall-Lande J, Morrier MJ, Christensen D, Shenouda J, Baio J. Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors. Autism Res 2020; 13:464-473. [PMID: 31868321 PMCID: PMC7521364 DOI: 10.1002/aur.2255] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 01/23/2023]
Abstract
The objectives of our study were to (a) report how many children met an autism spectrum disorder (ASD) surveillance definition but had no clinical diagnosis of ASD in health or education records and (b) evaluate differences in demographic, individual, and service factors between children with and without a documented ASD diagnosis. ASD surveillance was conducted in selected areas of Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin. Children were defined as having ASD if sufficient social and behavioral deficits and/or an ASD diagnosis were noted in health and/or education records. Among 4,498 children, 1,135 (25%) had ASD indicators without having an ASD diagnosis. Of those 1,135 children without a documented ASD diagnosis, 628 (55%) were not known to receive ASD services in public school. Factors associated with not having a clinical diagnosis of ASD were non-White race, no intellectual disability, older age at first developmental concern, older age at first developmental evaluation, special education eligibility other than ASD, and need for fewer supports. These results highlight the importance of reducing disparities in the diagnosis of children with ASD characteristics so that appropriate interventions can be promoted across communities. Autism Res 2020, 13: 464-473. © 2019 International Society for AutismResearch,Wiley Periodicals, Inc. LAY SUMMARY: Children who did not have a clinical diagnosis of autism spectrum disorder (ASD) documented in health or education records were more likely to be non-White and have fewer developmental problems than children with a clinical diagnosis of ASD. They were brought to the attention of healthcare providers at older ages and needed fewer supports than children with a clinical diagnosis of ASD. All children with ASD symptoms who meet diagnostic criteria should be given a clinical diagnosis so they can receive treatment specific to their needs.
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Affiliation(s)
- Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen Durkin
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Amy Esler
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Li-Ching Lee
- Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland
| | - Walter Zahorodny
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Catherine Rice
- Department of Psychiatry, Early Emory Center for Child Development and Enrichment, Emory University, Atlanta, Georgia
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole F Dowling
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota
| | - Michael J Morrier
- Department of Psychiatry, Early Emory Center for Child Development and Enrichment, Emory University, Atlanta, Georgia
| | - Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Josephine Shenouda
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jon Baio
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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192
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Soltys SM, Scherbel JR, Kurian JR, Diebold T, Wilson T, Hedden L, Groesch K, Diaz-Sylvester PL, Botchway A, Campbell P, Loret de Mola JR. An association of intrapartum synthetic oxytocin dosing and the odds of developing autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1400-1410. [PMID: 32054311 PMCID: PMC7376627 DOI: 10.1177/1362361320902903] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio = 2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother’s body mass index was 35 or higher at birth (odds ratio = 2.34) and subjects in which the reason for delivery was categorized as “fetal indication” (odds ratio = 2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio = 3.48) and high cumulative dose of synthetic oxytocin (odds ratio = 2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.
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Affiliation(s)
| | | | | | - Todd Diebold
- Southern Illinois University School of Medicine, USA
| | - Teresa Wilson
- Southern Illinois University School of Medicine, USA
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193
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McCormick CEB, Kavanaugh BC, Sipsock D, Righi G, Oberman LM, Moreno De Luca D, Gamsiz Uzun ED, Best CR, Jerskey BA, Quinn JG, Jewel SB, Wu PC, McLean RL, Levine TP, Tokadjian H, Perkins KA, Clarke EB, Dunn B, Gerber AH, Tenenbaum EJ, Anders TF, Sheinkopf SJ, Morrow EM. Autism Heterogeneity in a Densely Sampled U.S. Population: Results From the First 1,000 Participants in the RI-CART Study. Autism Res 2020; 13:474-488. [PMID: 31957984 DOI: 10.1002/aur.2261] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
Abstract
The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.
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Affiliation(s)
- Carolyn E B McCormick
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Danielle Sipsock
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Giulia Righi
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Lindsay M Oberman
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daniel Moreno De Luca
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Ece D Gamsiz Uzun
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for Computational Molecular Biology, Brown University, Providence, Rhode Island
| | - Carrie R Best
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Beth A Jerskey
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Pei-Chi Wu
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island
| | - Rebecca L McLean
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Todd P Levine
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Hasmik Tokadjian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Kayla A Perkins
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elaine B Clarke
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Brittany Dunn
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Gerber
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena J Tenenbaum
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Thomas F Anders
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Stephen J Sheinkopf
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Eric M Morrow
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island.,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island.,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island
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194
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McNally Keehn R, Enneking B, Ramaker M, Goings M, Yang Z, Carroll A, Ciccarelli M. Family-Centered Care Coordination in an Interdisciplinary Neurodevelopmental Evaluation Clinic: Outcomes From Care Coordinator and Caregiver Reports. Front Pediatr 2020; 8:538633. [PMID: 33194884 PMCID: PMC7661956 DOI: 10.3389/fped.2020.538633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Children with neurodevelopmental disabilities experience many unmet healthcare needs. Care coordination is one critical solution to addressing the substantial strain on families, local communities, and the larger healthcare system. The purpose of this study was to implement a care coordination program in an interdisciplinary pediatric neurodevelopmental evaluation clinic and examine care coordinator and caregiver outcomes. Following neurodevelopmental diagnosis, children were provided with either care coordination (CC) or care as usual (CAU). For those receiving CC, the care coordinator documented family goals and care coordination activities, outcomes, and time spent. Caregivers in both groups completed a survey measuring access to needed services and caregiver stress and empowerment following their child's evaluation (T1) and 4-6 months post-evaluation (T2). Care coordinator findings demonstrated that over 85% of family goals focused on understanding the child's diagnosis, getting needed interventions and educational support, and accessing healthcare financing programs. More than half of care coordination activities were spent on engaging and educating the family; similarly, the most time-consuming care coordination efforts were in helping families understand their child's diagnosis and meeting family's basic needs. For those children referred to needed services, 54% were enrolled in one or more service at T2. Caregivers in both the CC and CAU groups reported an increase in stress related to interactions with their child as well as increased empowerment from T1 to T2. Contrary to our hypotheses, there were no significant group-by-time interactions across caregiver-report measures. While these findings further our understanding of care coordination delivery, they diverge from previous evidence demonstrating care coordination efficacy. This study paves the way for future opportunities to evaluate what kinds of care coordination supports family need at varying times in their child's healthcare journey and how the outcomes important to all stakeholders are measured to reflect true evaluation of efficacy.
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Affiliation(s)
- Rebecca McNally Keehn
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brett Enneking
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Margo Ramaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael Goings
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Aaron Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Mary Ciccarelli
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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195
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Micheletti M, McCracken C, Constantino J, Mandell D, Jones W, Klin A. Research Review: Outcomes of 24- to 36-month-old children with autism spectrum disorder vary by ascertainment strategy: a systematic review and meta-analysis. J Child Psychol Psychiatry 2020; 61:4-17. [PMID: 31032937 PMCID: PMC6819204 DOI: 10.1111/jcpp.13057] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite widespread recommendations for early surveillance of risk for autism spectrum disorder (ASD), no research to date has shown that early surveillance leads to better clinical outcomes. Preliminary research has suggested that children with ASD ascertained via prospective follow-up have better outcomes than those ascertained via community referral. Because prospective studies include early surveillance, by comparing outcomes of children with ASD across ascertainment strategies, we may gain insight into the effects of early surveillance relative to its absence. METHODS A systematic review was conducted to identify studies reporting outcomes of 24- to 36-month-olds with ASD ascertained via prospective follow-up, community referral, or universal screening. A meta-analysis using a random effects model was used to calculate overall effect size estimates for developmental level and symptom severity across ascertainment cohorts. RESULTS Eleven prospective, ten community referral, and eight universal screening studies were identified, reporting on 1,658 toddlers with ASD. We found no differences in outcomes between community referral and universal screening studies. Relative to both, prospective studies reported significantly higher developmental levels and lower symptom severities. CONCLUSIONS Outcomes of young children with ASD ascertained via prospective follow-up are better than those of children with ASD recruited via community referral or universal screening. Although we discuss why sampling bias is not likely the driving force behind these findings, we cannot rule out the possibility that sampling bias contributes to the observed differences; future studies should probe the effects of sociodemographic variables on clinical outcomes as a function of ascertainment strategy. This limitation notwithstanding, our results raise the possibility that prospective follow-up may confer a 'surveillance effect' that contributes to improved developmental and diagnostic outcomes in children with ASD. Future research should test this hypothesis and determine the specific mechanism by which surveillance may improve outcomes.
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Affiliation(s)
- Megan Micheletti
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Courtney McCracken
- Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - John Constantino
- Departments of Psychiatry and Pediatrics, and Intellectual and Developmental Disabilities Research Center, Washington University, St Louis, MO
| | - David Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Jones
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,Emory Center for Translational Social Neuroscience, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,Emory Center for Translational Social Neuroscience, Atlanta, GA, USA
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196
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Son E, Magaña S, Pedraza FDM, Parish SL. Providers' Guidance to Parents and Service Use for Latino Children With Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:64-75. [PMID: 31877261 DOI: 10.1352/1944-7558-125.1.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To better understand disparities between Latino and White children with autism or other developmental disabilities (ASD/DD), we examined whether Latino ethnicity predicted the number of specialty care services received by children with severe functional limitations depending on medical providers' responses to parents' initial concerns about their child's development. Through linkage of the Pathways and NS-CSHCN datasets, we found ethnic disparities in the receipt of specialty services associated with providers' responsiveness to parent-reported concerns among children with ASD/DD. Among children with significant functional limitations, Latino children whose parents received passive/reassuring responses from their providers were less likely to receive specialty services than White children with ASD/DD. Providers' guidance to parents may be a promising point of intervention for future disparity reduction efforts.
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Affiliation(s)
- Esther Son
- Esther Son, College of Staten Island, The City University of New York; Sandy Magaña, The University of Texas at Austin; Frances D. Martínez-Pedraza, Florida International University; and Susan L. Parish, The Virginia Commonwealth University
| | - Sandy Magaña
- Esther Son, College of Staten Island, The City University of New York; Sandy Magaña, The University of Texas at Austin; Frances D. Martínez-Pedraza, Florida International University; and Susan L. Parish, The Virginia Commonwealth University
| | - Frances D Martínez Pedraza
- Esther Son, College of Staten Island, The City University of New York; Sandy Magaña, The University of Texas at Austin; Frances D. Martínez-Pedraza, Florida International University; and Susan L. Parish, The Virginia Commonwealth University
| | - Susan L Parish
- Esther Son, College of Staten Island, The City University of New York; Sandy Magaña, The University of Texas at Austin; Frances D. Martínez-Pedraza, Florida International University; and Susan L. Parish, The Virginia Commonwealth University
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197
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Increasing Access to Autism Spectrum Disorder Diagnostic Consultation in Rural and Underserved Communities: Streamlined Evaluation Within Primary Care. J Dev Behav Pediatr 2020; 41:16-22. [PMID: 31490843 PMCID: PMC6933088 DOI: 10.1097/dbp.0000000000000727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preliminary feasibility and clinical utility research has demonstrated that implementation of a streamlined diagnostic model embedded within primary care (PC) clinics promotes early identification of young children with autism spectrum disorder (ASD). Use of this model results in dramatically reduced waits for diagnostic consultation, high levels of family/provider satisfaction, and reductions in referrals to overtaxed tertiary diagnostic centers. The current study extends this work by providing data before/after implementation of a streamlined model across a diverse range of PC clinics that provide health care to rural and underserved communities. METHODS The streamlined assessment involved record/history review, diagnostic interview, standard rating scales, and an interactive screening tool. Eighty children between the ages of 19 and 47 months were seen across 5 different clinics. Data were collected through chart review. RESULTS Implementation of streamlined model resulted in a significant decrease in latency to diagnostic conclusion from a mean of 144.7 to 49.9 days. Children were likely to experience a greater reduction in wait times if they were a PC patient versus a non-PC patient. CONCLUSION Results show significant reduction in wait times for ASD diagnostic decisions across both PC and non-PC patients. By reducing waits and identifying concerns more efficiently, we may increase the ability of families to access early intervention and support services.
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198
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Barnard-Brak L. Educational Versus Clinical Diagnoses of Autism Spectrum Disorder: Updated and Expanded Findings. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr-2018-0009.v48-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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199
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Sullivan AL. School-Based Autism Identification: Prevalence, Racial Disparities, and Systemic Correlates. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2013.12087475] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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200
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Zeleke WA, Hughes TL, Drozda N. Disparities in Diagnosis and Service Access for Minority Children with ASD in the United States. J Autism Dev Disord 2019; 49:4320-4331. [PMID: 31342443 DOI: 10.1007/s10803-019-04131-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study examined children with an autism spectrum disorder (ASD) using data from the 2011 Survey of Pathway to Diagnosis and Services national data set (n = 1715). When comparing white and minority families, results indicate there were no differences between the child's treatment needs based on the number and type of ASD symptoms or insurance coverage. However, minority parents were less likely to contact a doctor or health care professionals about their concerns, waiting years, rather than months as described by white families, to have the child evaluated. Although both white and minority families received similar types of care (e.g., conducting developmental tests, making a referral to a specialist, suggesting that the parent discuss the concern with the school), white families reported they were more formally engaged in the diagnostic process and subsequently visited a larger variety of service providers. White parents were more satisfied with the services that their child received from doctors and other health care providers whereas minority families indicated school services were more responsiveness to their needs. Recommended outreach efforts are suggested and described.
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