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Floríndez LI, Como DH, Law E, Tran CF, Johnson R, Polido JC, Cermak SA, Stein Duker LI. Oral care interventions for autistic individuals: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241260171. [PMID: 39056277 DOI: 10.1177/13623613241260171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
LAY ABSTRACT Oral care-related challenges are well documented in the autistic community; dental care remains one of the most prevalent unmet health needs among autistic individuals. This review examined interventions designed to improve oral health in autistic individuals from children and adult populations. Through a systematic process, 36 studies were identified. These studies focused on improving home-based oral care skills and routines and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated different types of techniques for facilitating oral care practice, including preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management. Using an evidence-based rubric, we reviewed the methodological quality of the studies and found that most were only "adequate" (n = 8) or "weak" (n = 23) in reporting their evidence. This review has two key findings: (1) there is support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits; and (2) distraction or sensory-reducing interventions may also improve experiences in the dental clinic. Only one study purposefully recruited autistic adults, and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for more studies investigating the impact of oral care-related interventions for autistic individuals of all ages and identifies a gap in interventions for autistic adults and those from minoritized populations.
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Hoang AQ, Lerman DC, Nguyen JT. Virtual Training of Medical Students to Promote the Comfort and Cooperation of Patients with Neurodevelopmental Disabilities. J Autism Dev Disord 2024; 54:1249-1263. [PMID: 36648564 PMCID: PMC9844946 DOI: 10.1007/s10803-023-05896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
Patients with neurodevelopmental disabilities generally have less access to necessary medical care compared to those without disabilities. Barriers to adequate care include patient fear and uncooperative behavior during routine medical procedures and inadequate preparation of medical professionals to treat this population. Researchers have identified multiple behavior-analytic procedures for promoting comfort and cooperation during medical treatments. Efficient, cost-effective training programs are needed to widely disseminate behavior-analytic procedures to medical students and professionals. The purpose of this study was to assess the efficacy of a virtual training to prepare medical students to implement behavioral procedures that could be easily incorporated into typical wellness examinations. Seven medical students received behavioral skills training (BST) delivered remotely via the Internet. Results showed that the training successfully increased students' correct implementation of the procedures in roleplay with the experimenter and with patients with neurodevelopmental disabilities. Responding also maintained at high levels 2 weeks after the training. These findings suggest that virtual BST is an efficient, practical approach for training health care professionals to implement general behavior management strategies to increase the comfort and cooperation of patients with NDD.
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Affiliation(s)
- Andrea Q Hoang
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA
| | - Dorothea C Lerman
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA.
| | - Jennifer Trang Nguyen
- Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Campus Box 245, Houston, TX, 77058, USA
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Arnold SRC, Bruce G, Weise J, Mills CJ, Trollor JN, Coxon K. Barriers to healthcare for Australian autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:301-315. [PMID: 37161777 PMCID: PMC10851652 DOI: 10.1177/13623613231168444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
LAY ABSTRACT This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge.
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Affiliation(s)
- Samuel RC Arnold
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | | | | | | | - Julian N Trollor
- UNSW Sydney, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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Son JW, Nam SH. Basic Management Strategies by Life Cycle for Treatment of the Persons With Autism Spectrum Disorder. Soa Chongsonyon Chongsin Uihak 2024; 35:22-28. [PMID: 38204737 PMCID: PMC10774562 DOI: 10.5765/jkacap.230011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/14/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
Interventions for targeted symptoms are important when setting treatment strategies for individuals with autism spectrum disorder (ASD) and developmental disabilities. Especially, the goal should be to achieve individual "niche construction" by allowing them to select and adjust an environment where they can demonstrate their special characteristics and strengths. In addition, these choices should vary depending on the stage of development of each person with ASD and developmental disabilities. It is necessary to establish a detailed and systematic plan for diagnosis and treatment necessary for infants and toddlers, school placement in school age, and employment or self-reliance in adult transition period to establish customized treatment strategies that fit the individual level of people with ASD and developmental disabilities.
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Affiliation(s)
- Jung-Woo Son
- Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Hyun Nam
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
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Mazurek MO, Sadikova E, Cheak-Zamora N, Hardin A, Sohl K, Malow BA. Health Care Needs, Experiences, and Perspectives of Autistic Adults. AUTISM IN ADULTHOOD 2023; 5:51-62. [PMID: 36941853 PMCID: PMC10024270 DOI: 10.1089/aut.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Autistic adults have high rates of co-occurring health conditions, suicide, and premature mortality, yet often experience health care barriers and poor health outcomes. A better understanding of the health care needs and experiences of autistic adults is essential for improving the health care system and patient experience. Methods This study examined the perspectives of autistic adults regarding their health care experiences in primary care and other settings and their suggestions for improvement using both qualitative and quantitative methods. Twenty autistic adults (aged 18-35 years, 65% male) completed surveys and individual semi-structured interviews. Results Qualitative data analysis results revealed 10 subthemes across 3 overarching themes: (1) system- and clinic-level factors affect access to care, (2) aspects of the clinic environment affect health care experiences, and (3) provider knowledge and practices affect health care experiences. Within the first theme, participants described barriers to obtaining services, including scheduling logistics, costs and inadequate insurance coverage, and transportation barriers. The second theme focused on aspects of the clinic environment that participants found especially relevant to their health care experiences and that required specific accommodations. This included sensory input, anxiety-provoking situations and procedures, and wait time. Within the third theme, participants emphasized aspects of providers' care that affected their health care experiences. Key factors included provider knowledge about autism, communication, rapport, and individualized care and patient-provider partnerships. Conclusion Overall, the findings point to a need for provider training and improvements to the health care delivery system to better meet the unique needs of autistic adults.
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Affiliation(s)
- Micah O. Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Nancy Cheak-Zamora
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Amber Hardin
- Supporting Transformative Autism Research (STAR) Initiative, University of Virginia, Charlottesville, Virginia, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
| | - Beth A. Malow
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Identifying Components of Autism Friendly Health Care: An Exploratory Study Using a Modified Delphi Method. J Dev Behav Pediatr 2023; 44:e12-e18. [PMID: 36367772 DOI: 10.1097/dbp.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Autistic individuals report lower health care satisfaction. However, there is currently no set of "best practice" standards about caring for autistic individuals. In this exploratory study, we aim to identify features of Autism Friendly practice according to a sample consisting of mainly professionals whose interests include autism using a modified 3-round Delphi-a method that identifies a consensus view across subject participants. METHODS Statements about components of an Autism Friendly health care practice were compiled in consultation with the steering committee of an Autism Friendly Initiative at a single, urban academic safety-net hospital. Participants were recruited through our national network of professionals and patients/families mailing list. Examples of invited professionals included researchers, health care workers, and educators. In the first 2 rounds, we distributed electronic surveys to participants, who scored statements from 1 to 9 regarding importance. In round 2, statements that were scored low by all stakeholder groups were eliminated. Seventy-eight participants responded to the first-round survey, and 51 participants responded to the second-round survey. In the third round, 38 participants ranked 16 statements from most to least important. Statements are summarized and presented in the Results section. RESULTS Topics that emerged from highly ranked statements include environmental/operational modifications (e.g., longer appointment times) and staff training to support autistic patients. CONCLUSION Highly ranked statements represented previously reported barriers, including the need for staff training and inclusive engagement with the autistic community. The findings can help inform health care organizations to determine priorities when building an Autism Friendly health care practice.
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Stein Duker LI, Goodman E, Pomponio Davidson A, Mosqueda L. Caregiver perspectives on barriers and facilitators to primary care for autistic adults: A qualitative study. Front Med (Lausanne) 2022; 9:1022026. [PMID: 36438029 PMCID: PMC9685801 DOI: 10.3389/fmed.2022.1022026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/27/2022] [Indexed: 09/19/2023] Open
Abstract
Background Primary care is associated with greater access to healthcare services and improved health outcomes. However, autistic adults report challenges accessing and utilizing primary care, in addition to unmet healthcare needs. The need to minimize existing barriers and identify strategies to facilitate successful healthcare encounters is increasingly important as autistic adults represent a growing segment of society. Minimal research has examined primary healthcare encounters for this population. Methods As part of a larger convergent parallel design mixed-methods study that recruited autistic adults, caregivers of autistic adults, and primary care providers treating autistic adults, interviews were conducted with 31 caregivers of autistic adults. Caregivers were predominantly female (94%), and the autistic adult they cared for were primarily male (87%), with a mean age of 24 years. Thematic analysis was employed to elucidate the barriers to care, suggestions to mitigate challenges, and/or successful strategies implemented during care encounters for autistic adults, as reported by their caregivers. Results Reported here are the results only from the caregiver interviews, in which seven themes emerged: (1) finding a primary care provider; (2) patient-provider communication; (3) anxiety due to unpredictability, an overstimulating sensory environment, and waiting time; (4) participation of consumers in the healthcare process; (5) stigma and assumptions about autism; (6) caregiver experiences; and (7) the impact of culture and ethnicity on care. Conclusion Findings from this study have the potential to inform the development of, or improve existing, client-centered interventions to improve primary healthcare services for autistic adults.
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Affiliation(s)
- Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Elizabeth Goodman
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Amber Pomponio Davidson
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Laura Mosqueda
- Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations. Encephale 2022; 48:555-559. [DOI: 10.1016/j.encep.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
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Dhuga Y, Feeney Y, Gallaher L, White A, Wright J, Banerjee S, Daley S. Developing undergraduate autism education for medical students: a qualitative study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001411. [PMID: 36053627 PMCID: PMC9345079 DOI: 10.1136/bmjpo-2022-001411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Autistic adults and children experience considerable health inequalities and have high rates of premature mortality, hospital admissions and emergency department visits. This is in part due to a lack of autism awareness in the healthcare and social care workforce. A new educational programme, Time for Autism (TfA), for medical students is being developed to address this challenge. This qualitative study was undertaken to support the development of the new programme in order to (1) understand the medical care experiences of parents of autistic children and (2) assess their views on the acceptability of the new TfA programme and willingness to be involved. METHODS A convenience sample of 11 parents of autistic children were recruited across the South of England. The ages of the autistic children ranged from 3 to 17 years. Semistructured interviews were completed between October and December 2019. Interview transcripts were analysed using thematic analysis. RESULTS Three key themes were identified: diagnosis, experiences of doctors and TfA considerations. There was support for and willingness to take part in a dedicated autism education programme for medical students, and constructive feedback to inform and improve its delivery. CONCLUSION The findings from this study provide insights into the medical care experiences of parents/carers of autistic children. Understanding how parents/carers of autistic children would like medical care to be improved can be used to develop TfA and other autism programmes. Parental/carer support for the development of and involvement in an autism medical education programme enhances the feasibility of the new programme.
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Affiliation(s)
- Yasmin Dhuga
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Yvonne Feeney
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Laura Gallaher
- School of Media Arts and Humanities, University of Sussex, Brighton, UK
| | - Ann White
- Sea Side View, Child Development Centre, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Juliet Wright
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Sube Banerjee
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Stephanie Daley
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Voillemont C, Imbault E, Schoenberger M, Di Patrizio P. Care and management of adults with autism spectrum disorder in family practice: difficulties experienced by general practitioners. Fam Pract 2022; 39:464-470. [PMID: 34595508 DOI: 10.1093/fampra/cmab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies exist regarding the management and support of adults with autism spectrum disorder (ASD) in family practice. Most of them concern the management of children. As a primary care professional however, the general practitioner (GP) has a role to play at every step of the autistic adult's care pathway. With this study, we sought to identify GPs' experienced difficulties in caring for and managing their adult patients with ASD. METHODS We conducted a qualitative study of 11 French GPs caring for adults with ASD via semistructured interviews and a thematic content analysis. GPs were recruited from 5 counties of the Grand Est Region (Marne, Haute-Marne, Meurthe-et-Moselle, Meuse and Vosges). RESULTS All of the GPs described difficulties with the diagnostic process and the lack of initial training. Most of the respondents expressed difficulties with medical consultations of patients presenting an intellectual disability (ID) and with the lack of communication between GPs and mental health specialists during the patient care process. More than half of the GPs described difficulties with referral pathways for diagnosis due to lengthy delays and patient reluctance to seek psychiatric care. More than half of the respondents also experienced difficulties with providing proper social care, and with responding to patient distress due to their healthcare experiences. CONCLUSION Improving awareness and training about ASD in adults, as well as harmonizing the diagnostic process and referral pathways, might reduce GPs' experienced difficulties in caring for this population.
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Affiliation(s)
- Cyrielle Voillemont
- Département de Médecine Générale, Faculté de Médecine, de Maieutique et des métiers de la santé de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Eric Imbault
- Département de Médecine Générale, Faculté de Médecine, de Maieutique et des métiers de la santé de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Marie Schoenberger
- Centre de Ressources Autisme Lorraine, Centre Psychothérapique de Nancy, Laxou, France
| | - Paolo Di Patrizio
- Département de Médecine Générale, Faculté de Médecine, de Maieutique et des métiers de la santé de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France.,Laboratoire Interpsy EA4432, Université de Lorraine, Nancy, France.,Département Grand Est de Recherche en Soins Primaires, Faculté de Médecine, de Maieutique et des métiers de la santé de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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Jacob B, Izar R, Tran H, Akers K, Aranha ANF, Afify O, Janks E, Mendez J. Medical student program to learn from families experiencing developmental disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:160-171. [PMID: 38456129 PMCID: PMC10916898 DOI: 10.1080/20473869.2022.2074243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/03/2022] [Indexed: 03/09/2024]
Abstract
Patients and families experiencing developmental disabilities (DDs) may lack trust in physicians due to negative experiences in healthcare. DDs include conditions impairing physical, learning, language, or behavior areas, beginning during the developmental period and impacting daily functioning ('Developmental Disabilities'). Medical students generally do not receive standard training to effectively communicate with and diagnose patients with DDs. ARIE is a program for medical students to meet and learn from these patients and their families. Students learn about these families' experiences during home visits, guided by standardized interview questions and surveys about families' trust in physicians. Families did not appear to strongly trust physicians, with no significant changes after the program. Families shared they experienced physicians' lack of empathy and knowledge when caring for patients with DDs. Families wanted future physicians to be empathetic and informed when treating children with disabilities. Students reported increased comfort and confidence in interacting with patients with DDs as well as their families after completing the training program. Implementing a service-learning model focused on DDs at other medical schools, incorporating training with communication techniques and home visits, can increase students' confidence and experiences when engaging with patients with DDs and their families.
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Affiliation(s)
- Brigid Jacob
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ragda Izar
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Hanna Tran
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Katherine Akers
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Anil N. F. Aranha
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Omar Afify
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elizabeth Janks
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jennifer Mendez
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
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Chiri G, Bergey M, Mackie TI. Deserving but not entitled: The social construction of autism spectrum disorder in federal policy. Soc Sci Med 2022; 301:114974. [PMID: 35452891 DOI: 10.1016/j.socscimed.2022.114974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
Public policies play an influential role in shaping public opinion about health conditions, who is affected by them, and potential pathways for identification and intervention. This study draws upon a social constructionist perspective of policy design and disability to examine how autism spectrum disorder (ASD) has been framed in United States federal legislation. Qualitative content analysis of autism legislation passed between 1973 and 2019 indicates that policies reinforced ASD as a largely medicalized, neurobiological condition of childhood; this was reflected in both the policy aims, sources of knowledge and groups prioritized to address ASD; and the symbolic or material resources committed (or not committed) by enacted federal legislation to specific constituencies. Policy aims of early ASD legislation were symbolic in nature, focusing predominantly on framing children with ASD as a group worthy of public recognition. More recent legislation, in contrast, conferred material resources - albeit in targeted ways. Funding for surveillance and medical research on causation, early detection, treatment, and health professional training were prioritized with little attention to either service delivery needs of individuals with ASD and their families, supports over the lifecourse, or the social factors influencing ASD.
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Affiliation(s)
- Giuseppina Chiri
- RTI International, Center for the Health of Populations, Waltham, MA, USA.
| | - Meredith Bergey
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
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Mukhamedshina YO, Fayzullina RA, Nigmatullina IA, Rutland CS, Vasina VV. Health care providers' awareness on medical management of children with autism spectrum disorder: cross-sectional study in Russia. BMC MEDICAL EDUCATION 2022; 22:29. [PMID: 35012536 PMCID: PMC8751116 DOI: 10.1186/s12909-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex developmental range of conditions that involves difficulties with social interaction and restricted/repetitive behaviors. Unfortunately, health care providers often experience difficulties in diagnosis and management of individuals with ASD, and may have no knowledge about possible ways to overcome barriers in ASD patient interactions in healthcare settings. At the same time, the provision of appropriate medical services can have positive effects on habilitative progress, functional outcome, life expectancy and quality of life for individuals with ASD. METHODS This online survey research study evaluated the awareness and experience of students/residents (n = 247) and physicians (n = 100) in the medical management of children with ASD. It also gathered the views and experiences of caregivers to children with ASD (n = 158), all based in Russia. RESULTS We have established that the Russian medical community has limited ASD knowledge among providers, and have suggested possible reasons for this. Based on results from online surveys completed by students/residents, non-psychiatric physicians, and caregivers of children diagnosed with ASD, the main problems pertaining to medical management of individuals with ASD were identified. Possible problem solving solutions within medical practice were proposed. CONCLUSIONS The results from this study should be considered when implementing measures to improve healthcare practices, and when developing models for effective medical management, due to start not only in Russia but also in a number of other countries.
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Affiliation(s)
- Y O Mukhamedshina
- Clinical Research Center for Precision and Regenerative Medicine, Kazan Federal University, Kremlevskaya St 18, Kazan, 420008, Tatarstan, Russia.
- Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia.
| | - R A Fayzullina
- Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - I A Nigmatullina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
| | - C S Rutland
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - V V Vasina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
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Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res 2022; 91:1028-1035. [PMID: 33767375 PMCID: PMC7993081 DOI: 10.1038/s41390-021-01465-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
Most individuals with autism spectrum disorder (ASD)-a complex, life-long developmental disorder-do not have access to the care required to address their diverse health needs. Here, we review: (1) common barriers to healthcare access (shortage/cost of services; physician awareness; stigma); (2) barriers encountered primarily during childhood (limited screening/diagnosis; unclear referral pathways), transition to adulthood (insufficient healthcare transition services; suboptimal physician awareness of healthcare needs) and adulthood (shortage of services/limited insurance; communication difficulties with physicians; limited awareness of healthcare needs of aging adults); and (3) advances in research/program development for better healthcare access. A robust understanding of barriers to accessing healthcare across the lifespan of autistic individuals is critical to ensuring the best use of healthcare resources to improve social, physical, and mental health outcomes. Stakeholders must strengthen healthcare service provision by coming together to: better understand healthcare needs of underserved populations; strengthen medical training on care of autistic individuals; increase public awareness of ASD; promote research into/uptake of tools for ASD screening, diagnosis, and treatment; understand specific healthcare needs of autistic individuals in lower resource countries; and conduct longitudinal studies to understand the lifetime health, social, and economic impacts of ASD and enable the evaluation of novel approaches to increasing healthcare access. IMPACT: Despite the growing body of evidence, our understanding of barriers to healthcare encountered by individuals with ASD remains limited, particularly beyond childhood and in lower resource countries. We describe current and emerging barriers to healthcare access encountered by individuals with ASD across the lifespan. We recommend that stakeholders develop evidence-informed policies, programs, and technologies that address barriers to healthcare access for individuals with ASD and consider broad, equitable implementation to maximize impact.
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Holingue C, Poku O, Pfeiffer D, Murray S, Fallin MD. Gastrointestinal concerns in children with autism spectrum disorder: A qualitative study of family experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1698-1711. [PMID: 34903078 PMCID: PMC9192824 DOI: 10.1177/13623613211062667] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
LAY ABSTRACT Gastrointestinal problems are common in the autism spectrum disorder community and may affect both the person with autism spectrum disorder and their families. However, little research is available on the experiences of families who have a child with both autism spectrum disorder and gastrointestinal symptoms. We held one-on-one interviews with 12 parents of children who had both autism spectrum disorder and gastrointestinal symptoms. We analyzed the raw text responses from these interviews and identified four main themes. First, parents shared that their children had trouble verbally communicating when they were experiencing gastrointestinal symptoms (Theme 1). This led parents to use bodily signs, such as changes in the stool, and non-verbal behaviors, such as irritability, to recognize when their child was having gastrointestinal symptoms. Next, gastrointestinal issues affected both the child's well-being and their ability to attend class and extracurricular or social activities (Theme 2). The gastrointestinal issues also affected the family's routines, overall well-being, and their ability to go out and do activities together as a family (Theme 3). Finally, parents often had challenges receiving accessible and quality healthcare for their child's gastrointestinal problems (Theme 4). Together, these findings highlight the enormous burden that gastrointestinal symptoms have on the wellness of children with autism spectrum disorder and their families.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health,Center for Autism and Related Disorders, Kennedy Krieger Institute
| | - Ohemaa Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danika Pfeiffer
- Center for Autism and Related Disorders, Kennedy Krieger Institute,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Sarah Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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16
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Ghanouni P, Hood G, Weisbrot A, McNeil K. Utilization of health services among adults with autism spectrum disorders: Stakeholders' experiences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104120. [PMID: 34736105 DOI: 10.1016/j.ridd.2021.104120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a lifelong disorder, beginning in early childhood, which often accompanies with several healthcare challenges. There is a need for consistent and continued healthcare services throughout the life of an individual with ASD. The majority of previous studies have examined healthcare services in children with ASD and there is limited evidence about healthcare needs of adults with ASD. OBJECTIVE The aim of this project was to capture the experiences of stakeholders including adults with ASD in receiving healthcare services. METHOD We interviewed 22 stakeholders, including adults with ASD (n = 13), parents of adults with ASD (n = 5), and service providers (n = 4). Open-ended questions were used to explore their experiences with the healthcare system. We analysed the data thematically to develop the overarching themes. RESULTS Three themes emerged from interviews including a) availability and accessibility of healthcare services, b) provision of quality healthcare and service delivery, and c) striving for better health outcomes. CONCLUSION This study found that many adults with ASD can experience a continued lack of access to services and the care they receive is often of limited quality. The unmet healthcare needs lead stakeholders to feel stress, frustration, exhaustion, and possible burnout. The detrimental cost of limited services not only impacts adults with ASD but also their caregivers.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Graham Hood
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Abby Weisbrot
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Karen McNeil
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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17
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Ee J, Lim JM, Stenfert Kroese B, Rose J. What Are the Experiences of People with Neurodevelopmental Disorders Receiving Outpatient Mental Health Services in Singapore? JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jonathan Ee
- Centre for Applied Psychology, School of Psychology University of Birmingham Birmingham UK
| | - Jan Mei Lim
- Department of Psychology Institute of Mental Health Singapore
| | - Biza Stenfert Kroese
- Centre for Applied Psychology, School of Psychology University of Birmingham Birmingham UK
| | - John Rose
- Centre for Applied Psychology, School of Psychology University of Birmingham Birmingham UK
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18
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Working Beyond Capacity: a Qualitative Review of Research on Healthcare Providers’ Experiences with Autistic Individuals. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Ghanouni P, Seaker L. Healthcare Services During the Transitions to Adulthood Among Individuals with ASD Aged 15-25 Years Old: Stakeholders' Perspectives. J Autism Dev Disord 2021; 52:2575-2588. [PMID: 34216328 DOI: 10.1007/s10803-021-05159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Although previous research has shown that the transition to adulthood may be challenging, there exists a lack of research regarding perspectives of stakeholders on the transition of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate stakeholders' experiences regarding healthcare services for youth with ASD during their transition. We involved 20 stakeholders, including 17 parents of youth with ASD as well as 3 services providers. The study yielded three major themes including: (a) accessibility and quality of care; (b) tensions and conflicts; and (c) navigation and integrated care. The findings can be used to direct change within the healthcare services towards better practices for youth with ASD and increasing the likelihood of positive health outcomes.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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20
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Lei J, Jones L, Brosnan M. Exploring an e-learning community's response to the language and terminology use in autism from two massive open online courses on autism education and technology use. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1349-1367. [PMID: 33567892 PMCID: PMC8264622 DOI: 10.1177/1362361320987963] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
LAY ABSTRACT Within the neurodiversity movement, one recent divergence is in the semantic choice of language when describing autism, as members of the autism and autistic community preferred to use identity-first language (autistic person), whereas professionals were more likely to use person-first language (person with autism). This study explored 803 e-learners' responses from their comments across two massive open online courses on autism education held between 2017 and 2019. Learners agreed that autistic individuals should guide others on which terminology to use when describing autism, and although identity-first language acknowledges autism as part of an individual's identity, it can also conjure up negative stereotypes and be stigmatising. Although family, friends and professionals highlighted that the diagnostic label is a way to facilitate understanding across stakeholder groups and help autistic individuals gain access to support, autistic self-advocates found the process of disclosing autism as a form of disability to conflict with their sense of identity, and broader terms such as 'autism spectrum' failed to capture individual strengths and weaknesses. Semantic language choices may matter less as long as the person's difficulties are clearly acknowledged, with adaptations made to meet their specific needs. Adding to a growing body of literature on terminology use in autism research and practice, we highlight that language used when describing autism should follow the autistic individual's lead, with the primary focus on communicating an individual's strengths and difficulties, to foster a sense of positive autism identity and inclusivity, and enable access to appropriate support.
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Affiliation(s)
- Jiedi Lei
- University of Bath, UK
- King’s College London, UK
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21
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Samuel P, Yew RY, Hooley M, Hickey M, Stokes MA. Sensory challenges experienced by autistic women during pregnancy and childbirth: a systematic review. Arch Gynecol Obstet 2021; 305:299-311. [PMID: 34085111 DOI: 10.1007/s00404-021-06109-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this systematic review was to identify challenges faced by autistic women during pregnancy and birth due to sensory issues or other features of Autism Spectrum Disorder. METHODS A systematic search of literature was conducted using Medline, PubMed, Embase, PsycINFO, CINAHL, MIDIRS, ProQuest Dissertations and Theses Global, and Open Access Theses and Dissertations. Eligible studies addressed autistic women's pregnancy or birth experiences, and were assessed for methodological quality. RESULTS The search generated 2656 results, with six meeting inclusion criteria. Data from 427 autistic participants were extracted from four qualitative and two quantitative studies for synthesis. CONCLUSION We found that the literature was exploratory and lacked focussed research questions addressing sensory issues in pregnancy. Sensory challenges were, however, identified as a key finding in all qualitative studies. Other challenges faced by autistic women during pregnancy and birth included communication issues in healthcare settings and lack of appropriate information and supports for pregnancy and birth. Implications for health professionals and challenges associated with research in this area are discussed.
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Affiliation(s)
- Priscilla Samuel
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Rui Ying Yew
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Merrilyn Hooley
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Mark A Stokes
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap St., Geelong, VIC, 3220, Australia. .,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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22
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Micai M, Ciaramella A, Salvitti T, Fulceri F, Fatta LM, Poustka L, Diehm R, Iskrov G, Stefanov R, Guillon Q, Rogé B, Staines A, Sweeney MR, Boilson AM, Leósdóttir T, Saemundsen E, Moilanen I, Ebeling H, Yliherva A, Gissler M, Parviainen T, Tani P, Kawa R, Vicente A, Rasga C, Budişteanu M, Dale I, Povey C, Flores N, Jenaro C, Monroy ML, Primo PG, Charman T, Cramer S, Warberg CK, Canal-Bedia R, Posada M, Scattoni ML, Schendel D. Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project. Front Psychiatry 2021; 12:614102. [PMID: 34122158 PMCID: PMC8193054 DOI: 10.3389/fpsyt.2021.614102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults-especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services.
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Affiliation(s)
- Martina Micai
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Antonio Ciaramella
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Tommaso Salvitti
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Francesca Fulceri
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Laura Maria Fatta
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
| | - Robert Diehm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria
| | - Georgi Iskrov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Institute for Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Andrew Martin Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | | | | | - Irma Moilanen
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Medical Faculty, PEDEGO Research Unit, Oulu University, Oulu, Finland
| | - Anneli Yliherva
- Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
- Faculty of Social Sciences, University of Tampere, Logopedics, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Stockholm, Karolinska Institute, Stockholm, Sweden
| | - Tarja Parviainen
- Finnish Association for Autism and Asperger's Syndrome, Helsinki, Finland
| | - Pekka Tani
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Rafal Kawa
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Célia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Center for Biodiversity, Functional and Integrative Genomics, Lisbon, Portugal
| | - Magdalena Budişteanu
- ‘Victor Babeş’ National Institute for Research and Development in Pathology and Biomedical Sciences, Timisoara, Romania
| | - Ian Dale
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Carol Povey
- National Autistic Society, The Center for Autism, London, United Kingdom
| | - Noelia Flores
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Cristina Jenaro
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Maria Luisa Monroy
- Departamento de Psicología Evolutiva y de la Educación, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Patricia García Primo
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Tony Charman
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Susanne Cramer
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ricardo Canal-Bedia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, INICO - Instituto Universitario de Integración en la Comunidad University of Salamanca, Salamanca, Spain
| | - Manuel Posada
- Instituto de Salud Carlos III, Institute of Rare Diseases Research Madrid, Madrid, Spain
| | - Maria Luisa Scattoni
- Istituto Superiore di Sanità, Research Coordination and Support Service, Rome, Italy
| | - Diana Schendel
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Department of Economics and Business, National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
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23
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Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1114-1124. [PMID: 33467914 PMCID: PMC8089036 DOI: 10.1177/1362361320982819] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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Affiliation(s)
- Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
| | | | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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24
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Nicolaidis C, Schnider G, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J. Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:767-773. [PMID: 32859135 PMCID: PMC8204689 DOI: 10.1177/1362361320949734] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT The adult healthcare system is ill-prepared to provide high-quality care to autistic adults. Lack of provider training may contribute to the problem, but there are few previously tested survey instruments to guide provider training efforts. Our objective was to develop and test a measure of healthcare providers' confidence (or "self-efficacy") in providing healthcare to autistic adults and to use it to better understand their training needs. We used a community-based participatory research (CBPR) approach, in partnership with academic researchers, autistic adults, supporters, and healthcare providers, throughout the project. We developed a one-page questionnaire and surveyed 143 primary care providers from eight primary care clinics in Oregon and California, United States. Preliminary testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale suggests that the measure is reliable and valid. Using this scale, we found only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients, and identify and make necessary accommodations. Future research is needed to further validate this scale and to understand how to meet providers' training needs most effectively.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
| | | | | | | | - Steven K Kapp
- Portland State University (PSU), USA
- University of Exeter, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- RMIT University, Australia
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25
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Cheak-Zamora N, Farmer JG, Crossman MK, Malow BA, Mazurek MO, Kuhlthau K, Stobbe G, Loftin R, Mirza-Agrawal M, Tapia M, Hess A, Davis K, Sohl K. Provider Perspectives on the Extension for Community Healthcare Outcomes Autism: Transition to Adulthood Program. J Dev Behav Pediatr 2021; 42:91-100. [PMID: 33044397 DOI: 10.1097/dbp.0000000000000872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite their complex health care needs, transition-aged youth diagnosed with autism spectrum disorder (TAY-ASD) receive few transition services and describe difficulty finding adult providers. A 12-week primary care provider (PCP) training was developed to improve the delivery of transition services for TAY-ASD [Extension for Community Healthcare Outcomes (ECHO) Autism: Transition to Adulthood program]. The current study examines the PCPs' perspectives and experiences of the program and application of the training material. METHODS This study used a qualitative descriptive framework to explore the experiences and perspectives of 10 PCPs who completed the ECHO Autism: Transition to Adulthood program. Semistructured focus groups, conducted through Zoom videoconferencing, were used to explore these topics. RESULTS Three overarching categories were identified: (1) beneficial and influential aspects of the ECHO, (2) perceived challenges, and (3) suggestions for improvements and adjustments. Overall, participants found the program highly beneficial, describing an increased sense of community and comprehensive recommendations from a multidisciplinary team. Challenges included difficulties participating in the program during clinical hours and difficulties meeting the educational needs of participants with a wide range of previous experience caring for TAY-ASD. Recommendations included embedding the location-specific material into the program to account for regional differences and the use of an online platform for participants to ask questions and discuss issues outside of the regular sessions. CONCLUSION The study results can inform the development and implementation of new virtual PCP trainings and future ECHOs, including the revision and broad implementation of the ongoing ECHO Autism: Transition to Adulthood program.
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Affiliation(s)
| | - Justin G Farmer
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Harvard Medical School, Boston, MA
| | - Morgan K Crossman
- Building Bright Futures, Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Beth A Malow
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Micah O Mazurek
- Department of Human Services, University of Virginia, Charlottesville, VA
| | - Karen Kuhlthau
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gary Stobbe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel Loftin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mavara Mirza-Agrawal
- Department of Humanities, Health and Society, Embrace Initiative, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Mark Tapia
- Department of Special Education, University of Texas at Austin, Austin, TX
| | - Amy Hess
- Child Development Center, Nationwide Children's Hospital, Columbus, OH
| | | | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, MO
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26
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Alaghband-rad J, Jamaloo S, Motamed M. Roozbeh adult autism spectrum disorder clinic: lessons learned from first 34 cases. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:766-772. [PMID: 36210907 PMCID: PMC9542341 DOI: 10.1080/20473869.2020.1855691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/16/2023]
Abstract
Autism Spectrum Disorder (ASD) is a complex heterogeneous clinical entity with many overlaps and comorbidities with other psychiatric and developmental disorders. Adults with ASD lack adequate access to facilities and supports. This article describes the clinical profile of the first 34 patients admitted to Roozbeh adult ASD clinic during a 12-month period. Twenty-eight patients were male, all were single, 22 patients were unemployed and 26 were living with their families of origin. Obsession, inattention and sexual problems were the most common chief complaints. Multifaceted and gender-specific presentations results in misdiagnoses. Knowledge and training of the mental health professionals on adult ASD seem to be seriously inadequate. There is virtually no other specialized clinical and rehabilitation facilitates to help this vulnerable group of patients in Iran.
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Affiliation(s)
- Javad Alaghband-rad
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
| | - Samira Jamaloo
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
| | - Mahtab Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Iran
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Walsh C, Lydon S, O'Dowd E, O'Connor P. Barriers to Healthcare for Persons with Autism: A Systematic Review of the Literature and Development of A Taxonomy. Dev Neurorehabil 2020; 23:413-430. [PMID: 36112897 DOI: 10.1080/17518423.2020.1716868] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: This review aimed to 1) synthesize extant research on barriers to healthcare access experienced by persons with autism, their caregivers, and health-care providers; and 2) present a taxonomy of barriers to physical healthcare for individuals with autism.Method: Systematic searches were conducted in five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Thematic analysis was used to classify barriers and to develop a taxonomy.Results: In total, 31 articles were included in the review. The resulting taxonomy consisted of four themes: 1) Challenges Associated with Autism-related Characteristics; 2) Health-care Provider-based Issues; 3) Healthcare System Issues; and 4) Patient-related factors.Conclusions: Barriers to healthcare access for persons with autism are prevalent and occur at the patient, provider, and system levels. The taxonomy developed may facilitate measurement of barriers within health-care facilities and prompt identification of areas where interventions are warranted to improve care.
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Affiliation(s)
- Chloe Walsh
- National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- National University of Ireland Galway, Galway, Ireland
| | - Emily O'Dowd
- National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- National University of Ireland Galway, Galway, Ireland
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Kim B, Lee D, Min A, Paik S, Frey G, Bellini S, Han K, Shih PC. PuzzleWalk: A theory-driven iterative design inquiry of a mobile game for promoting physical activity in adults with autism spectrum disorder. PLoS One 2020; 15:e0237966. [PMID: 32911501 PMCID: PMC7482920 DOI: 10.1371/journal.pone.0237966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Primary symptoms of adults with autism spectrum disorder (ASD), such as pervasive social deficits in social interaction and communication, cause adults with ASD to adopt a sedentary lifestyle. Meanwhile, gamified and behavioral theory-based interventions have been shown to improve physical activity in a fun and unobtrusive way. In this paper, we describe the iterative design inquiry process of PuzzleWalk, a gamified, physical activity-promoting mobile app designed for adults with ASD. We report the design rationales and lessons learned across four user-centered design phases with ASD experts and adults with ASD, including user requirement gathering, iterative participatory design, usability evaluation, and field deployment. The design insights generated from this work could inform future research focusing on designing sociotechnical systems, games, and interventions for people with ASD.
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Affiliation(s)
- Bogoan Kim
- Department of Software and Computer Engineering, Ajou University, Suwon, Republic of Korea
- Department of Artificial Intelligence, Ajou University, Suwon, Republic of Korea
| | - Daehyoung Lee
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, Minnesota, United States of America
| | - Aehong Min
- Department of Informatics, Indiana University, Bloomington, Indiana, United States of America
| | - Seungwon Paik
- Department of Software and Computer Engineering, Ajou University, Suwon, Republic of Korea
- Department of Artificial Intelligence, Ajou University, Suwon, Republic of Korea
| | - Georgia Frey
- Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
| | - Scott Bellini
- Department of Counseling and Educational Psychology, Indiana University, Bloomington, Indiana, United States of America
| | - Kyungsik Han
- Department of Software and Computer Engineering, Ajou University, Suwon, Republic of Korea
- Department of Artificial Intelligence, Ajou University, Suwon, Republic of Korea
| | - Patrick C. Shih
- Department of Informatics, Indiana University, Bloomington, Indiana, United States of America
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Tchanturia K, Smith K, Glennon D, Burhouse A. Towards an Improved Understanding of the Anorexia Nervosa and Autism Spectrum Comorbidity: PEACE Pathway Implementation. Front Psychiatry 2020; 11:640. [PMID: 32733294 PMCID: PMC7358367 DOI: 10.3389/fpsyt.2020.00640] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
This paper describes an eating disorder service development pilot project helping clinicians implement evidence-based research for patients with anorexia nervosa and autism spectrum condition comorbidity. Currently, there are no clear guidelines or recommendations for people who have the developmental condition of autism spectrum condition and a comorbid eating disorder. The Maudsley eating disorder team is pioneering a tailored approach of adaptations for this autism and eating disorder comorbidity to improve and adapt evidenced-based treatments and improve the experience for patients, families, and clinicians involved in their care. This paper aims to support the clinical and research community to implement some of the learning and new strategies developed through the PEACE pathway. The authors aim is to collaborate with teams nationally and internationally to scale up the project to benefit patients with this comorbidity.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Danielle Glennon
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Burhouse
- Northumbria Healthcare NHS Foundation Trust, Patient Experience Department, Wansbeck General Hospital, Ashington, United Kingdom
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Abstract
PURPOSE OF REVIEW The steady rise in number of youth diagnosed with autism spectrum disorder (ASD) has led to the need to examine transition of care considerations specific to ASD. Improved understanding and guidance addressing these needs will allow pediatric and adult providers to work together to optimize social, medical, and occupational outcomes for these patients. RECENT FINDINGS Health-care transition is a delicate time when children with ASD outgrow the services of pediatric programs and enter a fragmented healthcare system that is unfamiliar, insufficiently knowledgeable, and underfunded for their needs. SUMMARY Increasing autism prevalence and an aging population with autism lend urgency to improve outcomes in children transitioning to adult-care. Research reveals poor consequences in social support, education, vocational training and employment, housing, and healthcare. Specific considerations to address these issues and ensure successful transition from pediatric to adult care are needed.
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Adamson J, Kinnaird E, Glennon D, Oakley M, Tchanturia K. Carers' views on autism and eating disorders comorbidity: qualitative study. BJPsych Open 2020; 6:e51. [PMID: 32419683 PMCID: PMC7331083 DOI: 10.1192/bjo.2020.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/04/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals. AIMS The aim of this study was to explore carers' experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved. METHOD Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis. RESULTS Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers' problems with clinical services, the impact on carers and suggestions for future improvements. CONCLUSIONS Carers agreed that autism played a significant role in the development and maintenance of their daughters' anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.
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Affiliation(s)
- James Adamson
- Department of Psychological Medicine, Kings College London, UK
| | - Emma Kinnaird
- Department of Psychological Medicine, Kings College London, UK
| | - Danielle Glennon
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, UK
| | | | - Kate Tchanturia
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, UK; and Department of Psychological Medicine, Kings College London, UK
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Mazurek MO, Stobbe G, Loftin R, Malow BA, Agrawal MM, Tapia M, Hess A, Farmer J, Cheak-Zamora N, Kuhlthau K, Sohl K. ECHO Autism Transition: Enhancing healthcare for adolescents and young adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:633-644. [PMID: 31581793 DOI: 10.1177/1362361319879616] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Transition-age youth and young adults with autism spectrum disorder have complex healthcare needs, yet the current healthcare system is not equipped to adequately meet the needs of this growing population. Primary care providers lack training and confidence in caring for youth and young adults with autism spectrum disorder. The current study developed and tested an adaptation of the Extension for Community Healthcare Outcomes model to train and mentor primary care providers (n = 16) in best-practice care for transition-age youth and young adults with autism spectrum disorder. The Extension for Community Healthcare Outcomes Autism Transition program consisted of 12 weekly 1-h sessions connecting primary care providers to an interdisciplinary expert team via multipoint videoconferencing. Sessions included brief didactics, case-based learning, and guided practice. Measures of primary care provider self-efficacy, knowledge, and practice were administered pre- and post-training. Participants demonstrated significant improvements in self-efficacy regarding caring for youth/young adults with autism spectrum disorder and reported high satisfaction and changes in practice as a result of participation. By contrast, no significant improvements in knowledge or perceived barriers were observed. Overall, the results indicate that the model holds promise for improving primary care providers' confidence and interest in working with transition-age youth and young adults with autism spectrum disorder. However, further refinements may be helpful for enhancing scope and impact on practice.
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Affiliation(s)
| | | | | | | | | | | | - Amy Hess
- Nationwide Children's Hospital, USA
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Abstract
Most research on autism spectrum disorder (ASD) has focused on younger individuals, but there is increasing awareness that more must be known about the clinical needs and outcomes of older adults with ASD. This article reviews what is known about barriers to recognition in the elderly, the prevalence of ASD over the lifespan, outcomes in adulthood in comparison to the general population, co-occurring psychiatric diagnoses, and healthcare needs in this population.
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Liu G, Pearl AM, Kong L, Brown SL, Ba D, Leslie DL, Murray MJ. Risk Factors for Emergency Department Utilization Among Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4455-4467. [PMID: 31414259 DOI: 10.1007/s10803-019-04166-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study reaffirms our previous work documenting a higher number of Emergency Department (ED) visits by adolescent females with Autism Spectrum Disorder (ASD) as compared to adolescent males with ASD, as well as significantly more ED visits by older adolescents than younger adolescents with ASD. Combined externalizing and internalizing psychiatric co-morbidities as well as internalizing conditions alone predict a higher number of ED visits in this study. Illness severity as demonstrated by patterns of visits to primary care physicians and psychiatric referrals prior to ED visits and the prescription of two or more classes of psychotropic medications also predict higher number of ED visits. Finally, as expected, previous ED visits predict future ED visits. The identification of these factors may prove helpful in determining adequacy of current supports and resources for teens with ASD navigating the challenges of adolescence.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, 90 Hope Drive, Hershey, PA, 17033, USA. .,Department of Psychiatry, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA.
| | - Amanda M Pearl
- Department of Psychiatry, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA
| | - Lan Kong
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Sierra L Brown
- Department of Psychiatry, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA
| | - Djibril Ba
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Doug L Leslie
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, 90 Hope Drive, Hershey, PA, 17033, USA.,Department of Psychiatry, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA
| | - Michael J Murray
- Department of Psychiatry, College of Medicine, Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA
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Doody O, Murphy F, Lyons R, Gallen A, Ryan J, Downey J, Sezgin D. Development of nursing quality care process metrics and indicators for intellectual disability services: a literature review and modified Delphi consensus study. BMC Health Serv Res 2019; 19:909. [PMID: 31783758 PMCID: PMC6883715 DOI: 10.1186/s12913-019-4749-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Nursing process quality care metrics and indicators are quantifiable measures of the nursing care delivered to clients. They can be used to identify and support nurses’ contribution to high quality, safe, client care and are lacking in specialist intellectual disability nursing. In a national Nursing Quality Care-Metrics project for Irish intellectual disability services, a set of nursing quality care process metrics and associated indicators were established for intellectual disability services. Methods A two-stage design approach was undertaken; a broad scoping review of the literature and a modified Delphi consensus process. The Delphi included a four round e-Delphi survey and a consensus meeting. Four hundred one intellectual disability nurses working in Ireland were recruited for the surveys and 20 stakeholders attended the consensus meeting. Results From the review, 20 existing and 16 potential intellectual disability nursing metrics were identified for nurses to prioritise in the e-surveys. After the four survey rounds, 12 intellectual disability nursing metrics and 84 associated indicators were identified. Following the consensus meeting, these were reduced to 12 metrics and 79 indicators. Conclusions This first set of intellectual disability nursing process metrics and associated indicators has been identified for implementation in practice. These metrics while developed in Ireland have international relevance and their application and appropriateness in practice needs to be evaluated.
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Affiliation(s)
- Owen Doody
- Health Research Institute and Senior Lecturer, Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland.
| | - Fiona Murphy
- Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland
| | - Rosemary Lyons
- Lecturer, Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland
| | - Anne Gallen
- Director of Nursing and Midwifery Planning Development Unit, National Lead for Nursing and Midwifery Quality Care Metrics Project, Health Services Executive Ireland North West, Bishop Street, Ballyshannon, Donegal, Ireland
| | - Judy Ryan
- Director of Nursing and Midwifery Planning Development Unit, Intellectual Disability Services Work-stream Chairperson, Health Services Executive Ireland South East, Kilkenny, Ireland
| | - Johanna Downey
- Quality Care Metrics Project Officer, National Lead for Intellectual Disability Services Workstream, Health Services Executive, Ireland South, Cork, Ireland
| | - Duygu Sezgin
- Postdoctoral Researcher, College of Medicine, Nursing & Health Sciences, Clinical Sciences Institute, National University of Ireland Galway, Costello Road, Galway, Ireland
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Stein Duker LI, Sadie Kim HK, Pomponio A, Mosqueda L, Pfeiffer B. Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder. Am J Occup Ther 2019; 73:7305185030p1-7305185030p11. [PMID: 31484022 DOI: 10.5014/ajot.2019.037226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to identify perceived barriers and strategies to improve primary care encounters, as reported by adults with autism spectrum disorder (ASD), caregivers of adults with ASD, and primary care providers (PCPs) treating adults with ASD. METHOD As part of a larger mixed-methods design, adults with ASD, caregivers, and PCPs (N = 78) in Los Angeles and Philadelphia completed surveys examining barriers to care and strategies to improve care. RESULTS Multiple barriers to care were reported by adults with ASD and caregivers, including communication and sensory challenges. Adults with ASD and caregivers reported minimal use of strategies during primary care visits but indicated that those used were helpful during care. Expert PCPs reported using strategies more frequently than novice PCPs. All respondent groups endorsed that strategies had the potential to improve care in the future for adults with ASD. CONCLUSION Opportunities exist for occupational therapy collaboration in primary health care and primary care education to improve care for adults with ASD.
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Affiliation(s)
- Leah I Stein Duker
- Leah I. Stein Duker, PhD, OTR/L, is Assistant Professor of Research, Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles;
| | - Hee Kyung Sadie Kim
- Hee Kyung Sadie Kim, OTD, OTR/L, is Occupational Therapist. At the time of the study, she was Clinical Doctoral Resident, Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles
| | - Amber Pomponio
- Amber Pomponio, MPH, is Research Coordinator, Department of Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Laura Mosqueda
- Laura Mosqueda, MD, is Dean, May S. and John H. Hooval Dean's Chair in Medicine, and Professor of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Beth Pfeiffer
- Beth Pfeiffer, PhD, OTR/L, BCP, is Associate Professor, Department of Rehabilitation Sciences, Temple University, Philadelphia, PA
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Thom RP, McDougle CJ, Hazen EP. Challenges in the Medical Care of Patients With Autism Spectrum Disorder: The Role of the Consultation-Liaison Psychiatrist. PSYCHOSOMATICS 2019; 60:435-443. [DOI: 10.1016/j.psym.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022]
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Abstract
Many people perceive autism spectrum disorder (ASD) as a childhood disorder, yet ASD is a lifelong condition. Although little is known about the mental and physical health issues of aging individuals with ASD, there are increasing numbers of older adults being diagnosed with ASD. Although there has been a recent "call to action" (to address lack of knowledge and the dearth of services and programs for aging individuals with autism, the authors think it is also important for those who are involved in educational programs related to gerontology and geriatrics settings to be aware of "autism aging." This term conceptualizes the demographics, person and contextual factors, and intellectual awareness of the trends and patterns of ASD as a life course challenge and opportunity for well-being and quality of life. The purposes of this article are to (1) provide a general overview of autism issues and to examine several dimensions of ASD in the context of the emergent and relevant scholarship in the adult and aging domain, (2) propose how to address the "gap" in the literature on autism and aging in terms of a conceptual model and by improving the methodology, and (3) to discuss the implications of these dimensions for educators in gerontology and geriatrics, and for those professionals who work in clinical and health care services. It is the goal of the authors to have this article represent a general introduction to ASD and to be a part of the foundation for educational awareness for educators in gerontology and geriatrics.
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Affiliation(s)
- Scott D Wright
- a Gerontology Interdisciplinary Program, University of Utah , Salt Lake City , Utah , USA
| | - Cheryl A Wright
- b Family and Consumer Studies Department , University of Utah , Salt Lake City , Utah , USA
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Kinnaird E, Norton C, Stewart C, Tchanturia K. Same behaviours, different reasons: what do patients with co-occurring anorexia and autism want from treatment? Int Rev Psychiatry 2019; 31:308-317. [PMID: 30821179 DOI: 10.1080/09540261.2018.1531831] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
Abstract
Research suggests that up to one in four individuals with anorexia nervosa (AN) may be on the autistic spectrum, and that these autistic traits may not have been recognized or diagnosed prior to eating disorder (ED) treatment. Significantly, these heightened autistic traits are associated with poorer treatment outcomes, suggesting that treatment may need to be adapted for this population. The purpose of this study was to explore with people with AN on the autistic spectrum their experiences of ED treatment, and their views on what needs to be changed. Women with AN (n= 13), either with an autism diagnosis or presenting with clinically significant levels of autistic traits, were interviewed on their experiences of treatment and potential improvements. Interviews were analysed using thematic analysis. The findings suggest that this population experience unique needs associated with their autism that are not being met by standard ED treatments, and recommendations are made for potential future adaptations. Future research into a more systematic approach for treatment adaptations for this population, including education programmes for clinicians, could potentially lead to better treatment experiences.
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Affiliation(s)
- Emma Kinnaird
- a Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine , King's College London , London , UK
| | - Caroline Norton
- b Eating Disorders National Service, South London and Maudsley NHS Foundation Trust , London , UK
| | - Catherine Stewart
- a Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine , King's College London , London , UK
- b Eating Disorders National Service, South London and Maudsley NHS Foundation Trust , London , UK
| | - Kate Tchanturia
- a Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine , King's College London , London , UK
- b Eating Disorders National Service, South London and Maudsley NHS Foundation Trust , London , UK
- c Department of Arts and Sciences, Ilia State University , Tbilisi , Georgia
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Abstract
Autism spectrum disorder (ASD) describes a set of neurodevelopmental disorders. Despite extensive ASD research lasting more than 60 years, its causes are still unknown. Without indicating the etiology, its development cannot be stopped. Over the years, both the definition and diagnostic criteria have developed. The number of ASD incidence is rising. The economical aspect should also be highlighted. This disorder presents particular challenges to affected children, their parents and physicians. The research of ASD, physician activities, policy making and raising the level of awareness must be coordinated. Special attention should be paid to the problem among adults with ASD.
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Affiliation(s)
- Joanna Kałużna-Czaplińska
- Department of Chemistry, Institute of General and Ecological Chemistry, Lodz University of Technology, Żeromskiego 116 Street, 90-924 Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz, Poland
| | - Ewa Żurawicz
- Department of Chemistry, Institute of General and Ecological Chemistry, Lodz University of Technology, Żeromskiego 116 Street, 90-924 Lodz, Poland
| | - Jagoda Jóźwik-Pruska
- Department of Chemistry, Institute of General and Ecological Chemistry, Lodz University of Technology, Żeromskiego 116 Street, 90-924 Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz, Poland
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Bradshaw P, Pellicano E, van Driel M, Urbanowicz A. How Can We Support the Healthcare Needs of Autistic Adults Without Intellectual Disability? CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00159-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Information, Advocacy and Signposting as a Low-Level Support for Adults with High-Functioning Autism Spectrum Disorder: An Example from the UK. J Autism Dev Disord 2019; 48:511-519. [PMID: 29063482 PMCID: PMC5807481 DOI: 10.1007/s10803-017-3331-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
‘Low-level’ support is championed to support adults with high functioning autism spectrum disorder (HFASD) to achieve good quality health and social care, yet research in the area is sparse. Drawing on semi-structured interview data, this paper considers the efficacy of an intervention to provide low-level support to adults with HFASD with little or no funded support. The intervention led to a number of perceived positive outcomes for adults with HFASD, their families, and service providers in the city, including increased access to education, volunteering, support and information, socialising, improved health and wellbeing, and managing day-to-day. Although many of life’s difficulties still persisted, the intervention helped service users overcome barriers to availing further support, possibly leading to beneficial outcomes down the line.
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Burke SL, Wagner E, Marolda H, Quintana JE, Maddux M. Gap analysis of service needs for adults with neurodevelopmental disorders. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:97-116. [PMID: 28847208 DOI: 10.1177/1744629517726209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Florida, the Agency for Persons with Disabilities provides waivers for adults with the following types of disabilities: intellectual disability, autism spectrum disorder, cerebral palsy, spina bifida, Down syndrome, and Prader-Willi syndrome. This review examined the peer-reviewed literature to indicate and assess the common needs for individuals with intellectual and developmental disabilities. Current models of service delivery, the efficacy of these services, and remaining gaps in the need fulfillment of individuals within the six diagnostic categorizations of interest were examined. Severity level within each diagnostic category was plotted on a matrix according to whether the needs of individuals were minimal, moderate, severe, or universal. The study found that sexual health education, socialization, and adult-focused medical care are universal needs among the six conditions. The study indicates that health-care professionals must work toward addressing the many unmet needs in comprehensive life span care services for adult individuals with neurodevelopmental disorders.
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A Systematic Network of Autism Primary Care Services (SYNAPSE): A Model of Coproduction for the Management of Autism Spectrum Disorder. J Autism Dev Disord 2019; 50:1847-1853. [DOI: 10.1007/s10803-019-03922-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morris R, Greenblatt A, Saini M. Healthcare Providers’ Experiences with Autism: A Scoping Review. J Autism Dev Disord 2019; 49:2374-2388. [DOI: 10.1007/s10803-019-03912-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Austriaco K, Aban I, Willig J, Kong M. Contemporary Trainee Knowledge of Autism: How Prepared Are Our Future Providers? Front Pediatr 2019; 7:165. [PMID: 31106185 PMCID: PMC6498887 DOI: 10.3389/fped.2019.00165] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Over the last several decades, the prevalence of Autism Spectrum Disorder (ASD) has continued to increase, creating a unique challenge for general physicians who are likely to encounter these patients in their practice. The primary aim of this cross-sectional study design was to identify potential knowledge gaps that were present among medical students and pediatric trainees (interns, residents, and fellows) particularly during the management of a sick child with ASD. Methods: A 23-question online survey was developed and distributed to medical students and pediatric trainees at a tertiary children's hospital affiliated with a medical school. Results: Medical students and pediatric trainees reported a low general knowledge of ASD and were unfamiliar with sensory issues that are often present in these children. Increased discomfort and insufficient didactic and clinical training for providing care to children with ASD during an acute illness were also identified. Both medical students and trainees reported the need for increased education and training, preferentially via patient interaction and small group-based learning. We found that as education/training levels increased, participants perceived increased comfort, and knowledge in managing an ill child with ASD. Conclusions: A perceived knowledge gap and discomfort is present amongst medical students and pediatric trainees on the management of children with ASD. Across all education levels, awareness for sensory dysregulation in ASD children is low. Education programs using direct patient interaction and small group learning were the preferred training modalities to learn how to provide optimal care for children with ASD.
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Affiliation(s)
- Kristine Austriaco
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Inmaculada Aban
- University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - James Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michele Kong
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Addressing a Gap in Healthcare Access for Transition-Age Youth with Autism: A Pilot Educational Intervention for Family Nurse Practitioner Students. J Autism Dev Disord 2018; 49:1493-1504. [PMID: 30536218 DOI: 10.1007/s10803-018-3846-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deon Kidd V, De Claro AMO. Preparing for Autistic Patients in Orthopaedic Surgery: Tips for a Successful Health-Care Interaction. J Bone Joint Surg Am 2018; 100:e132. [PMID: 30334893 DOI: 10.2106/jbjs.18.00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The prevalence of autism in the United States has been climbing for the last 3 decades, and this comes at a time when the medical community is poorly equipped to address the various needs of individuals with autism spectrum disorder (ASD). Because busy orthopaedic surgery practices will invariably encounter more patients with ASD, they may want to develop pragmatic strategies and protocols that will promote a successful health-care interaction with these patients.
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Affiliation(s)
- Vasco Deon Kidd
- Orthopaedic Surgery PA Fellowship Program Director, Arrowhead Orthopaedics, Colton, California
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Tint A, Hamdani Y, Sawyer A, Desarkar P, Ameis SH, Bardikoff N, Lai MC. Wellness Efforts for Autistic Women. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Morris R, Muskat B, Greenblatt A. Working with children with autism and their families: pediatric hospital social worker perceptions of family needs and the role of social work. SOCIAL WORK IN HEALTH CARE 2018; 57:483-501. [PMID: 29667506 DOI: 10.1080/00981389.2018.1461730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Social workers with knowledge of autism can be valuable contributors to client- and family-centered healthcare services. This study utilized a qualitative design to explore pediatric hospital social workers' experiences and perceptions when working with children and youth with autism and their families. Interviews with 14 social workers in a Canadian urban pediatric hospital highlighted perceptions of the needs of families of children with autism in the hospital and challenges and benefits related to the role of social work with these families. Results suggest that pediatric social workers may benefit from opportunities to develop autism-relevant knowledge and skills.
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Affiliation(s)
- Rae Morris
- a The Redpath Centre , Toronto , Canada
- b School of Social Work , University of British Columbia , Vancouver , Canada
| | - Barbara Muskat
- c Department of Social Work , The Hospital for Sick Children , Toronto , Canada
| | - Andrea Greenblatt
- c Department of Social Work , The Hospital for Sick Children , Toronto , Canada
- d Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
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