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Uzonyi TE, Crais ER, Watson LR, Nowell SW, Baranek GT. Measuring Parent-Child Transactions for Early Identification of Young Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06281-x. [PMID: 38573445 DOI: 10.1007/s10803-024-06281-x] [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] [Accepted: 02/10/2024] [Indexed: 04/05/2024]
Abstract
This study explored the salient characteristics of transactions within parent-child engagement and investigated relationships between transactional characteristics and future identification of autism. The main aims of the study were to (1) examine if parents/children and their initial behaviors impact the length of transaction; (2) determine miscue differences among parents and children; and (3) determine if transactional characteristics are predictive of autism at preschool age.The study sample was drawn from extant data of a parent-mediated intervention for young children showing early sings of autism. Thirty parent-child dyad videos were randomly selected and coded for transactions. Statistical analyses were applied to examine the study aims and to perform post-hoc analyses.The length of transaction increased when children initiated with a look cue. Parents displayed a higher proportion of miscues and greater variance in their miscue behavior than their children. Neither the length of transaction nor the proportion of child miscues at 1-year of age predicted an autism diagnosis at preschool age. Post-hoc analyses revealed that girls with high variance of transaction length at 1-year of age, had a lower likelihood of showing autism traits at preschool age. Sustained transactions were more likely when children initiated engagement by looking. Early transactional characteristics were associated with later autism identification among girls, namely longer median transaction length with lower variance of transaction length. This transaction profile is believed to represent high fixation on topics with less ability to explore varied topics.
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Affiliation(s)
- Thelma E Uzonyi
- Center for Autism Services, Science and Innovation, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA.
| | - Elizabeth R Crais
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda R Watson
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sallie W Nowell
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA
| | - Grace T Baranek
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
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2
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Wieckowski AT, Ramsey RK, Coulter K, Eldeeb SY, Algur Y, Ryan V, Stahmer AC, Robins DL. Role of Primary Care Clinician Concern During Screening for Early Identification of Autism. J Dev Behav Pediatr 2024:00004703-990000000-00163. [PMID: 38564788 DOI: 10.1097/dbp.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism. METHODS Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24-22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study-before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation. RESULTS Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism. CONCLUSION The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.
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Affiliation(s)
| | | | - Kirsty Coulter
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Sherief Y Eldeeb
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA; and
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA; and
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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3
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ASD Diagnosis and Treatment Experiences Among Mexican Heritage Families. J Autism Dev Disord 2023; 53:1017-1033. [PMID: 35305543 PMCID: PMC9986214 DOI: 10.1007/s10803-022-05512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
To understand the ASD diagnosis and treatment pathways for US families, N = 38 Mexican-heritage mothers were interviewed about how and when they obtained an ASD diagnosis for their children. Most children (84%) were diagnosed between two and three years old. One-third of mothers reported receiving four to seven referrals before diagnosis. Mothers identified multiple diagnosis circumstances including two diagnoses and services offered before diagnosis. A multiple case study design documented the diagnosis and treatment experiences of four representative participants. As compared to previous studies that utilized a deficit lens to rationalize barriers to diagnosis and treatment (e.g., parents not knowledgeable about ASD), these findings revealed a complex understanding of how structural barriers (e.g., immigration status), initial diagnosis rejection among caregivers, and abrupt service cancellation complicated the diagnosis and treatment process. Implications identified suggestions to optimize and streamline ASD diagnosis and treatment pathways for Mexican heritage families.
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Williams LN, Wieckowski AT, Dieckhaus MFS, Dai YG, Zhang F, Dumont-Mathieu T, Barton M, Fein D, Robins DL. Primary Care Clinician and Child Characteristics Impacting Autism Surveillance. Brain Sci 2022; 13:brainsci13010018. [PMID: 36672000 PMCID: PMC9855901 DOI: 10.3390/brainsci13010018] [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: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Early detection of autism provides access to early intervention and subsequently fewer lifelong challenges. However, disparities in screening have been associated with socioeconomic status (SES) and race, and disparities in surveillance have been associated with clinician knowledge and beliefs about autism identification. The present study examines associations between demographic variables and clinician beliefs, and agreement between screening results and clinician surveillance. Surveillance included activities used by the primary care clinicians (PCCs) to assess risk for autism. PCCs reported their beliefs about autism screening and identification, their sex, race, years in practice, and racial distribution of their patient population. Children's demographic information was also collected. PCCs identified children as having, or not having, an increased likelihood of autism, and parents of children completed an autism screener. Agreement between screening and surveillance results were examined across PCC, practice, and child demographics. Higher confidence in autism knowledge and screening resources, female PCC sex, and majority White practice patient demographics all predicted agreement between screening and surveillance. Female child sex and higher maternal education also predicted agreement between screening and surveillance. These findings highlight the importance of PCC screening beliefs and child and PCC demographics on the autism identification process.
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Affiliation(s)
- Lashae N. Williams
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA
- Correspondence:
| | | | - Mary F. S. Dieckhaus
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Yael G. Dai
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Thyde Dumont-Mathieu
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA
| | - Marianne Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA
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Snijder MIJ, Dietz C, van Andel M, Ruiter ELM, Buitelaar JK, Oosterling IJ. Social COmmunication Program supported by E-health (SCOPE) for infants and toddlers at elevated likelihood of autism spectrum disorder: study design of a cluster randomized controlled trial. BMC Psychiatry 2022; 22:772. [PMID: 36482453 PMCID: PMC9733381 DOI: 10.1186/s12888-022-04351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the importance of early detection and early intervention of autism spectrum disorders (ASD) is widely recognized, multiple barriers exist in accessing early intervention services. As an alternative to these barriers, the SCOPE project presents a new, easy accessible and blended intervention called BEAR (Blended E-health for children at eArly Risk). This paper describes this BEAR intervention and study design of an ongoing two arm cluster randomized controlled trial (RCT). METHODS BEAR (Blended E-health for children at eArly Risk) is a blended e-health intervention, based on evidence-based naturalistic developmental behavioral interventions (NDBI's) and can be offered to parents and infants/toddlers at high likelihood for ASD. During the ongoing RCT, N = 88 high risk infants and toddlers will be cluster randomized over the BEAR intervention and care-as-usual (CAU) conditions. The finalized version of the intervention protocol and study design are presented in this paper. The primary outcome measure is joint engagement measured by the Joint Engagement Rating Inventory (JERI) during videotaped parent-child interaction. Secondary outcome measures include severity of ASD symptoms, global level of adaptive functioning, parental well-being, parental skills and satisfaction with healthcare. Also, costs will be estimated from society's perspective. Assessments take place at the start of the study (T1), after eight weeks (T2) and after six months (T3) and include behavioral home observations and parental questionnaires. DISCUSSION The SCOPE project aims to contribute to improved early identification and timely start of suitable interventions for infants and toddlers at elevated likelihood for ASD. This ongoing RCT will offer insight in the feasibility, short-term and six months effects of the innovative BEAR intervention. It is estimated that inclusion for the trial (N = 88) is completed in spring 2023. TRIAL REGISTRATION Dutch Trial Register, NTR7695. Registered at December 17th, 2018, www.trialregister.nl .
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Affiliation(s)
- Michelle I. J. Snijder
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands ,grid.5590.90000000122931605Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Claudine Dietz
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Mieke van Andel
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | | | - Jan K. Buitelaar
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands ,grid.5590.90000000122931605Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Iris J. Oosterling
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
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Wieckowski AT, Zuckerman KE, Broder-Fingert S, Robins DL. Addressing current barriers to autism diagnoses through a tiered diagnostic approach involving pediatric primary care providers. Autism Res 2022; 15:2216-2222. [PMID: 36254366 DOI: 10.1002/aur.2832] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022]
Abstract
Formal autism diagnosis from a specialist trained in autism assessment is customary prior to a child accessing early, intensive autism-specific services. However, long wait lists for diagnostic evaluations and limited specialty workforce have created substantial delays. Additionally, lengthy multidisciplinary evaluations are costly to insurers, inconvenient to families, and disproportionally impact under-resourced families. Diagnostic delays can impede access to intervention services. These barriers, combined with evidence regarding the importance of receiving early, autism-specific treatment, demand new approaches enabling access to autism specific services before comprehensive evaluation. Pediatric primary care providers (PCPs) are often the only health care professionals with whom a family interacts during early childhood and can play a crucial role in helping children with autism symptoms access services. Many strategies for autism diagnosis in primary care are being developed and tested; however, they have yet to be broadly adopted by PCPs, primarily due to critical implementation barriers in primary care settings. There is also not enough evidence on the accuracy of PCPs' diagnostic impressions without extensive specialty support, resulting in PCP hesitancy in diagnosing ASD, as well as family and service provider hesitancy in accepting a PCP autism diagnosis. In this commentary, we explore the acute need for shortening waitlists for autism evaluations through a tiered diagnostic approach, in which PCPs can rule in or rule out autism in children, for whom diagnosis is clear, and refer more complex cases for specialist evaluations, and explore implementation challenges to this approach.
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Affiliation(s)
| | | | - Sarabeth Broder-Fingert
- Department of Pediatrics and Eunice Kennedy Shriver Center, UMASS Chan Medical School, Worcester, Massachusetts, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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7
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Sheppard ME, Vitalone-Raccaro N, Kaari JM. Planting the Seeds of Collaboration: A Pilot for School/Clinic Partnerships During Pediatric Clerkship. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:453-464. [PMID: 36454613 DOI: 10.1352/1934-9556-60.6.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/04/2022] [Indexed: 06/17/2023]
Abstract
Although pediatricians and family physicians often refer children to early intervention (EI) and provide support and information to families, medical school training that provides information about special education policy and procedures is often limited. We piloted a program whereby medical students, during their pediatric clerkship, observed school classrooms that included young children with disabilities. Visit impact was measured through assessments of perceived competency and a written reflection. Students showed perceived competency growth across all areas measured. Written reflections demonstrated understanding of special education practices and collaborative opportunities. These findings suggest that incorporating experiential learning through facilitated school visits is a way to enhance the learning experience of medical students on topics essential to supporting children with disabilities and their families.
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8
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Smith CJ, James S, Skepnek E, Leuthe E, Outhier LE, Avelar D, Barnes CC, Bacon E, Pierce K. Implementing the Get SET Early Model in a Community Setting to Lower the Age of ASD Diagnosis. J Dev Behav Pediatr 2022; 43:494-502. [PMID: 36443921 PMCID: PMC9725891 DOI: 10.1097/dbp.0000000000001130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to implement a validated, university-based early detection program, the Get SET Early model, in a community-based setting. Get SET was developed to improve Screening, Evaluation, and Treatment referral practices. Specifically, its purpose was to lower the age of diagnosis and enable toddlers with autism spectrum disorder (ASD) to begin treatment by 36 months. METHODS One hundred nine pediatric health care providers were recruited to administer the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist at 12-month, 18-month, and 24-month well-baby visits and referred toddlers whose scores indicated the need for a developmental evaluation. Licensed psychologists were trained to provide diagnostic evaluations to toddlers as young as 12 months. Mean age of diagnosis was compared with current population rates. RESULTS In 4 years, 45,504 screens were administered at well-baby visits, and 648 children were evaluated at least 1 time. The overall median age for ASD diagnosis was 22 months, which is significantly lower than the median age reported by the CDC (57 months). For children screened at 12 months, the age of first diagnosis was significantly lower at 15 months. Of the 350 children who completed at least 1 follow-up evaluation, 323 were diagnosed with ASD or another delay, and 239 (74%) were enrolled in a treatment program. CONCLUSION Toddlers with ASD were diagnosed nearly 3 years earlier than the most recent CDC report, which allowed children to start a treatment program by 36 months. Overall, Get SET Early was an effective strategy for improving the current approach to screening, evaluation, and treatment. Efforts to demonstrate sustainability are underway.
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Affiliation(s)
| | - Stephen James
- Southwest Autism Research and Resource Center, Phoenix
| | - Erica Skepnek
- Southwest Autism Research and Resource Center, Phoenix
| | - Eileen Leuthe
- Southwest Autism Research and Resource Center, Phoenix
| | | | - Delia Avelar
- Southwest Autism Research and Resource Center, Phoenix
| | | | - Elizabeth Bacon
- University of California, San Diego Department of Neurosciences
| | - Karen Pierce
- University of California, San Diego Department of Neurosciences
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Guillon Q, Baduel S, Bejarano-Martín Á, Canal-Bedia R, MagÁn-Maganto M, FernÁndez-Álvarez C, Martín-Cilleros MV, SÁnchez-Gómez MC, García-Primo P, Rose-Sweeney M, Boilson A, LinertovÁ R, Roeyers H, Van der Paelt S, Schendel D, Warberg CK, Cramer S, Narzisi A, Muratori F, Scattoni ML, Moilanen I, Yliherva A, Saemundsen E, Jonsdottir SL, Efrim-Budisteanu M, Arghir A, Papuc SM, Vicente A, Rasga C, Xenia Kafka J, Poustka L, Kothgassner OD, Kawa R, Pisula E, Sellers T, Posada de la Paz M, Rogé B. Determinants of satisfaction with the detection process of autism in Europe: Results from the ASDEU study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2136-2150. [PMID: 35261293 DOI: 10.1177/13623613221080318] [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] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Professional guidance and support in response to first concerns appears to be an important predictor of the level of satisfaction with the detection process of autism in young children. In this study, we analyzed the views of 1342 family members, including 1278 parents, who completed an online survey form collecting information about their experience and satisfaction with the early detection of autism in their child. Specifically, we were interested in how specific experiences with the detection process relate to the satisfaction with it and whether we could identify important predictors of satisfaction. The detection process is an emotionally charged period for parents, often described as painful, chaotic, and lengthy. A better understanding of their experiences is important to take appropriate action to improve the detection process. In our sample, the level of satisfaction with the detection process varied greatly from one respondent to another. Among the different experiences we considered, whether or not respondents received professional guidance and support in response to first concerns explained most of this variation. We also found that difficulty finding information about detection services, lack of professional guidance and support in response to first concerns, having to find a diagnostic service on one's own, and longer delays between confirmation of concerns and first appointment with a specialist were experiences associated with a greater likelihood of being unsatisfied. The findings of this study highlight the importance of the parent-professional relationship in the detection process and have important practical implications for health administrations to improve the detection process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Renata LinertovÁ
- Canary Island Foundation for Health Research (Fundación Canaria de Investigación Sanitaria/FUNCANIS) and Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Spain
| | | | | | - Diana Schendel
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark.,Aarhus University, Denmark.,Drexel University, USA
| | | | | | | | | | | | - Irma Moilanen
- University of Oulu, Finland.,Oulu University Hospital, Finland
| | | | | | | | | | - Aurora Arghir
- Victor Babes - National Institute of Pathology, Romania
| | | | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Portugal
| | - Celia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Portugal
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Reducing Barriers to Autism Screening in Community Primary Care: A Pragmatic Trial Using Web-Based Screening. Acad Pediatr 2022; 22:263-270. [PMID: 33901728 PMCID: PMC8536796 DOI: 10.1016/j.acap.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether an intervention addressing both logistical and knowledge barriers to early screening for autism spectrum disorder (ASD) increases evidence-based screening during 18-month well-child visits and primary care providers' (PCPs') perceived self-efficacy in caring for children with ASD. METHODS Forty-six PCPs from 10 diverse practices across four counties in Washington State participated. PCPs attended a 2-hour training workshop on early recognition and care for toddlers with ASD and use of a REDCap-based version of the Modified Checklist for Autism in Toddlers-Revised with Follow-up (webM-CHAT-R/F) that provided automated presentation and scoring of follow-up questions. Data were collected at baseline and 6 months following each county's training window. PCPs' screening methods and rates and perceived self-efficacy regarding ASD care were measured by self-report and webM-CHAT-R/F use was measured via REDCap records. RESULTS At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%-28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%-68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008). CONCLUSIONS This brief intervention increased PCPs' self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity.
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11
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Wieckowski AT, Thomas RP, Chen CMA, Zitter A, Fein DA, Barton ML, Adamson LB, Robins DL. Effect of Brief Training to Identify Autism Spectrum Disorder During Toddler Well-Child Care Visits. J Dev Behav Pediatr 2021; 42:666-671. [PMID: 34618724 PMCID: PMC8497937 DOI: 10.1097/dbp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of a brief Enhanced training using the information-motivation-behavior (IMB) change model on improving providers' surveillance rates and accuracy of autism spectrum disorder (ASD) detection. METHOD Toddlers (n = 5,672) were screened for ASD during their pediatric well-child visits. Pediatric providers (n = 120) were randomized to receive Enhanced (incorporating components of the IMB model) or Control training. Providers indicated whether they had an ASD concern at each well-child visit. Toddlers who were positive on any screener and/or whose provider indicated ASD concern were invited for a diagnostic evaluation. Differences in provider-indicated ASD concerns before and after training were evaluated using log-linear analyses. RESULTS The Enhanced training did not have a significant effect on provider-endorsed ASD concerns (p = 0.615) or accuracy of endorsing concerns (p = 0.619). Providers in the Control training showed a significant reduction in indicating whether or not they had concerns after the training (from 71.9% to 64.3%), which did not occur in the Enhanced group. The Enhanced training led to more frequent endorsements of language (χ2 = 8.772, p = 0.003) and restricted and repetitive behavior (χ2 = 7.918, p = 0.005) concerns for children seen after training. CONCLUSION Provider training had limited impact on ASD surveillance, indicating the importance of using formal screening instruments that rely on parent report during well-child visits to complement developmental surveillance. Future research should examine whether providers who indicate specific concerns are more likely to accurately refer children for ASD evaluations.
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Affiliation(s)
| | - Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Chi-Ming A. Chen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Deborah A. Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Marianne L. Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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12
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Dick CC, Ibañez LV, DesChamps TD, Attar SM, Stone WL. Brief Report: Perceptions of Family-Centered Care Across Service Delivery Systems and Types of Caregiver Concerns About Their Toddlers' Development. J Autism Dev Disord 2021; 52:4181-4190. [PMID: 34510314 DOI: 10.1007/s10803-021-05248-6] [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] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
Family-centered care represents a collaborative partnership between caregivers and service providers, and is associated with positive caregiver and child outcomes. This approach may be especially important for caregivers with early concerns about autism, as service providers are often the gateway to appropriately-specialized intervention. Perceptions of family-centered care received from primary care providers (PCPs) and Part C Early Intervention (EI) providers were rated by two groups of caregivers: those concerned about autism (n = 37) and those concerned about another developmental problem (n = 22), using the Measure of Processes of Care (MPOC-20). Ratings did not differ across caregiver groups, but both groups rated EI providers significantly higher than PCPs, which may reflect systems-level differences between primary care and EI.
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Affiliation(s)
- Catherine C Dick
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Trent D DesChamps
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Shana M Attar
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
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13
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Shahrokhi H, Ghiasi A, Gholipour K, Fanid LM, Shamekhi HR, Iezadi S. Considerations about the implementation of an autism screening program in Iran from the viewpoints of professionals and parents: a qualitative study. BMC Psychiatry 2021; 21:55. [PMID: 33485323 PMCID: PMC7825177 DOI: 10.1186/s12888-021-03061-0] [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: 05/07/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aims of this study were to explore to explore the viewpoints of parents of children with Autism Spectrum Disorders (ASD) and professionals regarding the implementation of screening programs for ASD, to explore the challenges of the implementation of a universal screening program for ASD in Iran from their viewpoints, and, to explore their recommendations to overcome the potential challenges. METHOD This qualitative study was conducted using an inductive content analysis, between June 2018 and December 2018, in East-Azerbaijan province of Iran. Data was collected through in-depth interviews and focus group discussions. The participants were purposively selected among two groups: representatives of health system and representatives of children with ASD. A sample of 32 parents and 30 professionals were recruited in this study. RESULTS Totally, 9 main themes and 23 sub-themes were extracted in three main areas including: viewpoints of the participants about universal screening for ASD, challenges in implementation of the universal screening program, and participants' recommendations about how to overcome the potential challenges. Main challenges in implementation of the universal screening program included: shortages of ASD screening tools, weakness of the health system, lack of coordination among the ASD service providers, and social and ethical issues. CONCLUSION The parents and the professionals had different viewpoints about the implementation of ASD universal screening program in Iran. According to the professionals, there is not enough rational to implement ASD screening program for all children. However, the parents believed that universal screening program is inevitable, and it should be implemented in primary health centers during the early child-care visits. The results of this study open up unspoken issues that could help in initiating the screening program not only in Iran but also in other low- and middle-income countries as well.
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Affiliation(s)
- Hassan Shahrokhi
- grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Ghiasi
- grid.267572.30000 0000 9494 8951HEB School of Business & Administration, University of the Incarnate Word, San Antonio, TX USA
| | - Kamal Gholipour
- grid.412888.f0000 0001 2174 8913Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Mehdizadeh Fanid
- grid.412831.d0000 0001 1172 3536Division of Cognitive Neuroscience. Department of Psychology, Faculty of Education and Psychology. University of Tabriz, Tabriz, Iran
| | - Hamid Reza Shamekhi
- Education Development Office (EDO), Faculty of Medicine, Tabriz Azad Islamic University, Tabriz, Iran
| | - Shabnam Iezadi
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
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14
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Young RL, Nah Y. Examining Autism Detection in Early Childhood (ADEC) in the Early Identification of Young Children with Autism Spectrum Disorders (ASD). AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Dai YG, Miller LE, Ramsey RK, Robins DL, Fein DA, Dumont-Mathieu T. Incremental Utility of 24-Month Autism Spectrum Disorder Screening After Negative 18-Month Screening. J Autism Dev Disord 2020; 50:2030-2040. [PMID: 30830489 DOI: 10.1007/s10803-019-03959-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American Academy of Pediatrics recommends Autism Spectrum Disorder (ASD) screening at 18 and 24 months. However, utility of rescreening at 24 months, after a negative 18-month screening, remains unknown. We identified cases of ASD detected at 24 months after a negative 18-month screening (i.e., Catch-24 group; n = 10) and compared them to toddlers detected by 18-month screening (i.e., Early Diagnosis group; n = 203). Repeated ASD-specific screening at 24 months detected children who were missed at their 18-month screening. Thus, our findings support repeated screening for ASD at both 18 and 24 months in order to maximize identification of toddlers with ASD and other neurodevelopmental disorders who require intervention.
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Affiliation(s)
- Yael G Dai
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
| | - Lauren E Miller
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Riane K Ramsey
- Department of Psychology, Georgia State University, 33 Gilmer Street, Atlanta, GA, 30303, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Deborah A Fein
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Thyde Dumont-Mathieu
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
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16
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Abstract
As the prevalence of autism spectrum disorder (ASD) has increased in recent years, so too has the body of research describing the importance of early diagnosis and early intervention. Unfortunately, a large proportion of children with the disorder do not receive a diagnosis until after their fourth birthday. Various reasons exist for late diagnosis, including limited understanding of nuanced early warning signs and limited knowledge of effective early detection mechanisms among healthcare providers. Since early diagnosis enables access to treatment, and early intensive intervention improves long-term developmental outcomes, early detection by pediatric healthcare providers is critical. This article will review ASD prevalence rates, describe correlates and factors that might influence prevalence estimates, and highlight recent advances in early detection methods and intervention services.
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Affiliation(s)
- Stephen N James
- Research Department, Southwest Autism Research and Resource Center, Phoenix, AZ.
| | - Christopher J Smith
- Research Department, Southwest Autism Research and Resource Center, Phoenix, AZ
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17
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Delehanty A, Lee J, Hooker JL, Cortese J, Woods J. Exploring message framing to engage parents in early screening for autism spectrum disorder. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30342-6. [PMID: 32622690 DOI: 10.1016/j.pec.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE With the average age of diagnosis of autism hovering between 4 and 5 years of age, many children do not receive critical early intervention. Health information messages may be useful for increasing parents' understanding of the importance of early autism screening. METHODS Messages promoting autism screening were presented to 282 parents in a 2 (message frame: gain, loss) x 3 (evidence type: narrative, statistical, and hybrid), online, between-participants factorial design. Participants' involvement, affective responses, perceived threat to behavioral freedom, attitudes, and intentions to discuss screening with a healthcare provider were analyzed. RESULTS Loss-framed messages that included a hybrid of first-person narrative and statistical evidence were related to favorable ratings for most outcomes. Levels of perceived threat to behavioral freedom partially mediated involvement and attitudes, in a negative direction, for loss-framed narrative messages. CONCLUSION Results of this preliminary study supported the inclusion of both evidence types in messages developed to encourage parents to engage in early screening for autism, and partially supported focusing these messages on the potential costs of not screening. PRACTICE IMPLICATIONS Effective use of messaging with parents could help to increase knowledge and facilitate shared decision-making with health care providers to engage in early screening for autism.
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Affiliation(s)
- Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, 600 Forbes Ave Pittsburgh, PA 15282, USA.
| | - Jaejin Lee
- School of Communication Florida State University 4100 University Center, Building C Tallahassee, FL, 32306 USA.
| | - Jessica L Hooker
- Autism Institute, College of Medicine Florida State University, 2312 Killearn Center Blvd, Building A, Tallahassee, FL, 32308 USA.
| | - Juliann Cortese
- School of Communication Florida State University 4100 University Center, Building C Tallahassee, FL, 32306 USA.
| | - Juliann Woods
- Autism Institute, College of Medicine Florida State University, 2312 Killearn Center Blvd, Building A, Tallahassee, FL, 32308 USA.
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18
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Jackman TC, May W, Crais E. Understanding Mississippi's Current Practices Concerning Autism Screening at 18 & 24 Months. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:137-151. [PMID: 32479161 DOI: 10.1080/19371918.2020.1764431] [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] [Indexed: 06/11/2023]
Abstract
UNLABELLED Best practice recommendations by the American Academy of Pediatrics support routine screening for developmental delays in early childhood, specifically at 18 and 24 months for Autism Spectrum Disorder (ASD). During this critical developmental period, early identification and intervention are associated with best outcomes for ASD. Pediatricians perform a critical role in the early recognition of ASD, which can co-exist with other disorders further complicating the diagnosis. However, little is known about the current screening practices in Mississippi. This study provides a unique view of Mississippi pediatricians' perspectives of barriers to routine ASD screening. The intent of this phenomenology study was to better understand current practices and potential barriers, for performing ASD screening at the 18 and 24 month well child visits, as perceived by a sample of Mississippi's pediatric providers. Data collected through key informant interviews were coded to identify commonalities and patterns in responses and aided in the identification of current practices and perceived barriers through qualitative analysis. Although there was increasing implementation of ASD screening by health care providers, routine screening was not consistently conducted. The results suggest a need for a screening tool embedded in the electronic health record for easy access and monitoring. Findings replicated prior studies and endorsed the relevance of barriers that exist in screening Mississippi's youngest population. Mississippi children are at risk of delayed ASD diagnosis if modifications cannot be made to support the clinical environment for pediatricians. ABBREVIATIONS AAP: American Academy of Pediatrics; ASD: Autism Spectrum Disorder; EHR: Electronic Health Record; M-CHAT-R/F: Modified Checklist for Autism in Toddlers, Revised with Follow-Up; CAY: Center for Advancement of Youth; ABA: Applied Behavior Analysis.
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Affiliation(s)
- Tiffany C Jackman
- Department of Health Science and Administration, University of West Florida , Pensacola, Florida, USA
| | - Warren May
- Unaffiliated (Retired) , Clayton, Georgia, USA
| | - Elizabeth Crais
- University of North Carolina at Chapel Hill Medical School , Chapel Hill, North Carolina, USA
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19
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Taresh S, Ahmad NA, Roslan S, Ma’rof AM, Zaid S. Pre-School Teachers' Knowledge, Belief, Identification Skills, and Self-Efficacy in Identifying Autism Spectrum Disorder (ASD): A Conceptual Framework to Identify Children with ASD. Brain Sci 2020; 10:brainsci10030165. [PMID: 32183022 PMCID: PMC7139893 DOI: 10.3390/brainsci10030165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 11/16/2022] Open
Abstract
Recently, the identification and detection of children with autism spectrum disorder (ASD) has become an essential issue under ASD intervention services. The high percentage of ASD among children requires preschool teachers to recognizse children's abnormal development and identify them at an early stage, followed by referral to specialists. Therefore, this identification calls for a specific ability among preschool teachers, identified as knowledge, belief, identification skills, and self-efficacy (KBISSE). This conceptual framework aims to utilize the current literature to present a discussion on preschool teachers' KBISSE in identifying children with ASD and making decisions to refer children suspected with ASD to specialists. The conceptual framework is discussed based on social cognitive theory (SCT) and the health belief model (HBM). The conceptual framework emphasizes the need for preschool teachers to be educated in ASD via an educational module that could increase teachers' self-efficacy in identifying children with ASD. Besides, knowledge in ASD, belief in ASD, and identification skills are also necessary variables for building the educational module. The educational module is useful for guiding future research on preschool teachers' identification of children with any disability, one of which is ASD, and subsequent specialist referral at an early stage.
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Affiliation(s)
- Sahar Taresh
- Department of Foundations of Education, Faculty of Educational Studies, University Putra Malaysia, Serdang 43400, Malaysia; (S.T.); (S.R.); (A.M.M.)
| | - Nor Aniza Ahmad
- Department of Foundations of Education, Faculty of Educational Studies, University Putra Malaysia, Serdang 43400, Malaysia; (S.T.); (S.R.); (A.M.M.)
- Correspondence:
| | - Samsilah Roslan
- Department of Foundations of Education, Faculty of Educational Studies, University Putra Malaysia, Serdang 43400, Malaysia; (S.T.); (S.R.); (A.M.M.)
| | - Aini Marina Ma’rof
- Department of Foundations of Education, Faculty of Educational Studies, University Putra Malaysia, Serdang 43400, Malaysia; (S.T.); (S.R.); (A.M.M.)
| | - Sumaia Zaid
- Department of Psychology, Sana’a University, Sana’a 1247, Yemen;
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20
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Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities. J Autism Dev Disord 2020; 51:868-883. [PMID: 32144605 DOI: 10.1007/s10803-020-04429-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Health disparities in ASD detection affect children's access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14-36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.
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21
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Schrader E, Delehanty AD, Casler A, Petrie E, Rivera A, Harrison K, Paterniti T, Sebastiany L, Nottke C, Sohl K, Levy SE, Wetherby AM. Integrating a New Online Autism Screening Tool in Primary Care to Lower the Age of Referral. Clin Pediatr (Phila) 2020; 59:305-309. [PMID: 31976757 DOI: 10.1177/0009922819900947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Alix Casler
- Physician Associates of Orlando Health, Orlando, FL, USA
| | | | | | | | | | | | | | | | - Susan E Levy
- University of Pennsylvania, Philadelphia, PA, USA
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22
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Yingling ME. Participation in Part C Early Intervention: One Key to an Earlier Diagnosis of Autism Spectrum Disorder? J Pediatr 2019; 215:238-243. [PMID: 31351680 DOI: 10.1016/j.jpeds.2019.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether participation in a state early intervention program is associated with reduction in the age of diagnosis of autism spectrum disorder (ASD). STUDY DESIGN State agency, Medicaid, and Census data were integrated for children with ASD enrolled in a Medicaid waiver between February 2007 and March 2015 (N = 1613). Ordinary least squares regression was used to estimate the relationship between participation in a state early intervention program and their age of diagnosis of ASD. RESULTS The model explained 34% of variation in age of diagnosis (F[17,1595] = 49.20, P < .0001, adj R2 = 0.34). After adjustment for key variables, compared with children who did not participate in early intervention, children who did participate were diagnosed 2 years earlier (β = -23.97, P < .0001). CONCLUSIONS Although conducted in only 1 state, this study suggests that participation in early intervention programs may be instrumental in earlier diagnosis of ASD. These findings underscore the importance of identifying children who qualify for early intervention programs, the value of encouraging childhood professionals (eg, early care providers and educators) to refer given documented barriers to pediatrician referral, and the need for research that identifies the mechanisms by which programs may promote earlier diagnosis (eg, service coordination, parent support).
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23
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Ip A, Dupuis A, Anagnostou E, Loh A, Dodds T, Munoz A, Smile S. General paediatric practice in autism spectrum disorder screening in Ontario, Canada: Opportunities for improvement. Paediatr Child Health 2019; 26:e33-e38. [PMID: 33542776 DOI: 10.1093/pch/pxz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Screening is important for early identification of children with autism spectrum disorder (ASD), potentially leading to earlier intervention. Research has identified some barriers to early identification of ASD, however, information about ASD screening in Canadian general paediatric practice is lacking. Objectives The aim of the study is to better understand ASD screening practice patterns by examining the use of ASD and general developmental screening tools by general paediatricians. Methods The research team conducted a cross-sectional survey of general paediatricians. Results Two-hundred and sixty-seven paediatricians responded and 132 were eligible for the study. Ninety-three per cent of the responders used a developmental screening tool. Eighty-five per cent of the responders used an ASD screening tool when there were concerns for ASD, and 15% never used one. The most commonly used ASD screening tool was the M-CHAT. Children suspected of having ASD were referred to specialists not only to confirm the diagnosis but also to facilitate access to resources. General paediatricians were keen to incorporate formal ASD screening tools in their practice but identified the need for clearer guidelines. Conclusion Previous studies have shown that children at risk of ASD continue to be missed through developmental surveillance and targeted screening. Paediatricians are interested in implementing an ASD screening tool and cite brevity and forms that can be completed by parents as factors that would support the use of a screening tool. Clearer guidelines and tools to support ASD screening and access to resources are needed.
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Affiliation(s)
- Angie Ip
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of British Columbia, Vancouver, British Columbia
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Evdokia Anagnostou
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
| | - Alvin Loh
- Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario.,Surrey Place Centre, Toronto, Ontario
| | - Tyler Dodds
- Bloorview Research Institute, Toronto, Ontario
| | | | - Sharon Smile
- Bloorview Research Institute, Toronto, Ontario.,Division of Developmental Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
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24
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Bejarano-Martín Á, Canal-Bedia R, Magán-Maganto M, Fernández-Álvarez C, Cilleros-Martín MV, Sánchez-Gómez MC, García-Primo P, Rose-Sweeney M, Boilson A, Linertová R, Roeyers H, Van der Paelt S, Schendel D, Warberg C, Cramer S, Narzisi A, Muratori F, Scattoni ML, Moilanen I, Yliherva A, Saemundsen E, Loa Jónsdóttir S, Efrim-Budisteanu M, Arghir A, Papuc SM, Vicente A, Rasga C, Rogé B, Guillon Q, Baduel S, Kafka JX, Poustka L, Kothgassner OD, Kawa R, Pisula E, Sellers T, Posada de la Paz M. Early Detection, Diagnosis and Intervention Services for Young Children with Autism Spectrum Disorder in the European Union (ASDEU): Family and Professional Perspectives. J Autism Dev Disord 2019; 50:3380-3394. [DOI: 10.1007/s10803-019-04253-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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Martinez M, Thomas KC, Williams CS, Christian R, Crais E, Pretzel R, Hooper SR. Family Experiences with the Diagnosis of Autism Spectrum Disorder: System Barriers and Facilitators of Efficient Diagnosis. J Autism Dev Disord 2019; 48:2368-2378. [PMID: 29453706 DOI: 10.1007/s10803-018-3493-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper examines family experiences with the efficiency of ASD diagnosis. Children were age 8 or younger with ASD (n = 450). Outcomes were delay from first parent concern to diagnosis, shifting diagnoses, and being told child did not have ASD. Predictors were screening, travel distance, and problems finding providers. Logit models were used to examine associations. Screening was associated with reduced delay in diagnosis; problems finding providers were associated with greater delay. Screening, travel distance, and delay in diagnosis were associated with shifting diagnoses and being told child did not have ASD. Physician and parent training in communication and addressing mental health professional shortages and maldistribution may improve the diagnosis experiences of families of children with ASD.
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Affiliation(s)
- M Martinez
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA
| | - K C Thomas
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA.
| | - C S Williams
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA
| | - R Christian
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Ct, Carrboro, NC, 27510, USA
| | - E Crais
- Department of Allied Health Sciences, 321 S. Columbia Street, Bondurant Hall, CB#7190, Chapel Hill, NC, 27599-7190, USA
| | - R Pretzel
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Ct, Carrboro, NC, 27510, USA
| | - S R Hooper
- Department of Allied Health Sciences, 321 S. Columbia Street, Bondurant Hall, CB#7190, Chapel Hill, NC, 27599-7190, USA
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26
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Ghaderi G, Watson SL. "In Medical School, You Get Far More Training on Medical Stuff than Developmental Stuff": Perspectives on ASD from Ontario Physicians. J Autism Dev Disord 2019; 49:683-691. [PMID: 30220019 DOI: 10.1007/s10803-018-3742-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated the knowledge and perceived competence of Ontario physicians regarding the diagnosis and treatment of ASDs. Previous research demonstrates that many physicians would like more education regarding diagnosis and treatment of autism spectrum disorders (ASDs). Twenty-seven Ontario physicians filled out a questionnaire and participated in a semi-structured interview. Findings revealed that despite participants' high perceived knowledge regarding diagnosis and treatment of ASDs, they feel uncomfortable in providing care for this population. Furthermore, many participants stated diagnosing and treating ASDs is not within their scope of practice. Findings have implications for increasing physicians' knowledge of diagnosis and treatment of ASDs as well as what is required to enhance healthcare for individuals with ASDs and their families.
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Affiliation(s)
- Golnaz Ghaderi
- Department of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
| | - Shelley L Watson
- Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
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27
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Guillon Q, Baduel S, Arnaud M, Rog� B. Nouvelles technologies au service du d�pistage�: Chatbot pour la d�tection pr�coce de l�autisme. ENFANCE 2019. [DOI: 10.3917/enf2.191.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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28
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Ben-Sasson A, Atun-Einy O, Yahav-Jonas G, Lev-On S, Gev T. Training Physical Therapists in Early ASD Screening. J Autism Dev Disord 2018; 48:3926-3938. [PMID: 29971656 DOI: 10.1007/s10803-018-3668-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Physical therapists (PTs) are often one of the first professionals to evaluate children at risk. To examine the effect of an early screening training on pediatric PTs': (1) knowledge of autism spectrum disorder (ASD), (2) clinical self-efficacy, and (3) identification of markers. Twenty-six PTs participated in a 2-day "Early ASD Screening" workshop. The ASD Knowledge and Self-Efficacy Questionnaire, and video case study analysis were completed pre- and post-training. Changes following training were significant for ASD knowledge related to etiology and learning performance, early signs, risk factors, and clinical self-efficacy. Rating the videoed case study after the training, was significantly more accurate than it was before. Training PTs is important for enhancing early identification of ASD.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, University of Haifa, 3498838, Haifa, Israel.
| | - Osnat Atun-Einy
- Department of Physical Therapy, University of Haifa, 3498838, Haifa, Israel
| | - Gal Yahav-Jonas
- Association for Children at Risk, 9 Hazvi St., Tel Aviv, 67197, Israel
| | - Shimona Lev-On
- Weinberg Child Development Center, Sheba Tel-Hashomer Hospital, Ramat Gan, 52621, Israel
| | - Tali Gev
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel
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29
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Wetherby AM, Woods J, Guthrie W, Delehanty A, Brown JA, Morgan L, Holland RD, Schatschneider C, Lord C. Changing Developmental Trajectories of Toddlers With Autism Spectrum Disorder: Strategies for Bridging Research to Community Practice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2615-2628. [PMID: 30418491 PMCID: PMC6693568 DOI: 10.1044/2018_jslhr-l-rsaut-18-0028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/02/2018] [Accepted: 09/18/2018] [Indexed: 05/22/2023]
Abstract
PURPOSE The need for community-viable, evidence-based intervention strategies for toddlers with autism spectrum disorder (ASD) is a national priority. The purpose of this research forum article is to identify gaps in intervention research and needs in community practice for toddlers with ASD, incorporate published findings from a randomized controlled trial (RCT) of the Early Social Interaction (ESI) model (Wetherby et al., 2014) to illustrate community-based intervention, report new findings on child active engagement from the ESI RCT, and offer solutions to bridge the research-to-community practice gap. METHOD Research findings were reviewed to identify gaps in the evidence base for toddlers with ASD. Published and new findings from the multisite ESI RCT compared the effects of two different ESI conditions for 82 toddlers with ASD to teach parents how to support active engagement in natural environments. RESULTS The RCT of the ESI model was the only parent-implemented intervention that reported differential treatment effects on standardized measures of child outcomes, including social communication, developmental level, and adaptive behavior. A new measure of active engagement in the natural environment was found to be sensitive to change in 3 months for young toddlers with ASD and to predict outcomes on the standardized measures of child outcomes. Strategies for utilizing the Autism Navigator collection of web-based courses and tools using extensive video footage for families and professional development are offered for scaling up in community settings to change developmental trajectories of toddlers with ASD. CONCLUSIONS Current health care and education systems are challenged to provide intervention of adequate intensity for toddlers with ASD. The use of innovative technology can increase acceleration of access to evidence-based early intervention for toddlers with ASD that addresses health disparities, enables immediate response as soon as ASD is suspected, and rapidly bridges the research-to-practice gap.
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Affiliation(s)
- Amy M. Wetherby
- Department of Clinical Sciences, Florida State University, Tallahassee
- Autism Institute, Florida State University, Tallahassee
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Juliann Woods
- Autism Institute, Florida State University, Tallahassee
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Whitney Guthrie
- Autism Institute, Florida State University, Tallahassee
- Department of Psychology, Florida State University, Tallahassee
- Center for Autism Research, Children’s Hospital of Philadelphia, PA
| | - Abigail Delehanty
- Autism Institute, Florida State University, Tallahassee
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Jennifer A. Brown
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Lindee Morgan
- Autism Institute, Florida State University, Tallahassee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | | | - Catherine Lord
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
- Department of Psychiatry, University of California, Los Angeles
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Chambers NJ, de Vries PJ, Delehanty AD, Wetherby AM. Feasibility of utilizing autism navigator® for primary care in South Africa. Autism Res 2018; 11:1511-1521. [PMID: 30345721 DOI: 10.1002/aur.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/08/2018] [Indexed: 11/09/2022]
Abstract
There is a significant research-to-practice gap in early detection of young children with autism spectrum disorder (ASD) worldwide but particularly in low- and middle-income countries (LMICs) where expertise is limited and high-quality training is difficult to access. Autism Navigator® for Primary Care is a web-based course designed to increase awareness of red flags of ASD in the second year of life and thus promote earlier detection and referral for intervention. It contains extensive video illustrations that offer rapid access to multiple exemplars of ASD red flags. This study examined aspects of feasibility of the Autism Navigator® for Primary Care in one LMIC, South Africa. A mixed-methods quasi-experimental design was used to examine relevant professionals' implementation of the course and measure changes in their knowledge of red flags after training. Perceptions of the acceptability, demand, and practicality of the course were explored in focus groups. Sixty-two providers completed the course online with a 94% completion rate. Built-in learner assessment pass rates ranged from 88% to 100%. Second-language English speakers took longer to complete the learner assessments, and professionals with less access to the Internet spent less time in the course. Participants' perceptions of the acceptability, demand, and practicality of the course were mostly positive with some suggestions made for local conditions. Results supported the feasibility of the course in this LMIC with some supports required pertaining to language and Internet access. We propose that this training has the potential to lower the age of detection of ASD in South Africa and other LMICs. Autism Research 2018, 11: 1511-1521. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Professionals in low- and middle-income countries urgently need training to recognize red flags of autism in very young children. The feasibility of utilizing the Autism Navigator® for Primary Care course for this training was explored with 62 South African professionals. After training, professionals' knowledge of early red flags improved, and most reported the course important and needed in South Africa. They found the web-based design mostly acceptable, practical, and culturally applicable. The course could help lower the age of autism detection.
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Affiliation(s)
- Nola J Chambers
- Division of Child and Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
| | | | - Amy M Wetherby
- Autism Institute, Florida State University, Tallahassee, Florida
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Ben-Sasson A, Robins DL, Yom-Tov E. Risk Assessment for Parents Who Suspect Their Child Has Autism Spectrum Disorder: Machine Learning Approach. J Med Internet Res 2018; 20:e134. [PMID: 29691210 PMCID: PMC5941093 DOI: 10.2196/jmir.9496] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/04/2018] [Accepted: 02/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Parents are likely to seek Web-based communities to verify their suspicions of autism spectrum disorder markers in their child. Automated tools support human decisions in many domains and could therefore potentially support concerned parents. Objective The objective of this study was to test the feasibility of assessing autism spectrum disorder risk in parental concerns from Web-based sources, using automated text analysis tools and minimal standard questioning. Methods Participants were 115 parents with concerns regarding their child’s social-communication development. Children were 16- to 30-months old, and 57.4% (66/115) had a family history of autism spectrum disorder. Parents reported their concerns online, and completed an autism spectrum disorder-specific screener, the Modified Checklist for Autism in Toddlers-Revised, with Follow-up (M-CHAT-R/F), and a broad developmental screener, the Ages and Stages Questionnaire (ASQ). An algorithm predicted autism spectrum disorder risk using a combination of the parent's text and a single screening question, selected by the algorithm to enhance prediction accuracy. Results Screening measures identified 58% (67/115) to 88% (101/115) of children at risk for autism spectrum disorder. Children with a family history of autism spectrum disorder were 3 times more likely to show autism spectrum disorder risk on screening measures. The prediction of a child’s risk on the ASQ or M-CHAT-R was significantly more accurate when predicted from text combined with an M-CHAT-R question selected (automatically) than from the text alone. The frequently automatically selected M-CHAT-R questions that predicted risk were: following a point, make-believe play, and concern about deafness. Conclusions The internet can be harnessed to prescreen for autism spectrum disorder using parental concerns by administering a few standardized screening questions to augment this process.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Diana L Robins
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
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Myers K, Cummings JR, Zima B, Oberleitner R, Roth D, Merry SM, Bohr Y, Stasiak K. Advances in Asynchronous Telehealth Technologies to Improve Access and Quality of Mental Health Care for Children and Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nah YH, Young RL, Brewer N. Development of a brief version of the Autism Detection in Early Childhood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:494-502. [PMID: 29415559 DOI: 10.1177/1362361318757563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While autism spectrum disorder screening tools provide a useful resource for practitioners, the reality is they are underused. The justifications often provided include the time required for administration and the training involved. A brief tool with good psychometric properties that require minimal training is required. This study examined the development and the psychometric properties of a brief version of the Autism Detection in Early Childhood. The data showed the potential of the brief version of Autism Detection in Early Childhood for screening children age 12-36 months. Our dataset comprised 106 Diagnostic and Statistical Manual of Mental Disorders, 5th edition autism spectrum disorder, 86 non-typical development and 78 typical development participants age 12-36 months. Analyses comparing autism spectrum disorder and non-typical development groups supported the use of five critical items (i.e. response to name, social smiling, gaze switch, response to verbal command and use of gestures) to form the brief version Autism Detection in Early Childhood. The brief version of Autism Detection in Early Childhood's optimal cutoff score of 4 had sensitivity of 0.81, specificity of 0.78, positive predictive value of 0.81 and negative predictive value of 0.78. However, the results would need to be viewed as preliminary given the nature of the study sample and the findings might not be generalisable to samples with higher levels of cognitive functioning.
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Affiliation(s)
- Yong-Hwee Nah
- 1 Flinders University, Australia.,2 Nanyang Technological University, Singapore
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Cervantes PE, Matson JL, Peters WJ. An abbreviated scoring algorithm for the baby and infant screen for children with autism traits. Dev Neurorehabil 2017; 20:287-293. [PMID: 27715370 DOI: 10.1080/17518423.2016.1211189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Autism spectrum disorder (ASD) screening is recommended for all children aged 18-24 months. However, healthcare providers may be burdened with the responsibility of conducting these screens in addition to necessary services. Therefore, developing a time-efficient screener with sound psychometric properties is essential. METHODS This study sought to update the abbreviated scoring algorithm of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) and increase its clinical utility. Six thousand and three children with ASD or atypical development enrolled in an early intervention program participated. RESULTS A 6-item algorithm with a cutoff score of 3 was found to be optimal and yielded a sensitivity of 0.960 and a specificity of 0.864. CONCLUSION Sensitivity and specificity estimates were similar to that of the complete BISCUIT-Part 1; thus, the 6-item algorithm can reliably differentiate children at-risk for ASD requiring further assessment. The algorithm appears to be a promising tool for early identification.
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Affiliation(s)
- Paige E Cervantes
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
| | - Johnny L Matson
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
| | - W Jason Peters
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
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Campbell JM, Scheil KA, Hammond RK. Screening Methods. HANDBOOK OF ASSESSMENT AND DIAGNOSIS OF AUTISM SPECTRUM DISORDER 2016. [DOI: 10.1007/978-3-319-27171-2_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Miodovnik A, Harstad E, Sideridis G, Huntington N. Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics 2015; 136:e830-7. [PMID: 26371198 DOI: 10.1542/peds.2015-1502] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Symptoms of inattention, hyperactivity, and impulsivity are core features of attention-deficit/hyperactivity disorder (ADHD). However, children with autism spectrum disorder (ASD) often present with similar symptoms and may receive a diagnosis of ADHD first. We investigated the relationship between the timing of ADHD diagnosis in children with ASD and the age at ASD diagnosis. METHODS Data were drawn from the 2011-2012 National Survey of Children's Health, which asked parents to provide the age(s) at which their child received a diagnosis of ADHD and/or ASD. Using weighted prevalence estimates, we examined the association between a previous diagnosis of ADHD and the age at ASD diagnosis, while controlling for factors known to influence the timing of ASD diagnosis. RESULTS Our study consisted of 1496 children with a current diagnosis of ASD as reported by parents of children ages 2 to 17 years. Approximately 20% of these children had initially been diagnosed with ADHD. Children diagnosed with ADHD before ASD were diagnosed with ASD ∼3 years (95% confidence interval 2.3-3.5) after children in whom ADHD was diagnosed at the same time or after ASD. The children with ADHD diagnosed first were nearly 30 times more likely to receive their ASD diagnosis after age 6 (95% confidence interval 11.2-77.8). The delay in ASD diagnosis was consistent across childhood and independent of ASD severity. CONCLUSION To avoid potential delays in ASD diagnosis, clinicians should consider ASD in young children presenting with ADHD symptoms.
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Affiliation(s)
- Amir Miodovnik
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Harstad
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
| | - Georgios Sideridis
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts; and
| | - Noelle Huntington
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
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Baranek GT, Watson LR, Turner-Brown L, Field SH, Crais ER, Wakeford L, Little LM, Reznick JS. Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample. AUTISM RESEARCH AND TREATMENT 2015; 2015:386951. [PMID: 25648749 PMCID: PMC4306223 DOI: 10.1155/2015/386951] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/07/2014] [Indexed: 01/04/2023]
Abstract
This study examined the (a) feasibility of enrolling 12-month-olds at risk of ASD from a community sample into a randomized controlled trial, (b) subsequent utilization of community services, and (c) potential of a novel parent-mediated intervention to improve outcomes. The First Year Inventory was used to screen and recruit 12-month-old infants at risk of ASD to compare the effects of 6-9 months of Adapted Responsive Teaching (ART) versus referral to early intervention and monitoring (REIM). Eighteen families were followed for ~20 months. Assessments were conducted before randomization, after treatment, and at 6-month follow-up. Utilization of community services was highest for the REIM group. ART significantly outperformed REIM on parent-reported and observed measures of child receptive language with good linear model fit. Multiphase growth models had better fit for more variables, showing the greatest effects in the active treatment phase, where ART outperformed REIM on parental interactive style (less directive), child sensory responsiveness (less hyporesponsive), and adaptive behavior (increased communication and socialization). This study demonstrates the promise of a parent-mediated intervention for improving developmental outcomes for infants at risk of ASD in a community sample and highlights the utility of earlier identification for access to community services earlier than standard practice.
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Affiliation(s)
- Grace T. Baranek
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Linda R. Watson
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Lauren Turner-Brown
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Samuel H. Field
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Elizabeth R. Crais
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Linn Wakeford
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - Lauren M. Little
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
| | - J. Steven Reznick
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7122, USA
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