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Davin N, Watson S, Harding K, Ghaderi G. A cohort of Ontario physicians' knowledge regarding autism spectrum disorder: a mixed methods study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:915-924. [PMID: 39131760 PMCID: PMC11308962 DOI: 10.1080/20473869.2022.2149101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/13/2022] [Accepted: 11/15/2022] [Indexed: 08/13/2024]
Abstract
Employing a mixed methods approach, this study examined the knowledge and information Ontario physicians have concerning Autism Spectrum Disorder (ASD). Physicians are at the front line when it comes to identifying ASD. The Healthcare Professional Questionnaire was filled out by 46 physicians and 16 filled out the Knowledge about Childhood Autism among Health Workers Questionnaire (KCAHW) before being asked to participate in a semi-structured interview in which 7 participated. Paediatricians and psychiatrist reported having the highest levels of knowledge. Findings revealed that physicians are lacking in information regarding some early signs (i.e. social smiling = 50%), added diagnostic criteria (i.e. hypo-reactivity to sensory information = 56%), and the prevalence rate of ASD (average estimate of 1 in 1109). Additionally, exposure to individuals with ASD was found to be a facilitator to knowledge acquisition regarding ASD. The physicians recommended a road map method to disseminate information and increase knowledge and awareness. Implications of the findings include what areas of knowledge and information need to be increased, and how knowledge and competency can be increased, to better care for this population.
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Hamner T, Shih E, Ichord R, Krivitzky L. Children with perinatal stroke are at increased risk for autism spectrum disorder: Prevalence and co-occurring conditions within a clinically followed sample. Clin Neuropsychol 2021; 36:981-992. [PMID: 34308766 DOI: 10.1080/13854046.2021.1955150] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children with perinatal stroke are at increased risk for developmental language disorders, learning difficulties, and other mental health conditions. However to date, autism (ASD) prevalence in this group has not been reported. Given that early identification of ASD is essential to promoting optimal outcomes, our goal was to establish prevalence of ASD in children with perinatal stroke. METHOD A prospectively enrolled, single-center stroke registry maintained at our institution since 2005 was queried for all potentially eligible patients with a history of perinatal stroke. Information regarding stroke features, ASD diagnosis/concern, intellectual disability/global developmental delay, cerebral palsy/hemiparesis, epilepsy, and language disorder were collected via retrospective chart review from electronic health records. RESULTS 311 children were identified, of which 201 complete records were analyzed. Twenty-three cases were formally diagnosed with ASD (11.4%). First concerns were noted in toddlerhood (Mage = 2.66 years), yet the average age of diagnosis was 6.26 years. Children with ASD were more likely to have earlier diagnoses of intellectual disability/global developmental delay or a mixed receptive-expressive language disorder (ps < .001) but did not differ on CP/hemiplegia or epilepsy diagnoses. Risk for ASD increased with accumulating diagnoses. DISCUSSION Children with perinatal stroke have an increased prevalence of ASD (11.4%) than in the general population. ASD concerns arise at a similar age as the general population, yet ASD is diagnosed almost two years later than the general population and 3.60 years after first concerns present. Co-occurring neurological conditions are common. Clinicians must be aware of increased prevalence and implement screening as part of routine care for all pediatric patients with perinatal stroke.
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Affiliation(s)
- Taralee Hamner
- Drexel University, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Evelyn Shih
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology & Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ichord
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology & Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Krivitzky
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Wieckowski AT, Hamner T, Nanovic S, Porto KS, Coulter KL, Eldeeb SY, Chen CMA, Fein DA, Barton ML, Adamson LB, Robins DL. Early and Repeated Screening Detects Autism Spectrum Disorder. J Pediatr 2021; 234:227-235. [PMID: 33711288 PMCID: PMC8238814 DOI: 10.1016/j.jpeds.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/07/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate timing and accuracy of early and repeated screening for autism spectrum disorder (ASD) during well-child visits. STUDY DESIGN Using a longitudinal study design, toddlers (n = 5784) were initially screened at 12 (n = 1504), 15 (n = 1228), or 18 (n = 3052) months during well-child visits, and rescreened at 18, 24, and 36 months. Of those screened, 368 toddlers attended an ASD evaluation after a positive screen and/or a provider concern for ASD at any visit. RESULTS Screens initiated at 12 months yielded an ASD diagnosis significantly earlier than at 15 months (P = .003, d = 0.99) and 18 months (P < .001, d = 0.97). Cross-group overall sensitivity of the initial screen was .715 and specificity was .959. Repeat screening improves sensitivity (82.1%), without notably decreasing specificity (all >93.5%). Screening at 18 months resulted in significantly higher positive predictive value than at 12 months (X2 (1, n = 221) = 9.87, P = .002, OR = 2.60) and 15 months (X2 (1, n = 208) = 14.57, P < .001, OR = 3.67). With repeat screening, positive predictive value increased for all screen groups, but the increase was not significant. CONCLUSIONS Screening as early as 12 months effectively identifies many children at risk for ASD. Children screened at 12 months receive a diagnosis of ASD significantly earlier than peers who are first screened at later ages, facilitating earlier intervention. However, as the sensitivity is lower for a single screen, screening needs to be repeated.
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Affiliation(s)
| | - Taralee Hamner
- A.J. Drexel Autism Institute, Drexel University,
Philadelphia, PA
| | - Sarah Nanovic
- A.J. Drexel Autism Institute, Drexel University,
Philadelphia, PA
| | - Katelynn S. Porto
- Department of Psychological Sciences, University of
Connecticut, Storrs, CT
| | - Kirsty L. Coulter
- Department of Psychological Sciences, University of
Connecticut, Storrs, CT
| | | | - Chi-Ming A. Chen
- Department of Psychological Sciences, University of
Connecticut, Storrs, CT
| | - 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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Harris HK, Lee C, Sideridis GD, Barbaresi WJ, Harstad E. Identifying Subgroups of Toddlers with DSM-5 Autism Spectrum Disorder Based on Core Symptoms. J Autism Dev Disord 2021; 51:4471-4485. [PMID: 33507459 DOI: 10.1007/s10803-021-04879-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/01/2022]
Abstract
The objective of this study was to identify subgroups of toddlers with DSM-5 ASD based on core ASD symptoms using a person-based analytical framework. This is a retrospective study of 500 toddlers (mean age 26 months, 79% male) with DSM-5 ASD. Data were analyzed using latent class analyses in which profiles were formed based on ASD symptomatology. Social communication (SC) symptoms favored a three-class solution, while restricted/repetitive behaviors (RRBs) favored a two-class solution. Classes with higher consistency of SC deficits were younger, with lower developmental functioning. The class with more RRBs was older, with higher functioning. If confirmed in other populations, these classes may more precisely characterize subgroups within the heterogeneous group of toddlers at time of ASD diagnosis.
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Affiliation(s)
- Holly K Harris
- Division of Developmental Medicine, Massachusetts and Harvard Medical School, Boston Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatrics, Baylor College of Medicine and Meyer Center for Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Collin Lee
- Division of Developmental Medicine, Massachusetts and Harvard Medical School, Boston Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Georgios D Sideridis
- Division of Developmental Medicine, Massachusetts and Harvard Medical School, Boston Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - William J Barbaresi
- Division of Developmental Medicine, Massachusetts and Harvard Medical School, Boston Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Elizabeth Harstad
- Division of Developmental Medicine, Massachusetts and Harvard Medical School, Boston Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Kulage KM, Goldberg J, Usseglio J, Romero D, Bain JM, Smaldone AM. How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis. J Autism Dev Disord 2020; 50:2102-2127. [PMID: 30852784 DOI: 10.1007/s10803-019-03967-5] [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: 11/30/2022]
Abstract
We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.
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Affiliation(s)
- Kristine M Kulage
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA.
| | - Johanna Goldberg
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, 701 West 168th Street, New York, NY, 10032, USA
| | - Danielle Romero
- Lucile Packard Children's Hospital at Stanford, 770 Welch Road, Palo Alto, CA, 94304, USA
| | - Jennifer M Bain
- Department of Neurology, Division of Child Neurology, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, 5th Floor, New York, NY, 10032, USA
| | - Arlene M Smaldone
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 479] [Impact Index Per Article: 119.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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West KL. Infant Motor Development in Autism Spectrum Disorder: A Synthesis and Meta-analysis. Child Dev 2018; 90:2053-2070. [PMID: 29766496 DOI: 10.1111/cdev.13086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies of infant motor development in autism spectrum disorder (ASD) have increased in recent years. This article synthesized this literature through meta-analysis to assess (a) whether infant motor ability differs in ASD relative to neurotypical controls; and (b) whether motor ability and communication are related in infants with ASD. Study 1 aggregated data from 1,953 infants with ASD (ages 3.0-42.0 months), and Study 2 included 890 infants with ASD (age 6.0-42.9 months). Study 1 revealed that infant motor ability differed significantly in ASD compared with neurotypical infants-this difference was robust to variation in measurement and design. Furthermore, this group difference amplified as age increased. Study 2 indicated that within ASD, infant motor ability and communication are related.
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Jeremić M, Grujičić R, Pejović-Milovančević M. Adaptive capabilities of children with autism and their connection with neurophysiological correlates. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-17744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Burns CO, Matson JL. An evaluation of the clinical application of the DSM-5 for the diagnosis of autism spectrum disorder. Expert Rev Neurother 2017; 17:909-917. [PMID: 28678629 DOI: 10.1080/14737175.2017.1351301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The changes to the diagnostic criteria for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) were met with much controversy by researchers, clinicians, and families of individuals with ASD. The goal of this paper is to review the literature on the impact of these changes. Areas covered: This paper reviews the major changes to diagnostic criteria from DSM-IV-TR to DSM-5. It emphasizes how these changes are hypothesized to impact prevalence rates, as well as trends in characteristics of individuals who would have met previous criteria for ASD but no longer qualify for a diagnosis under DSM-5. Policy issues such as access to services and research considerations are also briefly reviewed. Expert commentary: Researchers have found that the DSM-5 diagnostic criteria for ASD may significantly impact which children receive diagnoses, which in turn affects access to services that address impairments characteristic of this disorder. Despite the fact that the DSM-5 has now been in use for four years, fewer recent studies were identified than was expected. Future research should continue to focus on the impact of changes in criteria, as well as on translational scientific advances across disciplines.
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Affiliation(s)
- Claire O Burns
- a Louisiana State University , Department of Psychology, Clinical Psychology , Baton Rouge , LA , USA
| | - Johnny L Matson
- a Louisiana State University , Department of Psychology, Clinical Psychology , Baton Rouge , LA , USA
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