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Avrahami M, Ben-Dor DH, Ratzon R, Weizman A, Perlman Danieli P. Characterizing the clinical and sociodemographic profiles of hospitalized adolescents with autism spectrum disorder. Glob Ment Health (Camb) 2024; 11:e63. [PMID: 38827333 PMCID: PMC11140491 DOI: 10.1017/gmh.2024.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
The prevalence of autism spectrum disorder (ASD) is increasing worldwide. Youngsters with ASD demonstrate higher rates of intellectual disabilities (IDs), comorbid psychopathology and psychiatric hospitalizations, compared to children in the general population. This study characterizes the demographics and clinical parameters of adolescent psychiatric inpatients with ASD compared to inpatients without ASD, all hospitalized during the study period. Additionally, within the ASD group, those with ID were compared to those without. The rate of males among participants with ASD was significantly higher than among those without ASD, and the duration of hospitalization was longer. In contrast, the rate of cigarette smoking, major depressive disorder and suicidal thoughts among those with ASD was lower. One-third of those with ASD had moderate to severe ID, about 10% had comorbid epilepsy, and about half of them demonstrated aggressive behavior. Most ASD patients showed significant improvement upon discharge, although the extent of improvement was more prominent among ASD patients with no ID. Our findings, consistent with previous research, indicate that hospitalization is beneficial to youths with ASD, both those with and those without ID. Further studies that include long-term follow-up are needed.
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Affiliation(s)
- Matan Avrahami
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Haim Ben-Dor
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Ratzon
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
| | - Abraham Weizman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
- Research Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Polina Perlman Danieli
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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2
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Brown CE, Quetsch LB, Aloia LS, Kanne SM. Predictors of Aggression, Disruptive Behavior, and Anger Dysregulation in Youths with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1264-1280. [PMID: 36697931 DOI: 10.1007/s10803-022-05876-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Youth with autism spectrum disorder (ASD) often experience difficulties related to aggression, disruptive behavior, and regulation of emotions that precipitate these behaviors (i.e., anger). The extent to which aggression, disruptive behaviors, and anger dysregulation are correlated with distinct or overlapping factors has not yet been explored. The present study examined whether aspects of participant demographics, individual youth functioning, caregiver stress, and family warmth contributed to youth aggression, disruptive behavior, and anger dysregulation. Participants were caregivers of 511 youths with ASD. Analyses revealed that significant proportions of variance in aggression, disruptive behaviors, and anger dysregulation were accounted for by shared variables pertaining to demographics, the individual youth, and caregiver stress. Implications of treatment and future research are discussed.
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Affiliation(s)
- Cynthia E Brown
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA.
| | - Lauren B Quetsch
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Lindsey S Aloia
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
- Department of Communication, University of Arkansas, Fayetteville, AR, USA
| | - Stephen M Kanne
- Department of Psychiatry and Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, USA
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3
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Sidhu N, Wong Z, Bennett AE, Souders MC. Sleep Problems in Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:253-268. [PMID: 38423719 DOI: 10.1016/j.pcl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.
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Affiliation(s)
- Navjot Sidhu
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Zoe Wong
- The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA; The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University; Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine; Autism Integrated Care Program, Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Margaret C Souders
- The University of Pennsylvania School of Nursing, The Children's Hospital of Philadelphia
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4
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Clarke EB, McCauley JB, Lutz A, Gotelli M, Sheinkopf SJ, Lord C. Understanding profound autism: implications for stigma and supports. Front Psychiatry 2024; 15:1287096. [PMID: 38317766 PMCID: PMC10839016 DOI: 10.3389/fpsyt.2024.1287096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families. Methods The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults. Results The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma. Discussion Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.
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Affiliation(s)
- Elaine B. Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - James B. McCauley
- Department of Psychology, St. Mary’s College of California, Moraga, CA, United States
| | - Amy Lutz
- Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Marina Gotelli
- Fundación Brincar por un Autismo Feliz, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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5
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Taylor BJ, Pedersen KA, Mazefsky CA, Lamy MA, Reynolds CF, Strathmann WR, Siegel M. From Alert Child to Sleepy Adolescent: Age Trends in Chronotype, Social Jetlag, and Sleep Problems in Youth with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06187-0. [PMID: 38017309 PMCID: PMC11215932 DOI: 10.1007/s10803-023-06187-0] [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: 11/06/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Developmental changes in sleep in youth with autism spectrum disorder (ASD) are understudied. In non-ASD youth, adolescents exhibit a "night owl chronotype" (i.e., later sleep/wake timing) and social jetlag (i.e., shifts in sleep timing across school nights and weekends), with corresponding sleep problems. The purpose of this study is to evaluate age trends in chronotype, social jetlag, and sleep problems in high-risk youth with ASD. METHODS Youth with ASD (N = 171), ages 5-21 years old, were enrolled at the time of admission to specialized psychiatric units. Caregivers reported children's demographic information, habitual sleep timing, and sleep problems. Multivariate analyses evaluated the effect of age on chronotype, social jetlag, and sleep problems and the effects of chronotype and social jetlag on sleep problems. Covariates and moderators included sex, race, verbal ability, autism symptom severity, supplemental melatonin, and pubertal status. RESULTS Older age was associated with later chronotype, more social jetlag, fewer sleep anxiety/co-sleeping problems, fewer night waking and parasomnia problems, and more daytime alertness problems. The effect of age on chronotype was stronger for youth with greater social affective symptom severity. Mediation analyses showed that later chronotype statistically mediated the association between age and daytime alertness problems. CONCLUSIONS Youth with ASD may exhibit night owl chronotype behavior and social jetlag as they enter adolescence. Shifts toward a later chronotype may be exacerbated by autism severity and may contribute to alertness problems and sleepiness during the day. Chronotype is modifiable and may be leveraged to improve daytime functioning in youth with ASD.
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Affiliation(s)
- Briana J Taylor
- Life Sciences and Medical Research, The Roux Institute at Northeastern University, 100 Fore Street, Portland, ME, 04101, USA.
- Department of Psychology, Northeastern University, Boston, MA, USA.
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA.
| | - Kahsi A Pedersen
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martine A Lamy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Charles F Reynolds
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Matthew Siegel
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
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6
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Brown C, Lerner M, Stadheim J, Kerns C, Moskowitz L, Cohn E, Drahota A, Soorya L, Wainer A. Provider Self-Reported Use and Usefulness of Intervention Strategies for Externalizing Behaviors in Youths with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-15. [PMID: 37706638 PMCID: PMC10937329 DOI: 10.1080/15374416.2023.2251163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine predictors of implementation and perceived usefulness of four empirically supported strategies for treating externalizing behavior in youths with ASD. METHOD Participants were 557 providers in the United States with experience treating externalizing behavior in youths with ASD. Generalized estimating equations were used to determine whether self-reported use and usefulness of four empirically supported intervention strategies (functional communication training, functional behavior analysis, visual tools/supports, token economy) were predicted by key provider characteristics: professional discipline, experience, and practice specialization (across three indices) in ASD. Post-hoc contrasts were performed to identify provider groups reporting the greatest use and usefulness of the four strategies. RESULTS Strategies were most often used by providers with behavioral backgrounds, though perceived usefulness of strategies varied by providers' professional discipline. Compared to providers with more than 10 years of experience, less experienced providers endorsed the highest average use and usefulness of almost all strategies. Regarding ASD practice specialization, a lower volume of ASD cases, treating fewer youths with ASD over a 5-year period, and having a higher proportion of practice time working with youths with ASD reported were associated with greater use and usefulness of the strategies. CONCLUSIONS Empirically supported strategies are widely used by and perceived as useful by providers who treat youths with ASD and co-occurring externalizing behaviors. Use and usefulness varies based on provider discipline, experience, and ASD practice specialization.
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Affiliation(s)
| | | | - Jenna Stadheim
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Connor Kerns
- Department of Psychology, University of British Columbia
| | | | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York
| | - Amy Drahota
- Department of Psychology, Michigan State University
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center
| | - Allison Wainer
- Department of Psychiatry, Rush University Medical Center
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7
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Fucà E, Guerrera S, Valeri G, Casula L, Novello RL, Menghini D, Vicari S. Psychiatric Comorbidities in Children and Adolescents with High-Functioning Autism Spectrum Disorder: A Study on Prevalence, Distribution and Clinical Features in an Italian Sample. J Clin Med 2023; 12:jcm12020677. [PMID: 36675606 PMCID: PMC9864301 DOI: 10.3390/jcm12020677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
This study investigated the prevalence and distribution of psychiatric comorbidities in a group of 472 children and adolescents with ASD aged 3-18 years. We examined differences in age, sex, IQ, adaptive skills, and ASD symptom severity by comparing participants with ASD (ASD group) with participants with ASD and a psychiatric disorder (ASD/PSY group). Overall, 32.2% of participants had a comorbid psychiatric condition. Attention deficit/hyperactivity disorder (ADHD) was the most frequent diagnosis among preschoolers (20.4%); among school-age children, ADHD and anxiety/obsessive-compulsive disorders were the most frequent conditions (21% and 10.6%, respectively); finally, adolescents exhibit higher prevalence of anxiety/obsessive-compulsive disorders (21.8%). The ASD/PSY group showed a higher percentage of males, they were older and showed lower adaptive skills than the group with ASD; moreover, their mothers exhibited higher stress levels than mothers of participants in the ASD group. The comparison between age groups in participants within ASD/PSY group revealed that preschoolers had lower IQ than school-age children and adolescents, and worse adaptive skills, more repetitive behaviors, and restricted interests than adolescents. This study highlights the importance of an accurate diagnosis of psychiatric comorbidities in children and adolescents with ASD, also considering individual and family impairment.
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Affiliation(s)
- Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
| | - Silvia Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
| | - Laura Casula
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
| | - Roberta Lucia Novello
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
- Correspondence:
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (IRCCS), 00146 Rome, Italy
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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8
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Wolpert KH, Kodish I, Kim SJ, Uspal NG. Behavioral Management of Children With Autism in the Emergency Department. Pediatr Emerg Care 2023; 39:45-50. [PMID: 36580892 DOI: 10.1097/pec.0000000000002886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is characterized by impaired social communication in conjunction with patterned behaviors. Often associated with emotional dysregulation, irritability, aggression, depression, and suicidality, ASD youth frequently present to the emergency department for behavioral and mental health evaluation. Psychiatric comorbidities, agitation, and depression are commonly encountered. During these visits, practitioners must thoughtfully consider organic etiologies for presenting symptoms, formulate plans to address risk of agitation, and understand how to effectively formulate disposition options in this patient population.
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Affiliation(s)
- Katherine H Wolpert
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
| | - Ian Kodish
- Associate Professor (Kim and Kodish), Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Neil G Uspal
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
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9
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McMaughan DJD, Jones JL, Mulcahy A, Tucker EC, Beverly JG, Perez-Patron M. Hospitalizations Among Children and Youth With Autism in the United States: Frequency, Characteristics, and Costs. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:484-503. [PMID: 36454617 DOI: 10.1352/1934-9556-60.6.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/15/2022] [Indexed: 06/17/2023]
Abstract
National estimates of hospitalization diagnoses and costs were determined using the 2016 HCUP Kids' Inpatient Database. Children and youth with autism were hospitalized over 45,000 times at over $560 million in costs and 260,000 inpatient days. The most frequent principal diagnoses for hospitalizations of children and youth with autism were epilepsy, mental health conditions, pneumonia, asthma, and gastrointestinal disorders, which resulted in almost $200 million in costs and 150,000 inpatient days. Mental health diagnoses accounted for 24.8% of hospitalizations, an estimated $82 million in costs, and approximately 94,000 inpatient days. Children and youth with autism were more likely hospitalized for epilepsy, mental health diagnoses, and gastrointestinal disorders, and less likely for pneumonia and asthma compared to other children and youth.
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10
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Cleary M, West S, Hunt GE, McLean L, Hungerford C, Kornhaber R. How People with Autism Access Mental Health Services Specifically Suicide Hotlines and Crisis Support Services, and Current Approaches to Mental Health Care: A Scoping Review. Issues Ment Health Nurs 2022; 43:1093-1106. [PMID: 36041121 DOI: 10.1080/01612840.2022.2108529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
For people with autism spectrum disorder (ASD), the risk of mental illness, including suicidality, has a higher prevalence than the general population. This scoping review explored how people with ASD access suicide hotlines/crisis support services; and current approaches to delivering mental health services (MHS) to people with ASD. A search identified 28 studies meeting the selection criteria with analysis revealing four key findings. The support received by the person with ASD influenced how they accessed MHS; people often encounter barriers to accessing MHS; a separation exists between autism and MHS; and no studies on accessing or delivering MHS through crisis hotlines. The presence of such autism-specific crisis hotlines and the dearth of studies suggest a void in the existing research.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Glenn E Hunt
- Speciality of Psychiatry, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Loyola McLean
- Diploma of Psychodynamic Psychotherapy Cert ATP, Accredited AAI Coder and Trainer, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, Sydney, Australia.,Western Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, and School of Health, Federation University, VIC, Australia
| | - Rachel Kornhaber
- School of Nursing, University of Tasmania, Sydney, NSW, Australia
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11
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Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission. J Clin Med 2022; 11:jcm11216328. [PMID: 36362556 PMCID: PMC9658441 DOI: 10.3390/jcm11216328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
Children with autism spectrum disorder and developmental disabilities (ASD/DD) often experience severe co-occurring psychological and behavioral challenges, which can warrant inpatient psychiatric care. However, very little is known about the characteristics and clinical care of children with ASD/DD within the context of inpatient psychiatric settings. In this paper, we describe factors unique to inpatients with ASD or DD, by drawing on electronic health records from over 2300 children and adolescents ages 4–17 years admitted to a pediatric psychiatric inpatient unit over a 3-year period. Patients with ASD/DD accounted for approximately 16% of inpatients and 21% of admissions, were younger, more likely to be readmitted, more likely to be male, and more likely to have Medicaid insurance, as compared to patients without ASD/DD. Clinically, those with ASD/DD more frequently had externalizing concerns documented in their records, in contrast to more frequent internalizing concerns among other patients. Within the ASD/DD group, we identified effects of patient age, sex, and race/ethnicity on multiple dimensions of clinical care, including length of stay, use of physical restraint, and patterns of medication use. Results suggest the need for psychiatric screening tools that are appropriate for ASD/DD populations, and intentional integration of anti-racist practices into inpatient care, particularly with regard to use of physical restraint among youth.
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12
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Northrup JB, Goodwin MS, Peura CB, Chen Q, Taylor BJ, Siegel MS, Mazefsky CA. Mapping the time course of overt emotion dysregulation, self-injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study. Autism Res 2022; 15:1855-1867. [PMID: 35751466 PMCID: PMC9560956 DOI: 10.1002/aur.2773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/06/2022] [Indexed: 12/28/2022]
Abstract
Challenges with emotion dysregulation, self-injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross-sectional correlations of parent-report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real-time could add to our understanding of the context and function of these behaviors. The present study examined the real-time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co-occurrence. Both SIB and aggression co-occurred with overt emotion dysregulation at above-chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co-occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross-recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression. LAY SUMMARY: This study provides insight into how overt emotion dysregulation (i.e., visible distress), aggression, and self-injury unfold in real-time for autistic individuals. Participants were 53 autistic youth staying in a psychiatric hospital. Research staff observed participants in everyday activities on the hospital unit and noted instances of aggression, self-injurious behavior, and emotion dysregulation. Results suggest that aggression and self-injury sometimes occur with visible signs of distress but also often occur without visible distress. In addition, observable distress was more common in the moments after these behaviors than in the moments before.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Christine B Peura
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Qi Chen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Briana J Taylor
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Matthew S Siegel
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Song W, Nonnemacher SL, Miller KK, Anderson K, Shea LL. Living arrangements and satisfaction of current arrangement among autistic adults reported by autistic individuals or their caregivers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1174-1185. [DOI: 10.1111/jar.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/18/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Song
- College of Public Health Temple University Philadelphia Pennsylvania USA
| | - Stacy L. Nonnemacher
- Pennsylvania Department of Human Services, Office of Developmental Programs Bureau of Supports for Autism and Special Populations Harrisburg Pennsylvania USA
| | - Kaitlin Koffer Miller
- A.J. Drexel Autism Institute, Policy and Analytics Center Drexel University Philadelphia Pennsylvania USA
| | - Kristy Anderson
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
| | - Lindsay L. Shea
- A.J. Drexel Autism Institute, Drexel University Philadelphia Pennsylvania USA
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14
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Ozbaran B, Kose S, Barankoglu I, Dogan N. Inpatient Care Unit in Children and Adolescents With Autism Spectrum Disorder: Benefits, Difficulties, and Conditions of Hospitalization. J Nerv Ment Dis 2022; 210:206-211. [PMID: 34643184 DOI: 10.1097/nmd.0000000000001429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and behavior. The number of children and adolescents with ASD treated in mental health services has been growing in recent years. Knowing clinical and familial characteristics of hospitalized patients with ASD and multidisciplinary approach are crucial for children and adolescents mental health professionals. In this study, 253 Turkish children and adolescents, with and without ASD, treated in psychiatry inpatient care unit were examined. Applied approaches such as medical consultation areas, psychiatric management of mothers, and pharmacological treatment during hospitalization, were studied. In addition to familial and clinical characteristics of patients with ASD, the benefits and the hospitalization conditions were evaluated. Patients with ASD showed a higher tendency on having relatives with a psychiatric disorder than the patients without ASD. A significant difference was found in terms of age, sex, and intellectual functioning, whereas length of stay did not differ drastically. Also, suicide attempts were significantly higher in patients without ASD than in patients with ASD. This study eases the management of hospitalized ASD patients with giving important information of clinical and familial characteristics.
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Affiliation(s)
- Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
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15
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Lenart A, Pasternak J. Resources, Problems and Challenges of Autism Spectrum Disorder Diagnosis and Support System in Poland. J Autism Dev Disord 2021; 53:1629-1641. [PMID: 34345979 PMCID: PMC10066150 DOI: 10.1007/s10803-021-05142-1] [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: 06/09/2021] [Indexed: 11/30/2022]
Abstract
The article refers to resources, problems and challenges of autism diagnosis and support system in Poland. The resources include: the increasing number of specialists, diagnostic and therapeutic centres, well-established course of education for people working with youths, standardised and normalised diagnostic tools. The diagnostic process is not without some areas in need of our focus: the tendency of some specialists to make unauthorised diagnosis, overshadowing; underestimation of comorbidity of ASD with other disorders. The challenges refer to introducing an effective system of monitoring the services provided in form of certification and control in order to prevent their abuse, initiating category of temporary diagnosis; paying more attention on individual's resources, better cooperation among specialists, teachers and families, developing and unifying diagnostic standards.
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Affiliation(s)
- Anna Lenart
- College of Social Sciences, Institute of Pedagogy, Department of Psychology, University of Rzeszow, ul. Ks. Jalowego 24, 35-010, Rzeszow, Poland
| | - Jacek Pasternak
- College of Social Sciences, Institute of Pedagogy, Department of Psychology, University of Rzeszow, ul. Ks. Jalowego 24, 35-010, Rzeszow, Poland.
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16
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Brief Report: Impact of COVID-19 in Individuals with Autism Spectrum Disorders: Analysis of a National Private Claims Insurance Database. J Autism Dev Disord 2021; 52:2350-2356. [PMID: 34041682 PMCID: PMC8153091 DOI: 10.1007/s10803-021-05100-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic continues to have a detrimental impact on individuals with disabilities. Data from FAIR Health’s FH® NPIC (National Private Insurance Claims) database, one of the nation’s largest databases of private insurance claim records, were analyzed to understand the experiences of individuals with ASD in the COVID-19 pandemic. Multivariate logistic regression models revealed that individuals with ASD + ID were nine times more likely to be hospitalized following COVID-19 infection (OR = 9.3; 95% CI: 6.9–12.5) and were nearly six times more likely to have an elevated length of hospital stay (OR = 5.9; 95% CI: 3.5–10.1) compared to those without ASD + ID. These findings point to the need for prioritizing access to vaccines to prevent COVID-19 infection and morbidities. This is the first study to illustrate a higher likelihood of hospitalization and elevated length of hospital stay from COVID-19 in individuals with ASD and other comorbidities.
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17
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Abstract
Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.
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Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
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18
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Trial by trial EEG based BCI for distress versus non distress classification in individuals with ASD. Sci Rep 2021; 11:6000. [PMID: 33727625 PMCID: PMC7971030 DOI: 10.1038/s41598-021-85362-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/01/2021] [Indexed: 01/31/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is often accompanied by impaired emotion regulation (ER). There has been increasing emphasis on developing evidence-based approaches to improve ER in ASD. Electroencephalography (EEG) has shown success in reducing ASD symptoms when used in neurofeedback-based interventions. Also, certain EEG components are associated with ER. Our overarching goal is to develop a technology that will use EEG to monitor real-time changes in ER and perform intervention based on these changes. As a first step, an EEG-based brain computer interface that is based on an Affective Posner task was developed to identify patterns associated with ER on a single trial basis, and EEG data collected from 21 individuals with ASD. Accordingly, our aim in this study is to investigate EEG features that could differentiate between distress and non-distress conditions. Specifically, we investigate if the EEG time-locked to the visual feedback presentation could be used to classify between WIN (non-distress) and LOSE (distress) conditions in a game with deception. Results showed that the extracted EEG features could differentiate between WIN and LOSE conditions (average accuracy of 81%), LOSE and rest-EEG conditions (average accuracy 94.8%), and WIN and rest-EEG conditions (average accuracy 94.9%).
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19
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So P, Wierdsma AI, Kasius MC, Cornelis J, Lommerse M, Vermeiren RRJM, Mulder CL. Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth. Eur Child Adolesc Psychiatry 2021; 30:747-756. [PMID: 32440727 PMCID: PMC8060175 DOI: 10.1007/s00787-020-01558-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008-2017) on 1194 outpatient emergencies involving children aged 6-18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient's home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used.
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Affiliation(s)
- Pety So
- Youz, Center for Youth Mental Healthcare, Rotterdam, The Netherlands. .,Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
| | - André I. Wierdsma
- grid.5645.2000000040459992XErasmus MC, University Medical Center, Epidemiological and Social Psychiatric Research Institute and Department of Psychiatry, Rotterdam, The Netherlands
| | | | - Jurgen Cornelis
- grid.491093.60000 0004 0378 2028Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands ,grid.491093.60000 0004 0378 2028Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Marion Lommerse
- grid.491093.60000 0004 0378 2028Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Robert R. J. M. Vermeiren
- Youz, Center for Youth Mental Healthcare, Rotterdam, The Netherlands ,Youz, Center for Youth Mental Healthcare, The Hague, The Netherlands ,grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis L. Mulder
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands ,grid.5645.2000000040459992XErasmus MC, University Medical Center, Epidemiological and Social Psychiatric Research Institute and Department of Psychiatry, Rotterdam, The Netherlands
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20
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Shayakhmetova ES, Matveeva LM, Sitdikova AA, Sokolova VA. Features of teaching swimming to children of primary school age with autism spectrum disorder. BIO WEB OF CONFERENCES 2021. [DOI: 10.1051/bioconf/20212901005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The article presents an analysis of the peculiarities of teaching swimming to children of primary school age with autism spectrum disorder. The study was conducted on the basis of the sports complex “Burevestnik” in Kazan. According to the results of testing on the scale of assessment of the degree of autism of children, a group of boys aged 9-10 years was formed. In four children, the degree of autism is not expressed and moderately pronounced, in one child-a severe form of autism. At the time of the examination, the children did not know how to swim. Classes on the water were held for six months 3 times a week for 40 minutes. The children trained using the author’s equipment – special boards with an associative character (a fish with bubbles, a whale with a fountain, a dolphin, a frog, a turtle, a rocket). The size of the swimming board remained standard, 32x25cm. The development of the supporting device was due to the need to eliminate the inadequate response to various sensory stimuli, such as touching strangers or tactile contact with unfamiliar objects and textures, as well as to obtain positive associations and mental images for the successful development of a new exercise. At the end of six months of classes, all children with autism spectrum disorder have mastered swimming training according to the indicators: 1) immersion in water with exhalation in water, 2) sliding on the chest with the movement of the legs, 3) sliding on the chest with the movement of the legs and performing proper breathing. The study was determined by the ability to use boards to swim copyright form associative nature.
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21
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Blankers M, van der Post LFM, Dekker JJM. Predicting hospitalization following psychiatric crisis care using machine learning. BMC Med Inform Decis Mak 2020; 20:332. [PMID: 33302948 PMCID: PMC7731561 DOI: 10.1186/s12911-020-01361-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate prediction models for whether patients on the verge of a psychiatric criseis need hospitalization are lacking and machine learning methods may help improve the accuracy of psychiatric hospitalization prediction models. In this paper we evaluate the accuracy of ten machine learning algorithms, including the generalized linear model (GLM/logistic regression) to predict psychiatric hospitalization in the first 12 months after a psychiatric crisis care contact. We also evaluate an ensemble model to optimize the accuracy and we explore individual predictors of hospitalization. METHODS Data from 2084 patients included in the longitudinal Amsterdam Study of Acute Psychiatry with at least one reported psychiatric crisis care contact were included. Target variable for the prediction models was whether the patient was hospitalized in the 12 months following inclusion. The predictive power of 39 variables related to patients' socio-demographics, clinical characteristics and previous mental health care contacts was evaluated. The accuracy and area under the receiver operating characteristic curve (AUC) of the machine learning algorithms were compared and we also estimated the relative importance of each predictor variable. The best and least performing algorithms were compared with GLM/logistic regression using net reclassification improvement analysis and the five best performing algorithms were combined in an ensemble model using stacking. RESULTS All models performed above chance level. We found Gradient Boosting to be the best performing algorithm (AUC = 0.774) and K-Nearest Neighbors to be the least performing (AUC = 0.702). The performance of GLM/logistic regression (AUC = 0.76) was slightly above average among the tested algorithms. In a Net Reclassification Improvement analysis Gradient Boosting outperformed GLM/logistic regression by 2.9% and K-Nearest Neighbors by 11.3%. GLM/logistic regression outperformed K-Nearest Neighbors by 8.7%. Nine of the top-10 most important predictor variables were related to previous mental health care use. CONCLUSIONS Gradient Boosting led to the highest predictive accuracy and AUC while GLM/logistic regression performed average among the tested algorithms. Although statistically significant, the magnitude of the differences between the machine learning algorithms was in most cases modest. The results show that a predictive accuracy similar to the best performing model can be achieved when combining multiple algorithms in an ensemble model.
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Affiliation(s)
- Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, The Netherlands. .,Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521VS, Utrecht, The Netherlands. .,Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - Louk F M van der Post
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, The Netherlands.,Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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22
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Conner CM, Golt J, Shaffer R, Righi G, Siegel M, Mazefsky CA. Emotion Dysregulation is Substantially Elevated in Autism Compared to the General Population: Impact on Psychiatric Services. Autism Res 2020; 14:169-181. [PMID: 33815651 DOI: 10.1002/aur.2450] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Emerging evidence suggests that emotion regulation (ER) impairment in those with ASD is associated with poor mental health. This study used the Emotion Dysregulation Inventory, a new norm-referenced ER measure with clinical cut-offs, developed and validated in ASD and non-ASD samples, to establish rates of ER impairment and understand its association with psychiatric service use in ASD. Parents of 6-17 year olds in three well-characterized samples (nationally representative US n = 1,000; community ASD n = 1,169; inpatient ASD n = 567) completed a battery of questionnaires about their child. The prevalence of ER impairment was significantly higher in the ASD groups compared to the nationally representative sample and highest in the psychiatric Inpatient ASD group. The community ASD and inpatient ASD samples were four and seven times more likely, respectively, to exceed clinical cutoffs for emotional reactivity than the general US sample. Similarly, history of psychiatric hospitalization, recent emergency services use (police contact, emergency room visits, or in-home crisis evaluations for emotional or behavioral concerns in the past 2 months), and psychotropic medication prescriptions were significantly higher in the ASD groups. ER impairment was significantly associated with all forms of psychiatric service use, after controlling for demographics (age, sex, race), co-occurring intellectual disability, and ADHD symptoms. This is the first large-scale study to document substantially higher rates of ER impairment in youth with ASD compared to the general population. The importance of ER impairment is underscored by its association with higher utilization of inpatient, emergency, and medication services in ASD, after accounting for demographics and ADHD-related symptoms.
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Affiliation(s)
- Caitlin M Conner
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Josh Golt
- University of Alabama, Tuscaloosa, Alabama, USA
| | | | | | | | - Carla A Mazefsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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23
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Coffey AL, Shawler LA, Jessel J, Bain T, Nye M, Dorsey MF. Generality of the practical functional assessment and skill‐based treatment among individuals with autism and mental health disorders. BEHAVIORAL INTERVENTIONS 2020. [DOI: 10.1002/bin.1755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amanda L. Coffey
- School of Education Endicott College Beverly Massachusetts USA
- Behavior Network McKinney Texas USA
| | - Lesley A. Shawler
- School of Education Endicott College Beverly Massachusetts USA
- Behavior Network McKinney Texas USA
| | - Joshua Jessel
- Department of Psychology Division of Mathematics and the Natural Sciences Queens College Queens New York USA
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24
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Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses. J Autism Dev Disord 2019; 49:3477-3493. [PMID: 31127486 PMCID: PMC6667419 DOI: 10.1007/s10803-019-04061-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.
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25
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Vasa RA, Hagopian L, Kalb LG. Investigating mental health crisis in youth with autism spectrum disorder. Autism Res 2019; 13:112-121. [DOI: 10.1002/aur.2224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Roma A. Vasa
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
| | - Louis Hagopian
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
- Department of Behavioral PsychologyKennedy Krieger Institute Baltimore Maryland
| | - Luke G. Kalb
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Johns Hopkins University School of Public Health Baltimore Maryland
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26
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Li HJ, Chen CY, Tsai CH, Kuo CC, Chen KH, Chen KH, Li YC. Utilization and medical costs of outpatient rehabilitation among children with autism spectrum conditions in Taiwan. BMC Health Serv Res 2019; 19:354. [PMID: 31164130 PMCID: PMC6549303 DOI: 10.1186/s12913-019-4193-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background We examined the utilization of rehabilitation resources among children with autism spectrum condition (ASC), a neurodevelopmental condition, in Taiwan. Methods We derived from the National Health Insurance Research Database of Taiwan data pertaining to 3- to 12-year-old children for the period 2008–2010. Based on diagnoses executed in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification, we classified these data into the ASC and non-ASC groups and analyzed them through multiple linear regression model, negative binomial model, independent sample t testing, and χ2 testing. Results Compared with the non-ASC group, the ASC group exhibited higher utilization of rehabilitation resources. Because hospitals are constrained by overall expenditure limits, expenditure on rehabilitation resources has plateaued, preventing any increase in the utilization of rehabilitation resources. In our ASC group, preschool-aged children significantly outnumbered (p < 0.001) school-aged children. When stratified by the hospital level, district hospitals reported the highest utilization (p < 0.001). When stratified by region, the highest utilization was in Taipei, whereas the lowest was in the East region (p < 0.001). The total annual cost, average frequency of visits, utilization of rehabilitation resources, and average cost were all affected by such elements as patient demographics, hospital type and location (p < 0.001). Conclusions For improving treatment outcomes among children with ASC and decreasing treatment expenditure, policies that promote the timely ASC detection and treatment should be implemented.
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Affiliation(s)
- Hsing-Jung Li
- Department of Child & Adolescent Psychiatry, Kai-Syuan Psychiatric Hospital, No.130, Kaixuan 2nd Road, Lingya District, Kaohsiung City, 802, Taiwan, Republic of China
| | - Chi-Yuan Chen
- Department of Rehabilitation, Saint Joseph Hospital, No. 352, Chien Kuo 1st Road, Kaohsiung City, 802, Taiwan, Republic of China
| | - Ching-Hong Tsai
- Department of Child & Adolescent Psychiatry, Kai-Syuan Psychiatric Hospital, No.130, Kaixuan 2nd Road, Lingya District, Kaohsiung City, 802, Taiwan, Republic of China
| | - Chao-Chan Kuo
- Department of Adult Psychiatry, Kai-Syuan Psychiatric Hospital, No. 130, Kaixuan 2nd Road, Lingya District, Kaohsiung City, 802, Taiwan, Republic of China
| | - Kung-Heng Chen
- Department of Rehabilitation, Saint Joseph Hospital, No. 352, Chien Kuo 1st Road, Kaohsiung City, 802, Taiwan, Republic of China
| | - Kuan-Hsu Chen
- Department of Child & Adolescent Psychiatry, Kai-Syuan Psychiatric Hospital, No.130, Kaixuan 2nd Road, Lingya District, Kaohsiung City, 802, Taiwan, Republic of China
| | - Ying-Chun Li
- Department of Business Management, Institute of Health Care Management, National Sun Yat-Sen University, No. 70, Lienhai Road, Gushan District, Kaohsiung City, 804, Taiwan, Republic of China.
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27
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Siegel M. The Severe End of the Spectrum: Insights and Opportunities from the Autism Inpatient Collection (AIC). J Autism Dev Disord 2018; 48:3641-3646. [PMID: 30178106 DOI: 10.1007/s10803-018-3731-6] [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: 10/28/2022]
Abstract
Research on individuals severely affected by autism, including those who are minimally verbal, have intellectual disability or challenging behaviors, has become less common. The Autism Inpatient Collection (AIC) was initiated so data on this group is available to the research community. Ten studies utilizing phenotypic data from the first 350 AIC participants are presented. Greater autism severity, sleep disturbance, and psychiatric disorders are risks for hospitalization; fluently verbal youth experience more depression and oppositional symptoms; lower adaptive/coping skills are associated with increased problem behaviors; lower IQ is a risk for SIB; post-traumatic and suicidal symptoms are common; and challenging behaviors improve with specialized inpatient treatment. A new measure of emotion regulation and prescribing practices are described and future research discussed.
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Affiliation(s)
- Matthew Siegel
- Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA.
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Vijverberg R, Ferdinand R, Beekman A, van Meijel B. Factors associated with treatment intensification in child and adolescent psychiatry: a cross-sectional study. BMC Psychiatry 2018; 18:291. [PMID: 30200911 PMCID: PMC6131781 DOI: 10.1186/s12888-018-1874-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More knowledge about characteristics of children and adolescents who need intensive levels of psychiatric treatment is important to improve treatment approaches. These characteristics were investigated in those who need youth Assertive Community Treatment (youth-ACT). METHOD A cross-sectional study among children/adolescents and their parents treated in either a regular outpatient clinic or a youth-ACT setting in a specialized mental health treatment center in the Netherlands. RESULTS Child, parent and family/social context factors were associated with treatment intensification from regular outpatient care to youth-ACT. The combination of the child, parent, and family/social context factors adds substantially to the predictive power of the model (Nagelkerke R2 increasing from 36 to 45% for the three domains separately, to 61% when all domains are combined). The strongest predictors are the severity of psychiatric disorders of the child, parental stress, and domestic violence. CONCLUSIONS Using a wide variety of variables that are potentially associated with treatment intensification from regular outpatient clinic to youth-ACT, we constructed a regression model illustrating a relatively strong relation between the predictor variables and the outcome (Nagelkerke R2 = 0.61), with three strong predictors, i.e. severity of psychiatric disorders of the child, parental stress, and domestic violence. This emphasizes the importance of a system-oriented approach with primary attention for problem solving and stress reduction within the system, in addition to the psychiatric treatment of the child, and possibly also the parents.
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Affiliation(s)
- Richard Vijverberg
- Department of Child and Adolescent Psychiatry, GGZ Delfland, PO-box 5016, 2600, GA, Delft, The Netherlands. .,Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Robert Ferdinand
- Department of Child and Adolescent Psychiatry, GGZ Delfland, PO-box 5016, 2600 GA Delft, The Netherlands
| | - Aartjan Beekman
- Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands ,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Berno van Meijel
- Amsterdam UMC, location VUmc and GGZ inGeest, Department of psychiatry, Amsterdam, The Netherlands ,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.448984.dInholland University of Applied Sciences, Amsterdam, The Netherlands ,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands ,Parnassia Psychiatric Institute, The Hague, The Netherlands
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Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units? J Autism Dev Disord 2018; 48:4082-4089. [PMID: 29971653 DOI: 10.1007/s10803-018-3666-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McGuire K, Siegel M. Psychiatric hospital treatment of youth with autism spectrum disorder in the United States: needs, outcomes, and policy. Int Rev Psychiatry 2018. [PMID: 29537885 DOI: 10.1080/09540261.2018.1433134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Children with Autism Spectrum Disorder (ASD) are admitted to inpatient psychiatric units at markedly high rates. As health insurance companies and government healthcare systems and regulators seek more evidence for healthcare outcomes, it is important to learn more about the effectiveness of psychiatric inpatient admissions for children with ASD to best inform decisions on provision and access to this level of care. Evidence for models of inpatient treatment for youth with ASD is presented, and key characteristics and consensus recommendations for care are discussed.
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Affiliation(s)
- Kelly McGuire
- a Center For Autism and Developmental Disorders , Maine Behavioral Healthcare and Tufts University School of Medicine , South Portland , ME , USA
| | - Matthew Siegel
- b Developmental Disorders Service, Maine Behavioral Healthcare , Maine Medical Center Research Institute and Tufts University School of Medicine , South Portland , ME , USA
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