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Sadikova E, Soland J, Menezes M, Mazurek M. Impact of adverse childhood experiences and family resilience on sleep duration in autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2612-2622. [PMID: 38807297 DOI: 10.1177/13623613241235880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
LAY ABSTRACT Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience.
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Ataro Adere A, Dababnah S, Habayeb S. Identifying Needs of Ethiopian and Eritrean American Parents of Autistic Children. J Autism Dev Disord 2024; 54:3899-3907. [PMID: 37667075 DOI: 10.1007/s10803-023-06102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/06/2023]
Abstract
Collectively, Ethiopians and Eritreans represent one of the largest African immigrant groups in the US, yet no research to date exists on families from these communities raising autistic children. The purpose of our study was to examine the experiences of Ethiopian and Eritrean families of autistic children including experiences (1) receiving the autism diagnosis and interacting with healthcare providers, (2) obtaining services and supports for children (including satisfaction with services and barriers to care), and (3) accessing services and supports for caregivers and families (including needs and barriers to care). Ethiopian and Eritrean parents (N = 51) raising autistic children in the US completed an online survey. Parents reported limited prior knowledge of autism within their communities and had varied experiences with healthcare providers through the diagnostic process. They endorsed barriers to accessing care for their child and family supports (such as provider shortages and cost of services), service needs, and dissatisfaction with school-based and behavioral supports. Many parents reported a negative impact on workforce participation in order to meet their child's needs. Parents identified needs that would benefit their autistic children and families, such as accessible support groups to obtain relevant information. To our knowledge, this is the first systematic study exploring the experiences of Ethiopian and Eritrean families raising autistic children in the US. We discuss implications of our findings and recommendations for culturally responsive care.
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Affiliation(s)
| | - Sarah Dababnah
- University of Maryland School of Social Work, Baltimore, MD, USA
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Young K, Harris B, Hall-Lande J, Esler A. The Intersection of Systemic, Child, and Evaluation Factors in the Prediction of Autism Special Education Eligibility; Examining the Role of Race and Ethnicity. J Autism Dev Disord 2024; 54:3274-3289. [PMID: 37480439 DOI: 10.1007/s10803-023-06059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
Though there is evidence autism identification has been inequitable for populations who are culturally and linguistically minoritized, there is limited research that explains the issue of disproportionality and factors contributing to its occurrence, especially within an educational setting. To explore contributors to racial/ethnic disparities in autism special education eligibility, the current investigation evaluated child and evaluation characteristics as they relate to the absence of autism eligibility. Data were obtained from the Autism and Developmental Disabilities Monitoring (ADDM) Network Study and included children with behavioral characteristics consistent with autism and educational evaluation records. Despite documented characteristics consistent with autism, only 72% of the sample received educational services under autism eligibility. To characterize children without autism eligibility, hierarchical logistic regression was used to evaluate factors documented in evaluation records predicting the absence of autism eligibility. Factors influencing autism eligibility included behavioral characteristics documented, evaluation components completed, intellectual ability, and clinical diagnoses present. There was no unique contribution of race/ethnicity in predicting the absence of autism eligibility when accounting for these previous predictors, but many of these predictors differed by racial/ethnic group. Disproportionality in autism may be the manifestation of inequitable evaluation experiences, including experiencing less comprehensive evaluations, and not receiving an autism specific assessment. Though race/ethnicity did not uniquely contribute to the absence of autism eligibility above and beyond those combined factors, it is important to evaluate and reduce inequities experienced within the autism identification process for populations who are culturally and linguistically minoritized.
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Affiliation(s)
- Kelsey Young
- Department of Research, Assessment, & Measurement, Curriculum Associates, North Billerica, MA, USA.
| | - Bryn Harris
- School of Education & Human Development, University of Colorado Denver, Denver, CO, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota; Twin Cities, Minneapolis, MN, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota; Twin Cities, Minneapolis, MN, USA
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Barger B, Salmon A, Moore Q. Medical Home, Developmental Monitoring/Screening, and Early Autism Identification. J Autism Dev Disord 2024; 54:3242-3261. [PMID: 37477840 DOI: 10.1007/s10803-023-06044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
Developmental monitoring/screening predict early identified autism spectrum disorders (ASD), but studies have not yet robustly controlled for a key health care service impacting early identification: medical home. National Surveys of Children's Health (NSCH; 2016-2020) were used to determine the relationship between medical home, developmental monitoring/screening, and identified ASD. NSCH overall medical home variable had a minimal relationship with ASD (under 5 years of age, under 5 identified in last year, under 5 identified over a year prior). Usual source of care was positively, and care coordination negatively, associated with ASD identified in last year, suggesting the overall medical home variable may mask variance from subscales. Research is needed to determine how medical home relates to identification in applied settings.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA.
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
| | - Ashley Salmon
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
| | - Quentin Moore
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA
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Zandam H, Moura I, Akobirshoev I, Mitra M. Non-COVID Respiratory Infections Related Emergency Room Visits Among Autistic Adults in the United States. Am J Prev Med 2024:S0749-3797(24)00290-3. [PMID: 39181342 DOI: 10.1016/j.amepre.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/17/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION This is a retrospective study that examines the risk of non-COVID-19 respiratory infection (RI)-related emergency department (ED) visits and hospitalizations among autistic adults. The study compares these findings to non-autistic adults using the 2018 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. METHODS The data were analyzed in 2022 using the ICD-10-CM codes to extract 46,996 case records that included an autism diagonosis matched by age and sex (140,997) records that did not include an autism diagnosis in a 1:3 case-control ratio. Respiratory infections were also identified using the ICD-10-CM codes and classified by type. Logistic regression models were conducted for the likelihood of presenting with respiratory infections to the emergency department and subsequent hospitalization. All models were adjusted for covariates. RESULTS Autistic adults were more likely to present with any type of respiratory infection at the emergency department (AOR=1.83, CI=1.69-2.42), lower respiratory infections (AOR=1.37, CI=1.09-1.50), and pneumonia (AOR=2.42, CI=1.98-2.47) compared to non-autistic adults.. They were also more likely to be hospitalized from respiratory infection during emergency department visits (AOR=3.87, CI=3.21-4.30), including upper respiratory infections and lower respiratory infections, pneumonia, and bronchitis. CONCLUSIONS Individuals with autism were more likely to experience emergency department visits and hospitalizations because of respiratory infections than individuals without autism. Amid growing evidence of the disproportionate impact of COVID-19 on the autistic population, the study findings highlight a broader, pre-existing burden of respiratory infections among adults with autism in the U.S. that extend beyond the recent pandemic.
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Affiliation(s)
- Hussaini Zandam
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Ian Moura
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Jolibois MI, Roohani I, Moshal T, Lasky S, Urata M, Munabi NC, Johns AL, Sader N, Durham SR, Urata MM. Sociodemographic Factors Associated with Delayed Presentation in Craniosynostosis Surgery at a Tertiary Children's Hospital. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6035. [PMID: 39220750 PMCID: PMC11365692 DOI: 10.1097/gox.0000000000006035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 09/04/2024]
Abstract
Background Craniosynostosis is a common diagnosis requiring early referral to a pediatric plastic surgeon; however, disparities in healthcare may influence presentation timing and affect treatment options and outcomes. This study aimed to explore sociodemographic factors contributing to delay in craniosynostosis surgical consultation. Methods A retrospective cohort study of 694 California-based craniosynostosis patients at a tertiary children's hospital was performed from 2006 to 2023. State-specific Area Deprivation Index (ADI) and distance to the hospital were calculated using ZIP codes. Multivariate linear and logistic regressions considered race, insurance type, syndromic status, suture type, and ZIP code-based socioeconomic factors. Results Median age of presentation was 4.5 [interquartile range: 2.6-7.6] months with racial/ethnic breakdown of Hispanic/Latinx (41.2%), White (23.6%), Asian (3.7%), Black/African American (2.0%), or other/unreported (29.5%) with 58.4% having public insurance and an average distance to the hospital of 48.3 km. Median ADI was 5.4 [interquartile range: 4.0-7.1]. By linear regression, public insurance (P < 0.001) and higher ADI decile (P < 0.001) independently contributed to an older age of presentation. Patients with public insurance (odds ratio 1.90; P = 0.002) were more likely to present after 4 months of age. Conclusions Patients who had public insurance or resided in more disadvantaged areas presented later for craniosynostosis surgical consultation. Eliminating disparities in these populations ensures more equitable access to surgical options and can improve patient outcomes.
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Affiliation(s)
- Marah I. Jolibois
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Albany Medical College, Albany, N.Y
| | - Idean Roohani
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Tayla Moshal
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sasha Lasky
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Maya Urata
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Naikhoba C.O. Munabi
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Alexis L. Johns
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Nicholas Sader
- Division of Pediatric Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Susan R. Durham
- Division of Pediatric Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, Calif
| | - Mark M. Urata
- From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, Calif
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, Calif
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Covello M, Pelella MR, Bennett A, Gerdes M, Guthrie W, Wallis KE, Wong ZM, Miller JS, Truong DM. Missing Ethnicity and Language Information in Healthcare Records of Patients from the Asian Diaspora. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02059-0. [PMID: 38969925 DOI: 10.1007/s40615-024-02059-0] [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] [Received: 04/23/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
The electronic health record (EHR) should contain information to support culturally responsive care and research; however, the widely used default "Asian" demographic variable in most US social systems (including EHRs) lacks information to describe the diverse experience within the Asian diaspora (e.g., ethnicities, languages). This has a downstream effect on research, identifying disparities, and addressing health equity. We were particularly interested in EHRs of autistic patients from the Asian diaspora, since the presence of a developmental diagnosis might call for culturally responsive care around understanding causes, treatments, and services to support good outcomes. The aim of this study is to determine the degree to which information about Asian ethnicity, languages, and culture is documented and accessible in the EHR, and whether it is differentially available for patients with or without autism. Using electronic and manual medical chart review, all autistic and "Asian" children (group 1; n = 52) were compared to a randomly selected comparison sample of non-autistic and "Asian" children (group 2; n = 50). Across both groups, manual chart review identified more specific approximations of racial/ethnic backgrounds in 54.5% of patients, 56% for languages spoken, and that interpretation service use was underestimated by 13 percentage points. Our preliminary results highlight that culturally responsive information was inconsistent, missing, or located in progress notes rather than a central location where it could be accessed by providers. Recommendations about the inclusion of Asian ethnicity and language data are provided to potentially enhance cultural responsiveness and support better outcomes for families with an autistic child.
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Affiliation(s)
- Maxine Covello
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Maggie Rose Pelella
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda Bennett
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marsha Gerdes
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Whitney Guthrie
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kate E Wallis
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zoe M Wong
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Judith S Miller
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dieu M Truong
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Hamdan SZ, Bennett A. Autism-Friendly Healthcare: A Narrative Review of the Literature. Cureus 2024; 16:e64108. [PMID: 39114203 PMCID: PMC11305600 DOI: 10.7759/cureus.64108] [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: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals. Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, and collaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.
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Affiliation(s)
- Samar Z Hamdan
- Department of Pediatrics, College of Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Yu APL, Zeng W, Lopez K, Magaña S. Reducing Depressive Symptoms Among Latina Mothers of Autistic Children: A Randomized Controlled Trial. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:294-307. [PMID: 38917994 DOI: 10.1352/1944-7558-129.4.294] [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: 08/15/2023] [Accepted: 01/30/2024] [Indexed: 06/27/2024]
Abstract
This study examines the intervention effect of a culturally tailored parent education program in reducing depressive symptoms among Latina mothers of autistic children. In this two-site randomized waitlist-control study (n = 109 mother-child dyads), a peer-to-peer mentoring (promotora) model was used to deliver an intervention that was designed to increase mothers' self-efficacy and use of evidence-based strategies. We assessed mothers' depressive symptom (CES-D) scores at three time points and used linear mixed models to determine whether their scores significantly changed from baseline to postintervention (Time 2) and at 4 months postintervention (Time 3). Results show that mothers in the intervention group reported a significant decrease in mean depressive symptom scores at Time 2 and that the effect was maintained at Time 3 with intermediate to medium effect sizes. There were no differences in results across sites. Findings suggest that Parents Taking Action, a culturally tailored intervention led by peer mentors, showed a significant effect both immediately after the intervention and 4 months postintervention in reducing depressive symptoms among Latina mothers of autistic children.
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Affiliation(s)
- Amy Pei-Lung Yu
- Amy Pei-Lung Yu, The University of Texas at Austin, Steve Hicks School of Social Work
| | - Weiwen Zeng
- Weiwen Zeng, Brandeis University, The Lurie Institute for Disability Policy
| | - Kristina Lopez
- Kristina Lopez, Arizona State University, School of Social Work
| | - Sandy Magaña
- Sandy Magaña, The University of Texas at Austin, Steve Hicks School of Social Work
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Little LM, Avery A, Tomchek S, Baker A, Wallisch A, Dean E. Race and Ethnicity Reporting in Occupational Therapy Research Among Autistic Youth. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:385-395. [PMID: 38281154 DOI: 10.1177/15394492231225199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Historically marginalized racial and ethnic groups are underrepresented in autism research broadly; however, patterns of inclusion in occupational therapy research are unknown.In this secondary data analysis, we examined race and ethnicity reporting across articles included in a systematic review of evidence related to occupational therapy practice with autistic individuals <18 years (2013-2021).Two team members reached >90% interrater coding agreement in race and ethnicity reporting across articles in ADLs/IADLs, education/work, play, sleep, and social participation in clinics, homes/communities, and schools.Intervention outcomes of ADL/IADLs (66.7%) and play (66.7%) had low rates of reporting, while social participation in schools (100%) and education/work (100%) had higher rates of reporting. Sample diversity was greatest among research in schools and most limited in clinic-based settings.Systemic racism that limits individuals' participation in occupational therapy research perpetuates racial and ethnic health inequities among autistic children and adolescents.
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Affiliation(s)
| | | | - Scott Tomchek
- University of Louisville School of Medicine, KY, USA
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Habayeb S, Inge A, Eisenman E, Godovich S, Lauer M, Hastings A, Fuentes V, Long M, Marshall X, Khuu A, Godoy L. Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241260800. [PMID: 38907720 DOI: 10.1177/13623613241260800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
LAY ABSTRACT Primary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.
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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [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: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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Dy-Hollins ME, Carr SJ, Essa A, Osiecki L, Lackland DT, Voeks JH, Mejia NI, Sharma N, Budman CL, Cath DC, Grados MA, King RA, Lyon GJ, Rouleau GA, Sandor P, Singer HS, Chibnik LB, Mathews CA, Scharf JM. The Challenge of Examining Social Determinants of Health in People Living With Tourette Syndrome. Pediatr Neurol 2024; 155:55-61. [PMID: 38608551 PMCID: PMC11132913 DOI: 10.1016/j.pediatrneurol.2024.02.008] [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: 10/12/2023] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To examine the association between race, ethnicity, and parental educational attainment on tic-related outcomes among Tourette Syndrome (TS) participants in the Tourette Association of America International Consortium for Genetics (TAAICG) database. METHODS 723 participants in the TAAICG dataset aged ≤21 years were included. The relationships between tic-related outcomes and race and ethnicity were examined using linear and logistic regressions. Parametric and nonparametric tests were performed to examine the association between parental educational attainment and tic-related outcomes. RESULTS Race and ethnicity were collapsed as non-Hispanic white (N=566, 88.0%) versus Other (N=77, 12.0%). Tic symptom onset was earlier by 1.1 years (P < 0.0001) and TS diagnosis age was earlier by 0.9 years (P = 0.0045) in the Other group (versus non-Hispanic white). Sex and parental education as covariates did not contribute to the differences observed in TS diagnosis age. There were no significant group differences observed across the tic-related outcomes in parental education variable. CONCLUSIONS Our study was limited by the low number of nonwhite or Hispanic individuals in the cohort. Racial and ethnic minoritized groups experienced an earlier age of TS diagnosis than non-Hispanic white individuals. Tic severity did not differ between the two groups, and parental educational attainment did not affect tic-related outcomes. There remain significant disparities and gaps in knowledge regarding TS and associated comorbid conditions. Our study suggests the need for more proactive steps to engage individuals with tic disorders from all racial and ethnic minoritized groups to participate in research studies.
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Affiliation(s)
- Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Samuel J Carr
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angela Essa
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Osiecki
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel T Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Jenifer H Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, and Drenthe Mental Health Institute, Groningen, Netherlands
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A King
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Gholson J Lyon
- George A. Jervis Clinic and Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Paul Sandor
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harvey S Singer
- Departments of Pediatrics and Neurology, Johns Hopkins Hospital, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lori B Chibnik
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, University of Florida, Gainsville, Florida
| | - Jeremiah M Scharf
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Keen M, Wen S, Heussler H, Tracey J, Nasser C, Doyle R. A novel drive-through approach to vaccination of children and young people with neurodevelopmental disability. J Paediatr Child Health 2024; 60:164-167. [PMID: 38860667 DOI: 10.1111/jpc.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/07/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
Disparities in preventative health care likely contribute to comorbidities associated with neurodevelopmental disability. These comorbidities are risk factors for poor outcomes of COVID-19, making COVID-19 vaccination a priority for this population. In mid-2021, the Australian Technical Advisory Group (ATAGI) recommended the COVID-19 vaccination rollout include children and young people at risk of severe COVID-19 associated disease. This cohort included children/young people severely immunocompromised, with disability, and/or complex, multiple health conditions. Children and young people with neurodevelopmental disability can be challenging to vaccinate in conventional clinic environments and may experience exacerbation of behaviours posing barriers to vaccination. Remaining unvaccinated for COVID-19 increased risk of secondary complications and affected access to carers and respite facilities. This paper describes a novel, individualised approach to safe vaccination for this cohort. In consultation with stakeholders, a drive-through clinic vaccination model was developed and implemented for children/young people with neurodevelopmental disability. The model prioritised person-centred care and minimised triggering factors experienced in community clinics. Data were collected on successfully administered vaccine doses; administration safety and adverse events following immunisation. Parents/carers and staff provided reflective feedback. Twenty-four children and young people used the model with successful vaccination rate of 96% (n = 23). Most patients received multiple doses through the clinic (n = 16). Some patients were vaccinated after unsuccessful attempts elsewhere. Feedback from carers and staff was positive and no adverse events were reported. This model is generalisable to other health services and may be applied to other vaccinations for people of all ages with neurodevelopmental disabilities.
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Affiliation(s)
- Marlene Keen
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Sophie Wen
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Child Health Research Centre, University of Queensland, St Lucia, Queensland, Australia
| | - Helen Heussler
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Child Health Research Centre, University of Queensland, St Lucia, Queensland, Australia
| | - John Tracey
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Carolyn Nasser
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Rebecca Doyle
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
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15
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Mendez AI, McQueen E, Gillespie S, Klin A, Klaiman C, Pickard K. Access to Part C, Early Intervention for children younger than 4 years evaluated for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1431-1440. [PMID: 38360525 DOI: 10.1177/13623613241229150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
LAY ABSTRACT Health disparities are defined as preventable differences in the opportunities to achieve optimal health outcomes experienced by marginalized and underrepresented communities. For families with autistic children, health disparities limit accessing early intervention services-which have been found to improve quality of life and other outcomes. One specific early intervention service in the United States is Individuals with Disabilities Education Act, Part C Early Intervention programs, which are federally funded interventions for children birth-to-three with developmental delays. This study adds to this topic by examining which factors impact accessing Part C, Early Intervention services for children who were evaluated for autism. Results showed that only half of the sample received these services despite there being concerns about development for all children. In addition, results showed that those who identified as Black had decreased odds of having accessed Part C, Early Intervention compared to those who identified as White. These results suggest that there are disparities when it comes to accessing important early intervention services that may be negatively impacting the Black autistic community.
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Affiliation(s)
- Adriana I Mendez
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | | | - Scott Gillespie
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Cheryl Klaiman
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Katherine Pickard
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
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16
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Mire SS, Truong DM, Sakyi GJ, Ayala-Brittain ML, Boykin JD, Stewart CM, Daniels F, Duran B, Gardner S, Barth AM, Richardson G, McKee SL. A Systematic Review of Recruiting and Retaining Sociodemographically Diverse Families in Neurodevelopmental Research Studies. J Autism Dev Disord 2024; 54:2307-2321. [PMID: 37022579 DOI: 10.1007/s10803-023-05968-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
Underrepresentation of socioeconomically, culturally, and/or linguistically diverse (SCLD) children with neurodevelopmental disorders (NDD) and their families has become a focal point for researchers. This systematic review aimed to identify researchers' strategies for recruiting and retaining SCLD families of children with NDD, published between 1993 and 2018. One hundred twenty-six articles were included, and study samples were categorized as "High SCLD" and "Low SCLD". Chi-square tests of independence were used to determine associations between sample composition (i.e., High/Low SCLD sample) and study characteristics reported. Significant associations were found between sample composition and studies that explicitly stated intention to recruit SCLD families, χ2(1) = 12.70, p < .001, Phi = 0.38 (moderate); and for studies that reported the following participant characteristics: language, χ2(1) = 29.58, p < .001, Phi = 0.48 (moderate-to-large); and race/ethnicity + SES + language, χ2(1) = 19.26, p <. 001, Phi = 0.39 (moderate). However, associations were not found between recruitment and retention approaches and whether studies included High SCLD or Low SCLD samples. Further study of NDD researchers' recruitment and retention approaches that successfully include SCLD families is needed.
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Affiliation(s)
- Sarah S Mire
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA.
- School of Education, Department of Educational Psychology, Baylor University, One Bear Place #97304, Waco, TX, 76798-7304, USA.
| | - Dieu M Truong
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgina J Sakyi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Mycah L Ayala-Brittain
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Jelisa D Boykin
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Christian M Stewart
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Fre'Dasia Daniels
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Brenda Duran
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Scarlett Gardner
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Alexandra M Barth
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgette Richardson
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Shannon L McKee
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
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17
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Nutor C, Dunlop A, Sadler O, Brennan PA. Prenatal Cannabis Use and Offspring Autism-Related Behaviors: Examining Maternal Stress as a Moderator in a Black American Cohort. J Autism Dev Disord 2024; 54:2355-2367. [PMID: 37097527 PMCID: PMC10127191 DOI: 10.1007/s10803-023-05982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/26/2023]
Abstract
Prenatal cannabis use and maternal stress have been proposed as risk factors for autism spectrum disorder (ASD). Black mothers and mothers of lower socioeconomic status (SES) may be especially likely to experience high levels of stress. This study examined the impact of prenatal cannabis use and maternal stress (i.e., prenatal distress, racial discrimination, and lower SES) on child ASD-related behaviors in a sample of 172 Black mother-child pairs. We found that prenatal stress was significantly associated with ASD-related behaviors. Prenatal cannabis use did not predict ASD-related behaviors and did not interact with maternal stress to predict ASD-related behaviors. These findings replicate previous work on prenatal stress-ASD associations and add to the limited literature on prenatal cannabis-ASD associations in Black samples.
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Affiliation(s)
- C Nutor
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA.
| | - A Dunlop
- Department of Gynecology and Obstetrics, Emory University, 1365 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - O Sadler
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| | - P A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
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18
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Roux AM, Voltaire S, Steinberg H, Williams ED, Anderson KA, Hutson TM, Shea LL. More Than Just a Variable: The Need to Explicitly Focus on Black Youth Within Autism Transitions Research. AUTISM IN ADULTHOOD 2024; 6:119-127. [PMID: 39144071 PMCID: PMC11320561 DOI: 10.1089/aut.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Little evidence is available to provide context for understanding the experiences of parents and youth from historically marginalized groups as they age into adulthood, especially in regard to the transition experiences of Black autistic transition-age youth and their family members. This commentary builds upon recent publications that inform intersectional understandings of Black autistic experiences in America, and outlines research recommendations to better address the specific needs of Black autistic transition-age youth. Given the noted deficits in transition research and the transition process in regard to the experiences of Black autistic youth, we provide recommendations for improving autism transition research. We propose changes that are necessary to achieve equitable research processes, which could inform the design of targeted interventions to improve transition experiences for Black autistic youth.
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Affiliation(s)
- Anne M. Roux
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Samuelle Voltaire
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hillary Steinberg
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ed-Dee Williams
- School of Social Work, Boston College, Boston, Massachusetts, USA
| | - Kristy A. Anderson
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Turea M. Hutson
- 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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19
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Benevides TW, Jaremski JE, Williams ED, Song W, Pham HH, Shea L. Racial and Ethnic Disparities in Community Mental Health Use Among Autistic Adolescents and Young Adults. J Adolesc Health 2024; 74:1208-1216. [PMID: 38493400 DOI: 10.1016/j.jadohealth.2024.01.036] [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] [Received: 06/28/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The purpose of this cohort study was to evaluate differences in rate of co-occurring mental health (MH) conditions among transition-age autistic youth (TAYA) who are Black, indigenous, and other people of color, and to identify enabling variables associated with any community MH visit in this population. METHODS Medicare-Medicaid Linked Enrollees Analytic Data Source 2012 data were used for this study. TAYA 14-29 years old who received fee-for-service Medicare, Medicaid, or both were included. Predisposing, enabling, and need variables associated with both presence of MH conditions and any community MH visit were examined with general linear modeling. RESULTS N = 122,250 TAYA were included. Black, Asian/Pacific Islander, and Hispanic TAYA were significantly less likely than White TAYA to have a diagnosis of substance-use, depressive, anxiety, attention-deficit hyperactivity disorder, or post-traumatic stress disorders. These groups were also significantly less likely to have had a community MH visit in the past year after controlling for predisposing, enabling, and need variables. Enabling variables associated with greater use of at least one community MH visit included dual enrollment in both Medicare and Medicaid and 12+ months of enrollment in 1115 or 1915(C) Medicaid waivers. DISCUSSION Service delivery factors are an important area of future research, particularly dual enrollment and coverage disparities for Black, indigenous, and other people of color TAYA. Examining coverage of managed care enrollees, including differences by state, may offer additional insights on how these factors impact care.
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Affiliation(s)
- Teal W Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia.
| | - Jennifer E Jaremski
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Ed-Dee Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
| | - Wei Song
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | | | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
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20
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Alothman AA, Ebrahim MT, Gadelrab HF. Challenges, practices, and impact of COVID-19 among mothers of children with autism spectrum disorder in cities and remote areas in Saudi Arabia. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 148:104718. [PMID: 38484423 DOI: 10.1016/j.ridd.2024.104718] [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: 08/01/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Mothers of children with autism spectrum disorder (ASD) across Saudi Arabia have experienced tremendous challenges during the COVID-19 pandemic. However, the challenges may be different for mothers living in a city compared to those living more remotely. AIMS We investigated challenges and practices related to COVID-19 and their impact among Saudi mothers of children with ASD in cities and remote areas during the pandemic. METHODS A sample of 99 mothers (60 in cities and 39 remote) who had a child with ASD was surveyed using an electronic questionnaire. RESULTS Mothers who lived in remote areas reported more challenges, while mothers in cities reported adopting more new practices with children than remote mothers. Regression analyses revealed that place of residence and age of the child were significant predictors of the challenges experienced by mothers of children with ASD. RECOMMENDATIONS Intervention services, community-based education programs, and electronic media are recommended for use with mothers in Saudi Arabia to increase awareness of COVID-19, improve practices, and minimize challenges in protecting their children with ASD.
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Affiliation(s)
| | - Mona Tawakkul Ebrahim
- Department of Educational Sciences, College of Education, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Hesham Fathy Gadelrab
- Department of Psychology, College of Social Sciences, Kuwait University, Kuwait; Department of Educational Psychology, College of Education, Mansoura University, Egypt
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21
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Tovin MM, Núñez-Gaunaurd A. Implementation of Peer-Assisted Physical Activity Via Telehealth for Adults on the Autism Spectrum: A Mixed Methods Feasibility Study. Phys Ther 2024; 104:pzae005. [PMID: 38236176 DOI: 10.1093/ptj/pzae005] [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] [Received: 11/07/2022] [Revised: 09/02/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Adults on the autism spectrum are at risk for physical inactivity, obesity, and related health conditions. Physical activity provides physical, social, and mental health benefits across the lifespan. Previous research examined feasibility and effectiveness of physical activity intervention in autistic children, but very few studies target autistic adults. This study examined the feasibility and acceptability of Physical Activity Connections via Telehealth, implemented during the coronavirus disease 2019 (COVID-19) pandemic lockdown as an alternative to in-person programming for autistic adults aged 18 to 32. METHODS The 10-week intervention utilized telehealth and remote technologies to deliver a theoretically grounded program to improve physical activity. Strategies included peer-guidance, coaching, individualized wellness goals, customized exercise programs, and wearable activity trackers. Feasibility and acceptability were examined using a mixed-methods design including observational and survey data collection, as well as participant interviews. Data were analyzed using descriptive statistics and content analysis. RESULTS Findings support feasibility and acceptability of telehealth to promote physical activity among autistic adults who have cognitive capacity and ability to utilize remote technology, with applicability beyond pandemic-imposed challenges. CONCLUSION Telehealth delivery of physical activity interventions is a viable alternative to in-person programs and may enable autistic adults to overcome barriers to physical activity participation and access. IMPACT As the rate of autism continues to rise globally, rehabilitation professionals will play a significant role in promoting health and wellness for autistic individuals across the lifespan. Findings promote informed practice based on the health needs of this growing segment of society.
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Affiliation(s)
- Melissa M Tovin
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, USA
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22
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Allahdad M, Gluyas E, Spain D, Blainey S, Doswell S, Onyejiaka A. Implementing 'Transforming Care' - The first two years of a pilot service for autistic adults experiencing mental health crisis warranting psychiatric admission. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 147:104700. [PMID: 38430720 DOI: 10.1016/j.ridd.2024.104700] [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: 11/09/2023] [Revised: 01/11/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Autistic adults are at increased risk of mental health difficulties; however Adult Mental Health Services (AMHS) often struggle to offer appropriate support to this group. Within England, Government initiatives, such as the 'Transforming Care' programme which included 'Building the Right Support' (NHS England, 2015) have promoted the need for AMHS to consider how they can better provide autism-informed support to autistic adults. AIMS/METHODS Here, we describe the first two years of work of the Transforming Care in Autism (TCA) Team; a specialist service that supports autistic adults, without a moderate or severe intellectual disability or presenting significant risk to others, experiencing a mental health crisis. The service model is described, and descriptive data is presented over the two years of the service operation. RESULTS Between February 2019 and February 2021, 110 referrals were received; 52 (47%) were accepted. Support offered to autistic adults included psychoeducation, psychological interventions, family-focused interventions, and consultation with professionals about specific individuals. Seventy autism training sessions were delivered to professionals working in medical health settings, AMHS, social care and residential services. CONCLUSIONS/IMPLICATIONS Developing more autism-informed community and inpatient AMHS is vital for improving care. Further research about the experiences and needs of autistic adults using AMHS is needed, along with improved awareness of autism and provision of tailored intervention within these settings. LAY ABSTRACT Autistic people have mental health problems more often than people who are not autistic. When autistic people need help from mental health services, often these services do not know how to help autistic people. The Government says mental health services must do more to help autistic people. In this paper we write about a new team, called the Transforming Care in Autism team. In its first two years the team was asked to help 110 people and worked with 52 of them. Help included talking to autistic people about how autism affects them and offering therapy. We also worked with families and professionals supporting autistic adults and offered 70 training sessions. More work is needed to make sure mental health services work well with autistic people. We also need to ask autistic people about their experiences of getting help from mental health services.
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Affiliation(s)
- Mahdieh Allahdad
- South London & Maudsley NHS Foundation Trust, London, UK; Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Emma Gluyas
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Debbie Spain
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Sarah Blainey
- South London & Maudsley NHS Foundation Trust, London, UK; Central and North-West London NHS Foundation Trust, UK
| | - Sophie Doswell
- South London & Maudsley NHS Foundation Trust, London, UK
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23
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Harris HK, Weissman L, Friedlaender EY, Neumeyer AM, Friedman AJ, Spence SJ, Rotman C, Krauss S, Broder-Fingert S, Weitzman C. Optimizing Care for Autistic Patients in Health Care Settings: A Scoping Review and Call to Action. Acad Pediatr 2024; 24:394-407. [PMID: 37951351 DOI: 10.1016/j.acap.2023.11.006] [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: 06/26/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE We conducted a scoping review of interventions designed to improve the health care experiences of autistic individuals and assessed the methodology and outcomes used to evaluate them. METHODS Literature from January 2005 to October 2020 was searched using PubMed, Excerpta Medica dataBASE (EMBASE), Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO as well as hand searching. Studies included described an intervention for autistic individuals in inpatient or outpatient settings and evaluated the intervention using standardized methodology. Results were exported to Covidence software. Ten reviewers completed abstract screening, full text review, and then systematic data extraction of the remaining articles. Two reviewers evaluated each article at each stage, with a third reviewer arbitrating differences. RESULTS A total of 38 studies, including three randomized controlled trials (RCTs) were included. Twenty-six (68%) took place in dental, psychiatric, or procedural settings. Interventions primarily focused on visit preparation and comprehensive care plans or pathways (N = 29, 76%). The most frequent outcome was procedural compliance (N = 15), followed by intervention acceptability (N = 7) and parent satisfaction (N = 6). Two studies involved autistic individuals and caregivers in study design, and no studies assessed racial/ethnic diversity on intervention impact. CONCLUSIONS Well-designed evaluations of interventions to support autistic individuals in pediatric health care settings are limited. There is a need to conduct large multi-site intervention implementation studies.
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Affiliation(s)
- Holly K Harris
- Department of Pediatrics (HK Harris), Baylor College of Medicine and Meyer Center for Developmental Pediatrics, Texas Children's Hospital, Houston, Tex.
| | - Laura Weissman
- Division of Developmental Medicine (L Weissman and C Weitzman), Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Eron Y Friedlaender
- Department of Pediatrics (EY Friedlaender), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Ann M Neumeyer
- Lurie Center for Autism (AM Neumeyer), Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Alexander J Friedman
- Division of Developmental and Behavioral Pediatrics (AJ Friedman and S Krauss), Boston Medical Center, Boston, Mass
| | - Sarah J Spence
- Division of Neurology (SJ Spence), Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Chloe Rotman
- Medical Library (C Rotman), Boston Children's Hospital, Boston, Mass
| | - Shari Krauss
- Division of Developmental and Behavioral Pediatrics (AJ Friedman and S Krauss), Boston Medical Center, Boston, Mass
| | | | - Carol Weitzman
- Division of Developmental Medicine (L Weissman and C Weitzman), Boston Children's Hospital and Harvard Medical School, Boston, Mass
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24
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Alpert JS. Disparities in US Healthcare-A National Problem. Am J Cardiol 2024; 216:100-101. [PMID: 38417651 DOI: 10.1016/j.amjcard.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Joseph S Alpert
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.
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25
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Love AMA, Gibbs V, Cooper D, Benevides TW, Mogavero MC, Basketbill IL, Shea LL. Creating the Global Criminal Justice Survey: A Questionnaire Designed to Gather Perspectives from the Autism Community and Criminal Justice Professionals. J Autism Dev Disord 2024; 54:1425-1437. [PMID: 36637593 PMCID: PMC9838505 DOI: 10.1007/s10803-022-05835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/14/2023]
Abstract
Autistic people's perceptions of their interactions with criminal justice professionals are predominantly negative; however, little is known about the state of interactions on a global scale. To further understanding, a comprehensive stakeholder questionnaire was created. Aspects of reliability and validity including evidence for test content and internal structure were gathered using expert reviews, cognitive interviewing, pilot data collection, and a larger data collection effort (N = 1618). Data was gathered from the autism community through perspectives of parents/caregivers as well as from self-reported autistic adults. Criminal justice professionals included law enforcement officers, corrections professionals, probation and parole officers, forensic psychologists and legal professionals. The scale development process was detailed in order to sufficiently document the initial psychometric evidence and share the steps taken to gain diverse stakeholder input. This study is a critical first step in generating further information to facilitate policy and program development with wide applicability.
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Affiliation(s)
- Abigail M. A. Love
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Chatswood, NSW Australia
| | - Vicki Gibbs
- Aspect Research Centre for Autism Practice, Autism Spectrum Australia, Chatswood, NSW Australia
| | - Dylan Cooper
- Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Teal W. Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, GA USA
| | | | | | - Lindsey L. Shea
- Drexel Autism Institute, Drexel University, Philadelphia, PA USA
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26
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McDonald TAM, Scudder A. Mind the NIH-Funding Gap: Structural Discrimination in Physical Health-Related Research for Cognitively Able Autistic Adults. J Autism Dev Disord 2024; 54:1411-1424. [PMID: 36635433 PMCID: PMC10762646 DOI: 10.1007/s10803-022-05856-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/14/2023]
Abstract
Autistic adults experience disparities in physical health and health care access. A major barrier to addressing these disparities is a lack of federal funding for research on this topic. In seeking funding from the National Institutes of Health (NIH), we discovered nodes that contribute to structural discrimination in physical health-related research for autistic adults. To examine this structural discrimination, we systematically searched funded research on all physical health-disparity conditions in autistic adults using NIH RePORTER. Among 61 unique studies, none focused on improving the relevant physical health condition through intervention, programs, or services for autistic adults. Thus, we need updated policies and procedures that support research on physical health disparities in populations with developmental or mental health conditions.
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Affiliation(s)
- T A Meridian McDonald
- Department of Neurology, Vanderbilt University Medical Center, 37235, Nashville, TN, USA.
| | - Audrey Scudder
- Department of Psychology, Vanderbilt University, 37240-7817, Nashville, TN, USA
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Teo T, Koh HC, Mohd Zambri N, Zaccario ML, Sossin KM, Wong CM. Ethnic Group Differences in the Timing of Autism Diagnosis, Intellectual Disability, and Educational Placement of Autistic Children in Singapore. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01957-7. [PMID: 38489087 DOI: 10.1007/s40615-024-01957-7] [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: 10/24/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
AIM Given Singapore's distinct multicultural identity, this study examined the hypotheses that there may be ethnic group differences in diagnosis and outcomes in autistic children in Singapore. METHODS Retrospective data were obtained from medical records of all children born between 2008 and 2011 who were diagnosed with clinical or confirmed autism. One-way ANOVAs and regression analyses were used to analyze data. RESULTS Data from 2577 medical records were extracted. There were more boys (82.5%) and ethnic group distribution was Chinese (67%), Malay (14%), Indian (10%), and Others (10%). Chinese children were more likely to present at a developmental clinic with concerns 3-4 months younger compared to Malay children and those from Other Races (F(3, 2038) = 9.58, p < .001, Cohen's F = 0.12). Chinese children were also more likely to receive an autism diagnosis approximately 3 months younger compared to Malay children. Fewer autistic Chinese children were diagnosed with co-occurring intellectual disability (13.1%) while there were almost twice more Malay children than expected with co-occurring intellectual disability (29.9%) (χ2 (3) = 55.17, p < .001). There are correspondingly more Malay children on the autism spectrum who attend special education schools. Possible confounding variables such as household income level and mother's level of education were identified in some of these findings. CONCLUSION Several significant ethnic group differences in autistic children in Singapore exist that warrant more investigation into possible causes and support systems needed, with implications for other ethnically diverse nations.
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Affiliation(s)
| | - Hwan Cui Koh
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | | | - Chui Mae Wong
- KK Women's and Children's Hospital, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Singapore, Singapore.
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Nart L, Desikan M, Pietrusz A, Savvatis K, Quinlivan R. Neurodiversity, treatment compliance and survival in adults with Duchenne muscular dystrophy: a single-centre retrospective cohort review. Neuromuscul Disord 2024; 35:13-18. [PMID: 38194731 DOI: 10.1016/j.nmd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024]
Abstract
Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy worldwide. With increasing survival, there is now a greater awareness of associated neurodevelopmental co-morbidities. Despite this, there is currently a limited understanding of how these co-morbidities might potentially impact on health outcomes. This study reviewed the characteristics of 37 adults with DMD who died between 2011 and 2022. The median age of death was 22.25 years, and those with neurodevelopmental co-morbidities had statistically poorer survival than those without a neurodevelopmental disorder. Notably, the proportion of patients within this cohort with a diagnosis of a neurodevelopmental disorder was higher than previously reported studies in living cohorts. This study suggests that patients with a co-morbid neurodevelopmental disorder may have worse health outcomes than those who do not.
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Affiliation(s)
- Luca Nart
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Mahalekshmi Desikan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Aleksandra Pietrusz
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Konstantinos Savvatis
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; Barts Heart Centre, Saint Bartholomew's Hospital, London, United Kingdom
| | - Ros Quinlivan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
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Windarwati HD, Lestari R, Hidayah R, Hasan H, Ati NAL, Kusumawati MW, Selena IN, Dumar B, Rahayu G. Institutional and family support impact on health-related quality of life of children with autism spectrum disorders during the COVID-19 pandemic. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12450. [PMID: 38403996 DOI: 10.1111/jcap.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/01/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024]
Abstract
PROBLEMS Children with autism spectrum disorder (ASD) tend to have a notably poorer quality of life than the general population, especially during the COVID-19 pandemic. This study aimed to analyze the association between institutional support and family support on the health-related quality of life (HRQoL) of children with ASD during the COVID-19 pandemic. METHODS A cross-sectional study was conducted in October 2022 in a School for Special Needs in Malang City, East Java Province, Indonesia. The pediatric quality of life inventory (PedsQL) and Institutional and Family Support questionnaire were used to measure the HRQoL and support perceived by parents of children with ASD. We analyzed each component of the PedsQL and the Institutional and Family Support questionnaire. The independent T-test was performed to analyze the association between HRQoL and perceived support by parents of children with ASD. FINDINGS The results showed that most participants (72.7%) were women aged 40. As many as 69.39% of participants had more than one child, and 16.33% declared they had other children who experienced the same problem (special needs children). This study indicated that the average health-related quality of life score in children with ASD was 57.41 (9.418). The finding of this study showed a significant mean difference in HRQoL scores in children with ASD who received high institutional and family support compared to those who had low (p = 0.028, 95% confidence interval [CI] = -11.071 to 0.664). CONCLUSION Institutional support positively impacts children with ASD's quality of life. Therefore, it is essential to improve the adequacy of support felt by families while caring for children with ASD.
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Affiliation(s)
- Heni D Windarwati
- Department Mental Health Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
| | - Retno Lestari
- Department Mental Health Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
| | - Ridhoyanti Hidayah
- Department Mental Health Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
| | - Haliza Hasan
- Department of Special Care Nursing, International Islamic University Malaysia, Kulliyyah of Nursing, Kuantan, Malaysia
| | - Niken A L Ati
- Department of Community, Family & Geriatric Nursing, Faculty of Nursing, University of Jember, Jember, Indonesia
| | - Mira W Kusumawati
- Faculty of Health Sciences, University of Kusuma Husada, Surakarta, Indonesia
| | - Irhamna N Selena
- Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
| | - Bergita Dumar
- Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
| | - Gemi Rahayu
- Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia
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Pickard K, Maddox B, Boles R, Reaven J. A cluster randomized controlled trial comparing the effectiveness of two school-based interventions for autistic youth with anxiety. BMC Psychiatry 2024; 24:6. [PMID: 38166851 PMCID: PMC10763300 DOI: 10.1186/s12888-023-05441-0] [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: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Recent systematic reviews have indicated that cognitive behavioral therapy (CBT) is effective in reducing anxiety symptoms for autistic and non-autistic children. However, the vast majority of CBT research for autistic youth has been implemented within university settings and primarily by mental health providers. Schools hold great promise to equitably manage the mental health symptoms of autistic youth. Although preliminary research evaluating CBT within schools has been promising, CBT has not yet been compared to another readily available school mental health program. The goal of this protocol paper is to describe a multi-site study comparing two school-based interventions, Facing Your Fears-School Based (FYF-SB) and Zones of Regulation (ZOR) via a cluster randomized controlled type 1 hybrid effectiveness-implementation trial to determine which of the two interventions will best support autistic youth with anxiety in schools. METHODS Up to 100 elementary and middle schools will be randomized into FYF-SB or ZOR. Once schools are randomized, a minimum of two interdisciplinary school providers at each school will be trained to deliver either FYF-SB or ZOR over the course of 12 weeks to groups of 2-5 autistic students ages 8-14 years. Over the course of two years, a total of 200 autistic students will receive either ZOR or FYF-SB. The primary outcome of this trial is child anxiety, as rated by masked evaluators and via caregiver- and student-report, which will be measured at baseline, post-treatment, and 6-month follow-up. Semi-structured interviews will also be conducted with a purposive sample of students, caregivers, and school providers to understand the acceptability, appropriateness, and feasibility of either ZOR or FYF-SB. Stakeholder engagement is a central component of this project via two stakeholder advisory boards that will directly inform and oversee the project. DISCUSSION Results of this study will provide evidence about the relative impact of two school-based mental health interventions on outcomes reported as meaningful by caregivers and school providers. The additional focus on evaluating factors that support the implementation of FYF-SB and ZOR will allow future studies to test targeted implementation strategies that support mental health programming uptake and implementation within public schools. TRIAL REGISTRATION This trial is registered with clinicaltrials.gov (NCT05863520).
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Affiliation(s)
- Katherine Pickard
- Emory School of Medicine Department of Pediatrics, Division of Autism and Related Disabilities, 1920 Briarcliff Road, Atlanta, GA, 30329, USA.
| | - Brenna Maddox
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Richard Boles
- University of Colorado Anschutz Medical Campus, JFK Partners, Aurora, CO, USA
| | - Judy Reaven
- University of Colorado Anschutz Medical Campus, JFK Partners, Aurora, CO, USA
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Zavaleta-Ramírez P, Rosetti M, Albores-Gallo L, López ON, González PP. Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions. Clin Child Psychol Psychiatry 2024; 29:232-244. [PMID: 37541309 DOI: 10.1177/13591045231193817] [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: 08/06/2023]
Abstract
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente Muñiz, México City, México
| | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Omar Nafate López
- Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, México
| | - Paula Padierna González
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
- Fundación Alicia Koplowitz, Madrid, España
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Ben Natan M, Igbarin H, Watted A. Mothers' satisfaction with emergency care when their child has an autism spectrum disorder. J Pediatr Nurs 2024; 74:35-40. [PMID: 37992479 DOI: 10.1016/j.pedn.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the Emergency Department (ED), among mothers of children with autistic spectrum disorder (ASD) in comparison to mothers of children without ASD. DESIGN AND METHODS In this correlational quantitative study, 128 Israeli mothers - 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience. RESULTS Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care. CONCLUSIONS These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED. PRACTICE IMPLICATIONS It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Heba Igbarin
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Arwa Watted
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
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Coulter KL, Moreno P, Barton M, Dumont-Mathieu T, Robins DL, Fein DA. Validity of the Toddler Autism Symptom Inventory in Non-Hispanic White and Black Toddlers. J Autism Dev Disord 2024; 54:339-352. [PMID: 36316523 PMCID: PMC10148924 DOI: 10.1007/s10803-022-05756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 05/01/2023]
Abstract
Racial disparities exist in autism diagnosis, and yet, the development of most diagnostic tools has not explicitly examined measurement equity between racial and ethnic groups. We examined the validity of the Toddler Autism Symptom Inventory (TASI), a semi-structured interview developed for diagnosis of toddlers, in non-Hispanic Black/African American and non-Hispanic White children. After controlling for group differences in socio-economic status, no differences in diagnosis, age at diagnosis, mean developmental level, or autism severity were found. TASI ROC curves for both groups, in the overall sample, and in samples stratified by SES, showed high AUC values. Validity of two cutoff scores was acceptable. Lack of significant differences in TASI score or responses to individual items suggests similar symptomatology. These results provide early support for the use of the TASI in diagnostic evaluations of Black and White children.
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Affiliation(s)
- Kirsty L Coulter
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA.
| | - Paula Moreno
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Marianne Barton
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
| | - Thyde Dumont-Mathieu
- University of Connecticut School of Medicine, Connecticut Children's Medical Center, Farmington, CT, USA
| | | | - Deborah A Fein
- University of Connecticut, 406 Unit 1020, Babbidge Rd, 06269, Storrs, CT, USA
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Wagner L, Vehorn A, Weitlauf AS, Lavanderos AM, Wade J, Corona L, Warren Z. Development of a Novel Telemedicine Tool to Reduce Disparities Related to the Identification of Preschool Children with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06176-3. [PMID: 38064003 PMCID: PMC11161552 DOI: 10.1007/s10803-023-06176-3] [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: 10/29/2023] [Indexed: 12/20/2023]
Abstract
The wait for ASD evaluation dramatically increases with age, with wait times of a year or more common as children reach preschool. Even when appointments become available, families from traditionally underserved groups struggle to access care. Addressing care disparities requires designing identification tools and processes specifically for and with individuals most at-risk for health inequities. This work describes the development of a novel telemedicine-based ASD assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool). We applied machine learning models to a clinical data set of preschoolers with ASD and other developmental concerns (n = 914) to generate behavioral targets that best distinguish ASD and non-ASD features. We conducted focus groups with clinicians, early interventionists, and parents of children with ASD from traditionally underrepresented racial/ethnic and linguistic groups. Focus group themes and machine learning analyses were used to generate a play-based instrument with assessment tasks and scoring procedures based on the child's language (i.e., TAP-P Verbal, TAP-P Non-verbal). TAP-P procedures were piloted with 30 families. Use of the instrument in isolation (i.e., without history or collateral information) yielded accurate diagnostic classification in 63% of cases. Children with existing ASD diagnoses received higher TAP-P scores, relative to children with other developmental concerns. Clinician diagnostic accuracy and certainty were higher when confirming existing ASD diagnoses (80% agreement) than when ruling out ASD in children with other developmental concerns (30% agreement). Utilizing an equity approach to understand the functionality and impact of tele-assessment for preschool children has potential to transform the ASD evaluation process and improve care access.
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Affiliation(s)
- Liliana Wagner
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alison Vehorn
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy S Weitlauf
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ambar Munoz Lavanderos
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua Wade
- Adaptive Technology Consulting, LLC, Murfreesboro, USA
| | - Laura Corona
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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Onovbiona H, Quetsch L, Bradley R. Racial and Practical Barriers to Diagnostic and Treatment Services for Black Families of Autistic Youth: A Mixed-Method Exploration. J Autism Dev Disord 2023:10.1007/s10803-023-06166-5. [PMID: 38038872 DOI: 10.1007/s10803-023-06166-5] [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: 10/20/2023] [Indexed: 12/02/2023]
Abstract
The present study explored the role race-related barriers and practical barriers to treatment participation play in treatment effectiveness and satisfaction among Black families with autistic youth using a mixed-method approach. In a sample of Black caregivers with autistic youth (N = 101), multiple regressions were conducted to examine the impact of reported racial and practical barriers on parental stress, treatment effectiveness, and treatment satisfaction. Caregivers provided further narratives on their experience navigating diagnostic and treatment services in qualitative interviews. The study demonstrated that Black caregivers of autistic youth are still encountering several racial and logistical barriers when seeking treatment and diagnostic services for their children. These barriers negatively impact caregiver stress and caregiver perceived treatment quality. Contrary to the barriers and stress experienced by Black caregivers, caregivers are generally satisfied with the treatments they are utilizing and find them helpful. The narratives told by caregivers further elucidate the tumultuous experiences of Black caregivers as they seek diagnostic and treatment services for their children. An experience that may be worsened by family, professional, and systemic barriers, and can be improved by advocacy, acceptance, peer and community support, and increased knowledge. Black families of autistic youth call for increased compassion, support, training, and humility among professionals who serve autistic youth.
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Kahn NF, Sequeira GM, Reyes V, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Mental Health of Youth With Autism Spectrum Disorder and Gender Dysphoria. Pediatrics 2023; 152:e2023063289. [PMID: 37909059 DOI: 10.1542/peds.2023-063289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Habayeb S, Inge A, Myrick Y, Hastings A, Long M, Hoffman SB, Parker S, Theodorou P, Soutullo O, Beers L, Godoy L. A Multisystem Approach to Improving Autism Care. Pediatrics 2023; 152:e2022060584. [PMID: 37795558 DOI: 10.1542/peds.2022-060584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 10/06/2023] Open
Abstract
Children with autism face significant barriers to accessing evaluations and intervention services often because of confusing referral processes, lack of centralized coordination across organizations serving children with autism, insurance coverage gaps, multiyear waitlists for diagnostic services, and limited provider knowledge about autism. Racism and systemic inequities exist and persist in autism care across the United States. This article reviews targeted initiatives implemented by a multidisciplinary team to advocate for, and address barriers faced, by autistic children and their families in Washington, DC. We describe initiatives across multiple levels of the health care system including: 1. infrastructure-building initiatives (eg, coalition-building, policy, and advocacy); 2. enabling services (eg, population- and community-level supports that increase provider capacity to serve children's and families' needs); and 3. direct services (eg, innovative, gap-filling programs that directly serve children and families). We review outcomes and describe lessons learned.
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Affiliation(s)
- Serene Habayeb
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anne Inge
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Yetta Myrick
- DC Autism Parents, Washington, District of Columbia
| | - Amanda Hastings
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Melissa Long
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Shaakira Parker
- Children's National Hospital, Washington, District of Columbia
| | | | - Olivia Soutullo
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Lee Beers
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Leandra Godoy
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Rivard M, Morin D, Coulombe P, Morin M, Mello C. The Diagnostic Period for Autism: Risk and Protective Factors for Family Quality of Life in Early Childhood. J Autism Dev Disord 2023; 53:3755-3769. [PMID: 35917021 DOI: 10.1007/s10803-022-05686-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
During the diagnostic evaluation period for autism or intellectual disability (ID), families of young children are at risk for poor adjustment. The present study aimed to document family quality of life (FQOL), along with associated risk and protective factors, during this critical step of families' services trajectory. FQOL was measured in a large sample of families of children recently diagnosed with a neurodevelopmental disorder and examined in relation to the type of services received, children's clinical profile, and family variables. FQOL was related to types of services, children's challenging behavior, parenting stress, and several aspects of family composition and status. These findings highlight a need for mental health support for parents, coaching interventions for challenging behaviors, and family-centered supports.
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Affiliation(s)
- Mélina Rivard
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada.
| | - Diane Morin
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada
| | | | - Marjorie Morin
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada
| | - Catherine Mello
- The Pennsylvania State University - Berks, 19610, Reading, PA, USA
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Drahota A, Sridhar A, Moskowitz LJ, Kerns CM, Soorya L, Wainer A, Cohn E, Lerner MD. Community-based care for autistic youth: community providers' reported use of treatment practices in the United States. Front Psychiatry 2023; 14:1212084. [PMID: 37791130 PMCID: PMC10544899 DOI: 10.3389/fpsyt.2023.1212084] [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: 04/25/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization. Methods The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7-22 years) participated. Results Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status. Discussion Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.
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Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Connor M. Kerns
- Department of Psychology, University British Columbia, Vancouver, BC, Canada
| | - Latha Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- School of Nursing, Hunter College, CUNY, New York, NY, United States
| | - Matthew D. Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Ellis R, Williams K, Brown A, Healer E, Grant A. A realist review of health passports for Autistic adults. PLoS One 2023; 18:e0279214. [PMID: 37682898 PMCID: PMC10490970 DOI: 10.1371/journal.pone.0279214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. METHODS We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. FINDINGS 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. CONCLUSION There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.
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Affiliation(s)
- Rebecca Ellis
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
| | - Kathryn Williams
- Autistic UK CIC, Llandudno, Wales, United Kingdom
- School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Amy Brown
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
| | - Eleanor Healer
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
| | - Aimee Grant
- Centre for Lactation Infant Feeding and Translation (LIFT), Swansea University, Swansea, United Kingdom
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Rivera RA, Bennetto L. Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Front Psychiatry 2023; 14:1243657. [PMID: 37743980 PMCID: PMC10511883 DOI: 10.3389/fpsyt.2023.1243657] [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: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.
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Affiliation(s)
- Rachel A. Rivera
- Department of Psychology, University of Rochester, Rochester, NY, United States
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Miller HL, Thomi M, Patterson RM, Nandy K. Effects of Intersectionality Along the Pathway to Diagnosis for Autistic Children With and Without Co-occurring Attention Deficit Hyperactivity Disorder in a Nationally-Representative Sample. J Autism Dev Disord 2023; 53:3542-3557. [PMID: 35749001 PMCID: PMC9789199 DOI: 10.1007/s10803-022-05604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/26/2022]
Abstract
Children with complex behavioral profiles (e.g., ASD + ADHD) may experience delays in obtaining a final diagnosis. Low-resource or underrepresented groups may be at even greater risk for delayed diagnosis. We assessed the effect of sociodemographic factors, symptom complexity and co-occurring conditions, and identifier of first symptoms on diagnostic trajectories among children aged 3-17 years diagnosed with ASD (n = 52) or ASD + ADHD (n = 352) from a nationally-representative sample. Race/ethnicity and gender disparities were evident in both groups. Race, symptom complexity, and co-occuring conditions predicted age of final diagnosis and wait time between first concern and final diagnosis, both of which were staggeringly high. Results suggest a complex influence of sociodemographic factors on the diagnostic pathway, and risk of health disparities as a function of intersectionality.
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Affiliation(s)
- Haylie L Miller
- School of Kinesiology, University of Michigan, 830 N. University Ave., SKB 4120, Ann Arbor, MI, 48109, USA.
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA.
| | - Morgan Thomi
- Graduate School of Biomedical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- Department of Osteopathic Manipulative Medicine/Family Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Karabi Nandy
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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43
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Monteiro EM, Hyde C, Guardado D, Rosenau KA, Kuo A. Knowledge is Power: Rethinking Healthcare for Culturally and Linguistically Diverse Patients. Cureus 2023; 15:e45712. [PMID: 37868580 PMCID: PMC10590178 DOI: 10.7759/cureus.45712] [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: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/24/2023] Open
Abstract
Autism is a developmental disability that exists across racial, ethnic, linguistic, and socioeconomic boundaries. Unfortunately, the lived experiences of autistic individuals and their families as supported by evidence in the existing literature suggest that culturally and linguistically diverse families' engagement in healthcare and education face a multitude of challenges, particularly during high-stakes meetings and healthcare appointments (e.g., Individualized Education Plan meetings, patient visits, and diagnostic results interpretation meetings). These challenges prevent culturally and linguistically diverse autistic individuals from accessing adequate care. In this paper, we propose solutions to be adopted by healthcare and education systems to address those challenges. First, we urge providers to address the systemic problems that commonly occur during meetings. Second, we propose service providers adopt a cultural and linguistic 'match' process. We recommend asking families about their specific language preferences and ensuring the selection of translators who speak the family's preferred language and dialect. Employing these transformations will require education and healthcare systems to allocate more resources for translation services to enhance the training and recruitment of interpreters and ensure that interpreter-family pairs are provided time for consultation prior to high-stakes meetings. Ultimately, these adaptations to the service provision environment would produce opportunities for translators to act as cultural liaisons and, with time, become trusted partners for families.
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Affiliation(s)
- Elissa M Monteiro
- School of Education/Department of School Psychology, University of California Riverside, Riverside, USA
- Psychiatry, University of California Riverside School of Medicine, Riverside, USA
| | - Carly Hyde
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Dilian Guardado
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Kashia A Rosenau
- Division of Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Alice Kuo
- Division of Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Natri HM, Chapman CR, Heraty S, Dwyer P, Walker N, Kapp SK, Dron HA, Martinez-Agosto JA, Mikkola L, Doherty M. Ethical challenges in autism genomics: Recommendations for researchers. Eur J Med Genet 2023; 66:104810. [PMID: 37478903 DOI: 10.1016/j.ejmg.2023.104810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
Equitable and just genetic research and clinical translation require an examination of the ethical questions pertaining to vulnerable and marginalized communities. Autism research and advocate communities have expressed concerns over current practices of genetics research, urging the field to shift towards paradigms and practices that ensure benefits and avoid harm to research participants and the wider autistic community. Building upon a framework of bioethical principles, we provide the background for the concerns and present recommendations for ethically sustainable and justice-oriented genetic and genomic autism research. With the primary goal of enhancing the health, well-being, and autonomy of autistic persons, we make recommendations to guide priority setting, responsible research conduct, and informed consent practices. Further, we discuss the ethical challenges particularly pertaining to research involving highly vulnerable individuals and groups, such as those with impaired cognitive or communication ability. Finally, we consider the clinical translation of autism genetics studies, including the use of genetic testing. These guidelines, developed by an interdisciplinary working group comprising autistic and non-autistic individuals, will aid in leveraging the potential of genetics research to enhance the quality of life of autistic individuals and are widely applicable across stigmatized traits and vulnerable communities.
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Affiliation(s)
- Heini M Natri
- Translational Genomics Research Institute (TGen), Phoenix, AZ, 85004, USA.
| | - Carolyn R Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, 10016, USA; Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Síofra Heraty
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, University of London, Birkbeck, London, WC1E 7HX, UK
| | - Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, CA, 95618, USA; Department of Psychology, UC Davis, Davis, CA, 95618, USA; MIND Institute, UC Davis Health, Sacramento, CA, 95817, USA
| | - Nick Walker
- California Institute of Integral Studies, San Francisco, CA, 94103, USA
| | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, Hampshire, PO1 2UP, UK
| | - Heather A Dron
- Sterilization and Social Justice Lab, UCLA Institute for Genetics and Society, Los Angeles, CA, 90095, USA
| | | | - Lea Mikkola
- Turku Bioscience Center, InFLAMES Research Flagship Center, University of Turku, Turku, 20520, Finland
| | - Mary Doherty
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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Kahn NF, Sequeira GM, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents. Pediatrics 2023; 152:e2023061363. [PMID: 37395084 DOI: 10.1542/peds.2023-061363] [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] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. METHODS This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. RESULTS Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. CONCLUSIONS Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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46
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Linsao AW, McKiernan PM, Morgan SM. Mental health providers' perceptions of competency when working with autistic children with co-occurring mental health diagnoses. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2026-2034. [PMID: 36609698 DOI: 10.1002/jcop.22994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 06/14/2023]
Abstract
Psychotherapy research has long focused on provider competence and treatment efficacy. Mental health providers treat diverse client populations with varying, complex needs. Though estimates vary, the rate of children diagnosed with autism and a co-occurring psychiatric disorder is relatively high. While behavioral approaches to treatment have been established as the gold standard, talk-based therapies are increasingly common, and a broader range of providers are treating this population. There are gaps in the literature regarding empirically supported, targeted approaches, and provider sense of competency in addressing complex needs. The aim of this secondary qualitative analysis was to gain further insights into mental health providers' experiences of psychotherapy with autistic children with a cooccurring diagnosis. Eleven licensed clinicians participated in semistructured interviews. The following themes emerged: perception of competency, complex needs, and family involvement. Recommendations for a collaborative approach, increased opportunities for training, and standardized, targeted assessments and treatment protocols were made.
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Affiliation(s)
- Amy W Linsao
- School of Behavioral Sciences, California Southern University, Chandler, Arizona, USA
| | - Patrick M McKiernan
- School of Behavioral Sciences, California Southern University, Chandler, Arizona, USA
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Dickerson AS, Frndak S, DeSantiago M, Mohan A, Smith GS. Environmental Exposure Disparities and Neurodevelopmental Risk: a Review. Curr Environ Health Rep 2023; 10:73-83. [PMID: 37002432 PMCID: PMC11108231 DOI: 10.1007/s40572-023-00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE OF REVIEW Neurotoxicant exposures are of particular concern in historically marginalized communities. Often a consequence of structural racism, low-income minoritized populations experience a disproportionate burden of hazardous exposures through proximity to industrial facilities, high traffic roads, and suboptimal housing. Here, we summarize reports on exposures and neurodevelopment focused on differences by education, income, race/ethnicity, or immigration status from 2015 to 2022, discuss the importance of such investigations in overburdened communities, and recommend areas for future research. RECENT FINDINGS We found 20 studies that investigated exposure disparities and neurodevelopment in children. Most were conducted in the USA, and many focused on air pollution, followed by metal exposures and water contamination. Although several studies showed differences in exposure-outcome associations by income and education, many examining differences by race/ethnicity did not report notable disparities between groups. However, measures of individual race and ethnicity are not reliable measures of discrimination experienced as a consequence of structural racism. Our review supports scientific evidence that the reduction of individual and widespread municipal exposures will improve child development and overall public health. Identified research gaps include the use of better indicators of economic status and structural racism, evaluations of effect modification and attributable fraction of outcomes by these factors, and considerations of multidimensional neighborhood factors that could be protective against environmental insults. Considering that vulnerable populations have disparities in access to and quality of care, greater burden of exposure, and fewer resources to incur associated expenses, such populations should be prioritized.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Hopkins Center for Health Disparities Solution, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Melissa DeSantiago
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ankita Mohan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Genee S Smith
- Hopkins Center for Health Disparities Solution, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Wallisch A, Boyd BA, Hall JP, Kurth NK, Streed Jr CG, Mulcahy A, McMaughan DJ, Batza K. Health Care Disparities Among Autistic LGBTQ+ People. AUTISM IN ADULTHOOD 2023; 5:165-174. [PMID: 37346996 PMCID: PMC10280185 DOI: 10.1089/aut.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people. Objectives The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people. Methods We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression. Results The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met. Conclusions Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people.
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Affiliation(s)
- Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas, USA
| | - Brian A. Boyd
- School of Education, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean P. Hall
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Noelle K. Kurth
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Carl G. Streed Jr
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, Oregon, USA
| | - Darcy Jones McMaughan
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Katie Batza
- Women, Gender and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
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Strang JF, McClellan LS, Raaijmakers D, Caplan R, Klomp SE, Reutter M, Lai MC, Song M, Gratton FV, Dale LK, Schutte A, de Vries AL, Gardiner F, Edwards-Leeper L, Minnaard AL, Eleveld NL, Corbin E, Purkis Y, Lawson W, Kim DY, van Wieringen IM, Rodríguez-Roldán VM, Harris MC, Wilks MF, Abraham G, Balleur-van Rijn A, Brown LX, Forshaw A, Wilks GB, Griffin AD, Graham EK, Krause S, Pervez N, Bok IA, Song A, Fischbach AL, van der Miesen AI. The Gender-Diversity and Autism Questionnaire: A Community-Developed Clinical, Research, and Self-Advocacy Tool for Autistic Transgender and Gender-Diverse Young Adults. AUTISM IN ADULTHOOD 2023; 5:175-190. [PMID: 37346994 PMCID: PMC10280183 DOI: 10.1089/aut.2023.0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background Autistic transgender people face unique risks in society, including inequities in accessing needed care and related mental health disparities. Given the need for specific and culturally responsive accommodations/supports, the characterization of key experiences, challenges, needs, and resilience factors within this population is imperative. This study developed a structured self-report tool for autistic transgender young adults to communicate their experiences and needs in a report format attuned to common autistic thinking and communication styles. Methods This cross-nation project developed and refined the Gender-Diversity and Autism Questionnaire through an iterative community-based approach using Delphi panel methodology. This proof-of-principle project defined "expertise" broadly, employing a multi-input expert search approach to balance academic-, community-, and lived experience-based expertise. Results The expert collaborators (N = 24 respondents) completed a two-round Delphi study, which developed 85 mostly closed-ended items based on 90% consensus. Final item content falls within six topic areas: the experience of identities; the impact of experienced or anticipated discrimination, bias, and violence toward autistic people and transgender people; tasks and experiences of everyday life; gender diversity- or autism-related care needs and history; the experience of others doubting an individual's gender identity and/or autism; and the experience of community and connectedness. The majority of retained items relate to tasks and experiences of everyday life or the impact of experienced or anticipated discrimination, bias, and violence. Conclusions This study employed a multipronged multimodal search approach to maximize equity in representation of the expert measure development team. The resulting instrument, designed for clinical, research, and self-advocacy applications, has parallel Dutch and English versions and is available for immediate use. Future cross-cultural research with this instrument could help identify contextual risk and resilience factors to better understand and address inequities faced by this large intersectional population.
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Affiliation(s)
- John F. Strang
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
- Departments of Pediatrics, Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Lucy S. McClellan
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Daphne Raaijmakers
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Reid Caplan
- Brandeis University, Waltham, Massachusetts, USA
| | | | - Mindy Reutter
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Minneh Song
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | | | | | | | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Finn Gardiner
- Autistic People of Color Fund, Lincoln, Nebraska, USA
| | | | | | | | | | | | - Wenn Lawson
- Department of Disability, Inclusion and Special Needs, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Macquarie University, Sydney, Australia
- Curtin Autism Research Group, Curtin University, Perth, Australia
| | | | - Isa M. van Wieringen
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | - Lydia X.Z. Brown
- Disability Studies Program, Georgetown University, Washington, District of Columbia, USA
- Autistic Women & Nonbinary Network, Lincoln, Nebraska, USA
| | | | | | | | - Elizabeth K. Graham
- The Arc of the United States National Council of Self Advocates, Washington, District of Columbia, USA
| | - Sandy Krause
- Wisconsin Autism Empowerment, Milwaukee, Wisconsin, USA
| | - Noor Pervez
- Autistic Self-Advocacy Network, Washington, District of Columbia, USA
| | - Inge A. Bok
- Private Consultant, Amsterdam, The Netherlands
| | - Amber Song
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Abigail L. Fischbach
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Anna I.R. van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
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Mac Giolla Phadraig C, Kahatab A, Daly B. Promoting openness to autism amongst dental care professional students. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:396-401. [PMID: 35579049 DOI: 10.1111/eje.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Autism spectrum disorders (ASD) is a lifelong condition affecting communication and social interaction, characterised by repetitive or repeated patterns of behaviour. People with ASD experience poor systemic and oral health. They face reduced access to dental care related to provider barriers associated with lack of understanding of ASD, lack of training and a consequent reluctance to treat people with ASD. MATERIALS AND METHODS The effectiveness of training given by a person with autism to student dental care professionals was evaluated by measuring change in 62 students' openness to autism scale scores and confidence treating a person with autism. These students included third year dental students and second year dental nursing and hygiene students. This cohort was recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS®. RESULTS An increase in openness scale scores of 7.6% (p < .05) and in confidence of 4.9% (p < .05) between pre- and post-training was observed. Openness scale score predicted level of confidence at baseline (OR = 0.21 (95% CI = 0.02-0.39)). CONCLUSION An educational intervention delivered by a person with autism promoted modest increases in openness towards autism and confidence amongst dental care pre-service professionals. Whilst the results suggest that peer-led dental care professional teaching by people with autism may be beneficial, more research is needed.
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Affiliation(s)
- Caoimhin Mac Giolla Phadraig
- Department of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Ahmed Kahatab
- Department of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - Blánaid Daly
- Department of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
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